Internal contraction monitor?

[Lyss]

So, baby is breech at 33 weeks, and my OB referred me to an acupuncturist for moxabustion, etc., to help the baby turn.  She's been amazing and supportive in my quest for a VBA2C.  This has been a difficult pregnancy - not-great insurance, unexpected/unplanned, first trimester very bloody, previa cleared at 30 weeks, and now breech, but she's had my back all along.  She even said she would let me go over 40 weeks for spontaneous labor if everything looks good.

Some things that surprised me:

She wants me to get an epidural late in labor so that if I do need the c/s, I won't have to undergo general anesthesia.

She wants me to follow a standard labor curve: 1CM per hour.  In what planet is this "standard"?

They want to do internal monitoring of the contractions.  What is this?  Do they have to break the water?  I've heard of monitoring the baby from the inside, but not the contractions.  Does anyone know what this is called?

I have a history of uterine scarring and bad scarring from my first c-section, so I want to be as cautious as possible while still giving myself a chance to VBAC.  Does this all sound normal?

[LisaSedai]

She wants me to get an epidural late in labor so that if I do need the c/s, I won't have to undergo general anesthesia.

I don't get this. If it is not an emergency, you will have time to get an epidural if you decide to go c/section. If it is an emergency- well having an epidural in place probably isn't going to matter b/c it takes time for medication given through the epidural cath to take effect and they aren't going to wait around if you or the baby is in distress so you get general anyways.

This could be a prejudice your provider has against "epidural free" childbirth. When 99% of woman are getting their epi's like good little patients they don't demand to get up and walk around, change position, moan and holler. If you are already chained to the bed with an epidural, other interventions are easier for your medical team to give you (external/internal fetal monitoring, IV's,B/P monitoring, foley catheters in your bladder) You aren't going to be in the shower when it is time for you to get checked. It is easier for the doctors and nurses.

One of the main reasons I didn't get an epi was b/c if my uterus were to rupture, without an epidural I would likely feel it doing so. Epi's also can slow down labor (which is bad when you are on a 1cm per hour time schedule) can give you fever (extra blood work on baby, baby has to stay in hospital longer possible) can cause the baby distress (automatic c/sec.) Also I believe there is a purpose behind what we feel in labor- the baby needs us to move around and reposition sometimes.

She wants me to follow a standard labor curve: 1CM per hour.  In what planet is this "standard"?

This sucks. They all learn this in OB school apparently. Are there studies to back this up? Is it evidence based or something done "just because" they've always done it that way, like they used to give every one a shave and enema prep and an episiotomy.

They want to do internal monitoring of the contractions.  What is this?  Do they have to break the water?  I've heard of monitoring the baby from the inside, but not the contractions.  Does anyone know what this is called?

External fetal monitoring is when they strap the sensors to the outside of your belly. You may or may not be connected to a machine with this. Some hospitals have wireless, waterproof, telemetry external monitors and some hospitals have the kind which you have 2 feet of cords connected to the big beeping box at your bedside. All hospitals want everyone (but ESPECIALLY VBACers) connected to fetal monitoring. It keeps track of the baby's heartbeat and the contractions.

Internal fetal monitoring is when they break your water and go up into your uterus and screw a sensor into the baby's head (ouch). Then you have a wire coming out of your vagina. This can increase you and your baby's risk of infection. This means you have 12 hours to get that baby out or you are getting a c section.

Is your provider know around town as a genuine VBAC provider? Did they tell you how many VBAC's they delivered last year?  The things s/he is asking for do not sound VBAC friendly to me. Hope I am wrong. My advice is contact your local ICAN and get a VBAC experienced doula. Good luck.

[Lyss]

She has done VBA2c (but she says "not many").  I really like and trust her.  I didn't make an ICAN meeting in Jan, and I can't make the Feb one, either.  March is on the late side, but she's part of a midwife clinic and they and the hospital have a great reputation with other moms I've met and doulas I've met with for natural births.

As I mentioned, I have a history of scarring, both in and out of the uterus, which increases the risk of rupture.  Unfortunately, a doula is out of the question for us, but the nurses at the hospital have a great reputation for being supportive of natural births. 

Also, studies have shown that "stalled" labor increases the risk of rupture.  I was just surprised that anything that isn't 1 cm an hour is "stalled". 

Thanks for your point about the epidural!  I hadn't thought of that!  That's true, huh?  It is v. important to know what's going on with your body.

The internal monitor would be for strength of contractions, and it's probably because I'm overweight.  It's a lot to take in, but my prior OB wouldn't let me go for the VBAC for my second birth, even though my water had broken and I was in labor the day of my c-section.  He didn't even check me - just prep'd me for the OR, which was a good thing, I think.  I had a lot of scar tissue removed from the first CS that was inflamed and painful, and my incision was very carefully tended to the second time.  Hopefully it's enough to have fixed me!  Thanks.

[Monkey Keeper]

Originally Posted by Lyss 
She wants me to follow a standard labor curve: 1CM per hour.  In what planet is this "standard"?

My OB mentioned this in passing, too, when I was just past my EDD.  I kind of wrinkled my forehead at her and let it go.  As it was, I had a looong labor--over 9 hours of it in the hospital just getting from ~7 to baby.  Clearly she didn't hold me to the 1cm/hr thing.  I have read here often that VBAC labors often have a stop-start pattern or a long warm-up phase.  Can you talk to her about that?

And my c/s babe was breech as well.  Can you try chiropractic and massage as complements to the moxi?

[Lynann]

I had internal contraction monitoring after being transferred to the hospital from a homebirth with DS. My waters broke at the beginning of a very slow labor, which is why I ended up transferred. Internal contraction monitoring forces you to stay on your back, NOT GOOD positioning for natural labor. After 24 hrs at home and another 12 hours on my back at hospital I ended up with a c/s for failure to progress, even though it was all the hospital interventions that stopped any progress. My DS was asynclitic which was why my labor was so slow, but I should have been able to deliver him vaginally IF I had been allowed to move around and NOT given a set time in which to deliver. Asynclitic babies are not in optimal position, but they still can come out it just takes a lot longer because your body has to stretch a lot more.

I wouldn't recommend internal monitoring of any kind if you want to VBAC.

[womenswisdom]

Originally Posted by Lyss 

She wants me to get an epidural late in labor so that if I do need the c/s, I won't have to undergo general anesthesia.

The dose for a cesarean is higher than a dose for labor, so if it were truly an emergency, you would need general anyway.  No need to restrict your mobility, potentially slow labor and prevent you from feeling a rupture happen for something that isn't even going to be useful in the very rare circumstance of an emergency c-section.

She wants me to follow a standard labor curve: 1CM per hour.  In what planet is this "standard"?

Stalled labor isn't a risk factor in any of the research I've read.  It's associated with a rupture because the uterus begins contracting abnormally when that happens and the cervix stops dilating.  It happens because of a rupture, it doesn't cause one.

They want to do internal monitoring of the contractions.  What is this?  Do they have to break the water?  I've heard of monitoring the baby from the inside, but not the contractions.  Does anyone know what this is called?

IUPC (Intrauterine Pressure Catheter) is what she's referring to.  Yes, it does require breaking your water.  It's the only way to qualitatively measure the strength of contractions.  External monitors only show when the contractions stop and start, not how strong they are.  I do not understand why this is necessary, since there is no data that I'm aware of that shows a "safe" vs. and "unsafe" strength for contractions in terms of likelihood of rupture.  If you're being given pitocin, that's a different story.  Why don't you ask her what the reasoning is because I really don't get it.

I have a history of uterine scarring and bad scarring from my first c-section, so I want to be as cautious as possible while still giving myself a chance to VBAC.  Does this all sound normal?

Honestly, no. I have never heard of requiring an IUPC for a TOL.  I have heard of some non-supportive CPs asking for an epidural or having time limits on labor.  If you can call and speak with your local ICAN leader asap, I think that would be a good idea.  She can give you an idea of who the truly supportive care providers are, even if you can't make the meetings.