question about monitoring

[amydiane]

I have a consultation with a hospital-based CNM group next week and I just learned from another mama who VBACed with them a few weeks ago that they require CEFM until your water breaks, and then an internal monitor after that.  I do plan on asking them about this, and I know I can technically decline anything, but I wanted to learn more about internal monitoring and when it is truly necessary.  Any thoughts?

[kltroy]

So there's good clinical evidence that EFM is the most reliable way to detect UR earliest.  However, there is no reason to go for internal monitor unless the external EFM is not picking up baby's HB well, or unless they detect something concerning with the external monitor that they want to confirm more reliably with an internal monitor. 

That said, I've heard from many women that internal monitors aren't that much of an annoyance during labor, and can actually be a bit less annoying than external because it's simply a thin catheter taped to your inner thigh, rather than those dumb belts that you need to keep adjusting.  I'd ask some questions and if you're not comfortable w/ internal, you can decline unless there's a good reason to go for it at the time.  Personally, I was ok with the external because of the good clinical evidence that it is indeed the best way to detect early UR.

[akind1]

I had an EFM until AROM, then IFM afterwards with my first pregnancy. I will say that I found the Internal one to be easier by far to deal with. I could hardly move with the EFM because the baby kept jumping off the monitor and it would need adjusting. With the Internal one, I could get out of bed, move around, rock, whatever. I did end up with a c-section with him, but it had nothing to do with the monitors (which I was on due to being induced with Pitocin).

Personally, I far preferred the Internal monitor. It increases the chance of infection, but I feel that I have a much stronger chance of having a successful VBAC if I can be up and mobile. If you can get someone (DH, partner, doula) to hold the external ones on you while you move around, then that would work too. DS really, really didn't like the monitor though, and kept moving away and kicking it.

You could also see if it could be amended to intermittent monitoring, because I do agree with kltroy that monitoring is a good thing, especially in the event of a VBAC.

[~Amy~]

My hospital really treats VBAC moms as "normal". I was only required to have continuous EFM because I was being induced. Otherwise, I could have requested intermittent dopler monitoring instead.

[cinderella08]

Most will agree that CEFM is the best way to detect an early UR.  Many moms actually find they like the internal monitor more because if they are moving and changing positions alot, they don't have to worry about losing baby's tracing on the monitor. 

*most* hospitals 'require' CEFM for VBACs.  I have a client right now however that is a VBA2C and her OB only requires her to be on the monitor 20m out of every 60-90m.  I had a VBAC at the same hospital, though I was induced due to pre-e, and had CEFM.  Had I not had pit, I wouldn't have needed the CEFM.

ETA: as far as when internal monitoring is necessary - most OBs place an internal monitor if baby isn't staying on the EFM, or if baby shows stress.  The internal can give a more accurate ready for a stressed baby.  though I've seen OB's place internal monitors w/o even asking when they rupture mom's.