What was continuous monitoring like for you?

[Blanca78]

My doctor just told me she thinks continuous monitoring is a good idea in active labor. Well, actually, not my doctor, but her partner who may (but probably won't) end up being on call. Let me preface this by saying I like both these OBs in person. Their practice has a very low c-section rate for OBs (10%), they are not pushing any sort of mandatory induction deadline, my doula has worked with them and says she respects them a lot, and they are generally hands off and very forthright and respectful when answering my questions. The two sticking points are IV use (no heplock, unless I need to use the shower) and continuous monitoring. Which confuses me, because my doctor told me a long time ago that there was only continuous monitoring during pushing. So I still need to clarify this point with her, but just in case I want to be prepared.

At any rate, the one who said continuous monitoring stressed that she doesn't see it as restrictive. She said I can still be up, use the birth ball, chair, etc. and it can be removed if I want to use the shower or anything like that. In her words, "I don't understand why you would not use it if you are just going to be by the bed anyway." (Of course, then I think, "WHy would you use it, when studies show that in low risk births it isn't any more helpful than intermittent monitoring?" but I didn't say that.)

Mostly because of insurance reasons and lack of many options in my area, there is not a hospital midwife practice available to me, and no birth centers. There is one who works with a very interventive OB practice and there's a chance I'd end up w/one of those doctors, so rather than take that risk and switch at 32 weeks, I'm choosing to stick w/my OB practice, which I generally like. This is my first birth and both for insurance and comfort level reasons, I don't see homebirth as an option (possibly w/the next kid).

Anyway...all that is leading up to my question: for those of you who did have continuous monitoring, how was it for you? Was it uncomfortable and restrictive, or not that big a deal, as the doctor says?

My related question is, how much did you feel the need to move around in active labor? But I will start another thread for that.

TIA.

[Marissamom]

well, in my experience, it's extremely restrictive because if you move at all (change position just slightly) they lose the heartbeat. and then they act like it's a huge sign that the baby is in distress and threaten to give you a c-section if you don't consent to internal fetal monitoring. and then the baby ends up with a weird bump on their head where the scalp thingy was screwed in that lasts a couple of weeks. 

[JenRN]

I was induced with DD, so I had an IV pole and continuous monitoring.

The continuous monitoring wasn't so bad. I was on a telemetry unit (cordless), so I was free to be up and move however I wished. And I did - walking the halls, birthing ball, shower, labor tub - all while being monitored. The straps did get a little annoying at times, and occasionally my nurse had to adjust the monitors because DD's heart rate wasn't registering, but that was less often than if you were to be intermittently monitored (every 30 minutes in active labor).

The most annoying thing to me was the IV pole. Nothing restrictive, I was still able to be however I wanted to, just sometimes hard to manuever around with (I think it was more the specific pole I had, one wheel kept sticking so it tried to turn in circles when you walked with it).

I would still recommend talking to your doctor, and remember you can refuse anything you want to. In my situation it was necessary. For me, continuous monitoring just wasn't that big of a bother during labor.

[Blanca78]

Thank you both. Marissa--that's really scary. The doctor told me she used the birth ball during her own labor while hooked up to the monitors, so I'm hoping that means they understand movement is necessary. I am not giving up my mobility if that's what my body wants.

Jen--thanks for the reassurance and reminder that I can refuse. The IV pole has been a sticking point for me--it's like, both that and the monitoring seem like they would be more annoyances than dealbreakers, but then all those annoyances add up...

[carepear]

In my experience it was a huge pain in the ass.  And I only had intermittent because I didn't allow continuous.  I needed to labor on my hands and knees which was difficult to do with the slippy disc of hell, as I like to call it.

I mean, seriously...they lube up a disk and try to strap it to your huge pregnant belly with a freaking elastic strap.  How the heck is that supposed to stay in place.  The only way I could keep it in place was to hold it in place while sitting up.  Yea, pretty restrictive considering I was doing hypnobabies and needed to focus on what I was doing and it was a huge distraction.

20 minutes out of every hour was too much for me and only ended up with 20 minutes while in triage and then only through 2 full contractions once I was in my room.  I was only in the hospital for 4 hours before pushing her out though.  I have a vague memory of a nurse holding it up to my belly as I was pushing.  Not quite sure the point of that but whatever.

[carepear]

Eh, for the IV pole - agree to a hep lock but not an IV if that will work for you.  I agreed to a hep lock but they never got around to putting it in.

[kltroy]

FWIW, I had continuous monitoring with my VBAC a couple years ago.  I had no IV (but did agree to a saline lock) and was indeed able to move around etc.  I spent most of my labor sitting on a ball next to the bed.  It was fine.  Monitoring belts were a minor annoyance, which I unplugged whenever I needed to go to the bathroom or wanted to walk around a bit more.  If you have access to a telemetered system it's even less annoying and you should be able to use it in a tub.  Make sure you turn the sound all the way down, and that you remind your labor support people to pay attention to you and not to the monitor (husbands, esp. if this is the first time they've encountered it, tend to be fascinated by looking at the contraction monitor).

[alyrie]

I had continuous fetal monitoring with my VBAC a few weeks ago, and it wasn't a big deal. I had a heplock and my OB signed off for me to have intermittent monitoring, but once they were in place they really weren't too restrictive for me. I was able to move around the bed (hands and knees), stand beside the bed, get on the birth stool, etc with no interruptions to the baby's heartrate. I was really only there and hooked up to them for about an hour before baby was out. 

[wombatclay]

I apparently had constant monitoring during the birth of ds (my third child and second VBAC)... labor had gotten very intense and I didn't even notice them putting the monitor on!  Up till then I'd had intermittent monitoring, but like I said, by the time they moved to constant monitoring I was so out of it I didn't even notice.  DH said they removed the belt while I was pushing because it had slipped down when I turned onto my side and I didn't notice that either.

I think a lot depends on the type of labor you have, the type of monitoring system they use, and all sorts of things you can't really plan for (like, maybe your belly will be really sensitive to touch during contractions and maybe it wont, or maybe that sensitivity will change during the birth).  But I know that even with an old school monitor you should be able to bounce on a ball, rock in a rocking chair, flip around between positions.  If the monitors slip you can ask for washcloths or steristrips to help hold it in place while you move.

One of Penny Simkin's books (the Labor Progress Handbook I think) has lots of great ideas for keeping birth on track despite various interventions and I know the book had a lot of illustrations for "constant monitoring" and even "in bed monitoring" options.

[thencamehenry]

You've already gotten some good feedback, but I'd like to share my experience with you.

My son was born in a hospital with a NCB-friendly OB/CNM practice.  Their policy and my birth plan stated intermittent monitoring - I think 10 minutes every hour.  They put the belts on when I got there and it never came off the whole time I was in labor (7 hours from arrival to birth).  Apparently they required a solid 10 minute strip.  If the baby moves or I move and they lose the heartbeat for even a few seconds it didn't count.  At some point, not sure when because I was in heavy labor by then, they wanted to break my water and do a scalp electrode because they couldn't get a consistent reading. I could hear his heartbeat but the strip had some gaps as he wiggled and turned, much as you would expect a healthy baby to do as he finds his way out.  I said I didn't want to do it unless he was in trouble and asked if they could monitor him with a hand-held doppler.  The nurse basically said no, that's not the point, and eventually admitted that a full 10 minute strip was required for my chart, a CYA thing.  It had nothing to do with my baby's or my health.  I truly feel like breaking my water and forcing me to lay flat on my back in the middle of intense labor would have been the start of a cascade of interventions if I hadn't known enough to refuse.

I was lucky in that the nurse was very supportive of NCB and did her best to work with me.  I was on the birth ball and she was on her hands and knees holding the monitor on my belly, trying to follow baby's movements.  It's nice that she did that but it's still ridiculous that she had to.  I was also lucky that the negotiations and having a stranger crawling all around me didn't really interfere with my labor too much, but it was definitely a nuisance.  I know from talking to my OB that the monitoring protocol was hospital policy, not theirs.

The monitoring itself didn't bother me, it's just where it might lead.  I think that is why EFM has been shown to do more harm than good - because it tends to lead to unnecessary interventions.  When you do the hospital tour I would ask lots of questions about their monitoring protocol and then remember that you can refuse it in labor.  My friend was really bothered by the straps and she just took them off every time the nurse left the room.  After a few times they gave up on her.  It's not like they can kick you out, ya know?  You should be prepared to advocate for yourself if need be, but that's true of every birth, no matter the location or provider. 

Good luck!

[CherryBomb]

I had EFM during my vba2c, and it wasn't a big deal.  I was pretty far along by the time I got to the hospital, and wasn't interested in moving around anymore, anyway.  I didn't even notice it, honestly.  With my 4th (ended up a c/s) I asked to be induced, and had EFM since I was a vbac mom with induction.  I found it more annoying that time, but still not a big deal.  I walked around the room and used the birth ball, not a big deal.  Like a PP, I found the IV pole much more of a hassle than the EFM.

[kriket]

another vote for huge PITA. I had a hep lock, which means you get to drag the tower o'IV all over with you, the ctx belly thing, and the fetal HB thing, which never picked anything up, and was REALLY uncomfortable, so they went to the "internal" monitor. Which means they screw a probe into your kids head. Which I ripped out on the toilet. He had a scab on his head for a while after birth and I felt so bad :(

I couldn't get in the tub, I was constantly tangled in wires, I felt really restricted. All I wanted to do was go back and forth from my ball to the pot, but it was a major production with the wires and machines and things that go ping.

I birthed at 37w in a "baby friendly" hospital with a MW. I had to have the monitors because they pit me on pit, my water broke and I wasn't having ctx. They didn't really give me much time to start ctx on my own. I guess they were worried about crotch gremlins.

[briannas auntie]

My cousin had her first baby back in December and didn't care for the continuous monitoring, because she told me that she felt like she had to stay in one spot the entire time (reclining on her back), which made her labor very painful.  She eventually had to get an epidural, because she was so uncomfortable (which she regretted afterwards).  My sister was on continuous monitoring, and didn't mind it, but her labor was fast, so I guess that makes a difference as well.

If I am not able to have a homebirth, I would rather have intermittent monitoring, because when I am in pain, I need to move around to distract myself from it and relax completely.  This is especially true for menstrual cramp-like pain. I can't just stay in one spot exclusively.  I even told a ob/gyn that I saw back in December for a pre-pregnancy consultation/evaluation that I refused to have continous monitoring, and they told me that when I become pregnant that they would work with me on that.

Jessie

[Comtessa]

I was a HB transfer with my first baby.  The on-call doc at the hospital when I was admitted tried to screw in an internal monitor without even telling me, right after I was admitted.  Apparently continuous internal monitoring is their policy at this particular hospital!!!  I flipped my lid and kicked him out -- so they put me on a continuous EFM instead. 

I had an epidural at this point, which I already knew requires CEFM, but it was a gigantic PITA for me even with the epidural limiting my movement.  I was basically in bed on my back, more or less immobile, for the last several hours of my labor -- and still the stupid discs kept sliding all over the place and they kept losing the signal anyway.  I finally said to the nurse, "can we just take these things off?"  Because it seemed like they were having to adjust them after every contraction anyway.  She agreed, then they just did intermittent monitoring after that, which was much more comfortable and simple for me. 

OP, it sounds to me like your doc just has a bit of a CYA approach on the monitoring, but like a PP said, there's nothing to force you to comply with their policy.  You can agree to get a 10 or 20-minute continuous "test strip" when you first come in (which is what a lot of hospitals require), but then take it off and ask them to do intermittent monitoring.  The monitor is nothing but a distraction, and it has been proven to increase the likelihood of your having a C-section. 

As far as the IV goes, I would absolutely refuse it.  There is NO good reason to have you on an IV unless you are dehydrated, period.  If they push back on the IV, you can easily agree to a hep lock (though I'm refusing that in this labor too, I hate them).  The hep lock should remove any issues for them, 'cause if you get dehydrated they can just plug the thing into an IV at that point.  Hooking healthy laboring women up to an IV as a routine procedure doesn't make any sense -- it just makes them feel more powerless and more like a "patient." 

My perspective on a lot of these procedures has been informed by this really excellent article <http://www.terrylarimore.com/BirthRites.html> called "The Rituals of American Hospital Birth."  Here's an excerpt about IV's in particular: "The intravenous drips commonly attached to the hands or arms of birthing women make a powerful symbolic statement: they are umbilical cords to the hospital. The cord connecting her body to the fluid-filled bottle places the woman in the same relation to the hospital as the baby in her womb is to her. By making her dependent on the institution for her life, the IV conveys to her one of the most profound messages of her initiation experience: in American society, we are all dependent on institutions for our lives. The message is even more compelling in her case, for she is the real giver of life. Society and its institutions cannot exist unless women give birth, yet the birthing woman in the hospital is shown, not that she gives life, but rather that the institution does." 

So, no, I would NOT allow the doc to decide whether or not you get an IV upon arrival.  It's YOUR decision and YOUR body, not theirs.  But if I were you, I'd work it into a birth plan ahead of time, discuss it with the doc(s) in the practice, and be really clear about what you are OK with (or not) in birth.  If they know ahead of time, they might be more likely to support you (that's been my experience, anyway).  And if they refuse to support you, then you are armed with that information ahead of time and can figure out a Plan B (subterfuge?  Changing care providers?  Etc.). 

Good luck!  I've been in your situation (not having a lot of choice about my HCP and having to go with the lesser evil), and it's not easy.  Just hold your ground and fight for your natural birth -- you can do it!

[thencamehenry]

Re: IVs...

I don't disagree with what Comtessa had to say. But you asked for experiences and I wish I had gotten more fluids during labor. I had a heplock per hospital policy and got some fluids with abx for Group B Strep. I was really dehydrated from puking multiple times and had a hard time drinking even though that was unrestricted. It took 30 minutes+ to get the heplock started due to dehydration. A heplock is basically an IV thats not attached to anything but is ready just in case. It bothered me some that I could feel it in my wrist but I had complete freedom of movement. My next birth plan will say something like "IV fluids as indicated for hydration."

I would question pretty hard if they are saying IV instead of heplock. Is it just semantics? Or when they say IV does that mean they are also requiring something to be administered through the IV (fluids, meds, who knows what). If it's just in case then why be tied to an IV pole if a heplock is sufficient? Dr. policy or hospital?

[kriket]

I've heard having IVs during labor can be detrimental to your milk coming in. Granted, I've only heard it once, from a WIC breastfeeding class. But I was swimming in fluid, and it took my milk around 8 days to come in :(

[thencamehenry]

Another potential consequence of IV fluid overload (per my childbirth class) is that baby may be born waterlogged.  Then baby seems to lose too much weight and/or not regain enough because he appeared to weigh more at birth than he otherwise would have.  This sends up read flags, ped may be concerned and recommend supplementing, nursing relationship is sabotaged.  I've also heard stories of women coming home from the hospital weighing more than when they went in due to fluid retention.  I read all that and said "no fluids" in my birth plan but after my birth my views have moderated.  Now I think "fluids as needed on a case by case basis."

Also, mamas are required to get a bunch of fluids to counteract the drop in blood pressure that commonly happens when an epidural is administered.  I bet some doctors/hospitals have blanket rules about fluid administration to women in labor because they assume everyone wants an epidural. 

[Mulvah]

Response has been edited by Mulvah.

Edited by Mulvah - 10/16/11 at 5:39pm

[briannas auntie]

I honestly wonder if a doctor can force you to have monitoring during labor.  It seems like so many doctors are so used to monitoring that they'd use guilt trips to get you to keep it on.  Has anyone ever had a threat of having authorities called if you didn't comply with having continous fetal monitoring? 

Jessie

[jeminijad]

It wasn't a big deal for me. Really. Not a battle I cared about at all.