hospital vbac without telemetry?

[mamabyrdie]

I had a c-section with my first son basically because of malposition and interventions - basically, I knew he was posterior, caved and got an epidural anyway so labored on my back, he never turned, head circumference in the 95th percentile, blah blah.  They tried vacuum extraction unsuccessfully and went to c/s quickly because he had passed meconium (probably due to the pit they administered after the epidural slowed my contractions, which had me go from 5-10 cm in an hour).

This time I am focused on avoiding similar pitfalls.  I know the likelihood of posterior presentation (and back labor, joys) are good this time as well - at least that is what many people, including all of the doulas I have met suggest.  I have a great doula and am committed to natural, active birth.  I also switched providers to someone who has a better reputation of supporting vbac and who delivers at a more natural-birth friendly hospital.

However, upon visiting the hopsital, I found out they don't have telemetry units for monitoring, and the nurse giving the tour said if you are a vbac mother, your ob will likely have you on the monitors continuously.  When I followed up with my new ob he said they like "more or less" continuous monitoring once you are in active labor.  I pushed back on him a bit and he ended up saying he was sure that we could come to a happy medium, that nothing was set in stone, etc. 

Does anyone have experience laboring with "more or less" continuous monitoring and to what extent it limits you?  I know I can get off the bed but couldn't go far, couldn't get in the tub available.  Or experience refusing extensive monitoring in this situation?  I was thinking 15 min on 45 min off is a fair compromise - thoughts?  I am goign to try to stay at home as long as possible, but am worried I will still go too soon. 

Would love any input and advice.

Thanks!

[MaddieMay]

I attempted a VBAC a few weeks ago (ended up in another c-section) and my hospital had a continuous monitoring policy.  When I showed up in labor, they didn't want to budge.  I told my doula that there was NO WAY I could labor tied to that machine and they might as well section me then and there.  I had to do 30 minutes initially in the bed on my back. It was awful. 

I managed to get them to do 15 on, 45 off after much insistence.  I did them while on the birth ball next to the machine. The compromise was that if mom was well and baby were well, then we'd go with that.  If either of us showed any signs of distress, I agreed to continuous monitoring.

[AustinMom]

I think this is great.  I'm so happy you were able to be empowered to speak for yourself and have the monitoring go 'your way' if that's how you see it.  Good for you! I'm always so proud of mamas when they move the hospital protocols to fit what they want!

That's something to keep in mind, they are just PROTOCOLS!  Not LAWS.  You can always sign an AMA (Against Medical Advice) form if they start to try and get you to negotiate or budge.  Just ask for the form and say " I know the risks, thank you for concerning yourself with our well being." 

You DO have a choice, even if your hospital and OB say otherwise.  It's YOUR birth! 

Much Love!  Happy Birthing!
 

Originally Posted by MaddieMay 

I attempted a VBAC a few weeks ago (ended up in another c-section) and my hospital had a continuous monitoring policy.  When I showed up in labor, they didn't want to budge.  I told my doula that there was NO WAY I could labor tied to that machine and they might as well section me then and there.  I had to do 30 minutes initially in the bed on my back. It was awful. 

I managed to get them to do 15 on, 45 off after much insistence.  I did them while on the birth ball next to the machine. The compromise was that if mom was well and baby were well, then we'd go with that.  If either of us showed any signs of distress, I agreed to continuous monitoring.

[buckeyedoc]

I had an unmedicated VBAC with continuous external fetal monitoring. The monitor is a little annoying because it tends to lose the baby's heart rate when you get in certain positions (like all fours), but the nurse came and fixed it every time and told me not to worry about it and just "do my thing." I stayed out of bed pretty much the entire time, since the cord was maybe 12 feet long. I sat on a birthing ball or stool near the bed most of the time, or I stood alongside the bed and leaned on the railing during contractions, or I made the bed into a really upright chair by raising the top and flipping the bottom down. I did unhook from the monitor to use the bathroom at least every hour. The nursing staff was fine with it because my son was doing perfectly normally the whole time. I could not lie in bed at all because it gave me terrible back labor, but sitting and standing was fine. You can do it, even with the monitor!

[crystal_buffaloe]

I'm not even pregnant yet, so I'm not sure how valuable my contribution is, but I'd shoot for 5 or 10 minutes on per hour -- I was 20 minutes on with my labor that ended in c-section and it was torture. That would also give you room to "compromise" if their goal is 20 minutes, down to 15. I would also talk about maybe handheld monitoring so that the nurse or your partner or doula could hold the monitor on you if you find a comfortable but awkward-for-them position or want to change positions frequently. You might be able to use a handheld monitor in the tub, even.

I second the motion of getting off to go to the bathroom once every hour, too.

ELV!

[Monkey Keeper]

I VBACd in September and had continuous monitoring, but I also ended up with an epidural (sort of, but that's another story ;) ).  Had I NOT opted for the epi, I would have had intermittent monitoring.  Check with your OB--our hospital mostly says continuous, but OBs generally decide for their individual patients.

Discuss with your OB.  Come to a decision.  Then have it WRITTEN IN YOUR CHART. Check that it is there.  Have the OB add it to your orders. Then have someone ready to fight for what you and OB agreed to when the nurses try to force CEFM on you. Maybe even have your OB copy that page of your chart for you to keep with you.  I know my OB had very specific orders in my chart--she shares call but had me coded as "special" so that my admission paged her directly.

[LisaSedai]

My first labor I had internal monitoring and it was horrible. For my VBAC I had the external monitor and it wasn't so bad. The cord was long enough that I could get up out of bed and sit in the rocking chair- I didn't really want to walk the hallways or anything. Towards the end, my doula suggested we "go to the bathroom" and we were off for a while, no one bugged us.

I wish all Mamas would write on the hospital's comment card or send a letter to the hospital complaining about the lack of telemetry units. It is despicable that all the wretched hospital policy is written saying we have to be on fetal monitoring and they won't give us a unit that doesn't tie us to the bed!!

Every hospital I've ever worked at has telemetry cardiac monitors they could easily have telemetry fetal monitors as well.

[soccerchic21]

 had an unmedicated VBAC with continuous external fetal monitoring. The monitor is a little annoying because it tends to lose the baby's heart rate when you get in certain positions (like all fours), but the nurse came and fixed it every time and told me not to worry about it and just "do my thing." 

I had my VBAC 12 weeks ago and this was my same situation. The nurse just basically stayed next to me the entire time and adjusted as needed. I was able to do whatever I wanted and there were no restrictions as to position or where in the room I wanted to be. I also labored in the tub for quite a long time. If I wanted to I could have stood on my head and they would have let me. ;) I am just saying they were very accommodating to what I needed to do while laboring while being monitored because that was their policy. 

The nurse I had was so amazing though. It was like having a doula which we could not afford anyway. In the end I felt bad for her for having to sit there and hold the monitor.