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Can I violate "hospital policy" on wearing a fetal monitor?

post #1 of 71
Thread Starter 
Hey there - trying to figure out what my rights are, going into trying to have a vbac in August...

My midwife informed me at my last appointment that it's "hospital policy" that anyone attempting vbac has to be on constant fetal monitoring. I don't feel like this is necessary, especially because my previous cesarean was due to the baby's positioning. I don't object to periodic monitoring, but the midwife says that I won't be permitted to use the whirlpool tub because of the constant fetal monitoring required. I want to have the tub option - with ds it helped immensely with labor (I was fully dilated without meds before I had the cesarean). I suppose if there is no other option and it's the safest thing to do, I'll go along with the monitoring, but am I really required to? And will it really make things much safer than just checking the baby every 30 minutes or so? My midwife for ds had me sit up in the tub every 30 minutes to check the baby, and it didn't seem like a huge problem or anything...

Anyway, opinions?
post #2 of 71
You can refuse anything. It is your body! Just prepare yourself for not so happy staff, or find other ways around it.
post #3 of 71
You can refuse anything and everything. And they can make your life miserable.

I would find a more friendly birth place.

Have you considered homebirth?

good luck!

post #4 of 71
Yes, technically you can refuse it, but they might not be very nice to you. I probably wouldn't let them know ahead of time. I did have a friend who managed to avoid a lot of their monitoring by going to the bathroom a lot, and staying there and laboring on the toilet in the dark. They did get mad at her though. I have heard that one of the hospitals around me (the one that doesn't ban vbacs) has a telemtry monitor that makes it easier to be up and moving around while giving in to their demands of CFM.

I have to second Angela's suggestion on homebirth, but as another mom planning a VBAC for next time, I know how hard it is to find that option when going for a VBAC! If you do have to go to the hospital, stay at home and labor there as long as possible (get a doula to help if you haven't already).
post #5 of 71
I'll probably get strung up by my toes for suggesting this on MDC, but if you're committed to this hospital, and like your care providers other than this issue... I'd probably try to compromise with them. Say, 5-10 minutes of monitoring every hour or 2. Gives them their precious "strip" to stare at, and leaves you free to move most of the time.

But no, you don't HAVE to. You can refuse anything. Like Turtlewomyn's friend, I'd unplug the monitors to go hang out in the bathroom or walk around or whatever. Drove the nurses batty (at my hospital, they can watch the monitors from the nurses' station), but they couldn't do a whole lot about it.

Or you could have a homebirth. Or, if it's possible in your area, find another hospital or care provider with less strict policies. There's very little you have to do. You've almost always got options.
post #6 of 71
You don't HAVE to do anything you don't want to.
When you register at the hospital, go ahead of time and take the forms home to read over and modify. Specify on the forms what you DON'T want i.e. EFM, Episiotomy, epi. etc. then sign, photocopy and return the forms. That way they have to specifically ask your permission at the time to do anything you've specifically denied.

I would strongly suggest labouring at home as long as possible or even trying for a home birth.
post #7 of 71
Another here for laboring at home as long as possible.

I would also recommend getting a doula.

For my own perssonal story, I was going to do a vbac in a hospital, but with every prenatal I became increasingly aware from the cnm that the vbac was not going to happen so I started looking into doing a homebirth. I found a great midwife who would attend(after interviewing about 15 midwives) and pulled my records for her and got to read them myself and my cnm with the clinic blatantly said in my medical record, patient wants a vbac, but it will not happen due to history(my first baby wasy big at 11#'s). Long story short, I opted for the hbac and it was the best decision I ever made.
post #8 of 71
Originally Posted by turtlewomyn View Post
Yes, technically you can refuse it, but they might not be very nice to you.
This was my experience. At one point with periodic monitoring it was incredibly uncomfortable to be in the position they wanted me to be in. I tried to offer some kind of compromise - I don't even remember what it was - something like - OK, I'll lie down for you, but you have to let me.... (something else).

The nurse went all apeshit authoritarian on me. I guess no one had ever dared suggest a compromise. I think my doula got the nurse out of the room at that point. And pehaps DH stepped in. I thought I was being nice, offering her a way to get her damn strip. I think that nurse went off duty soon after and I got a better nurse.

Really, you don't need crappy people around you when you are laboring.

PS. I didn't have VBAC.
post #9 of 71
Thread Starter 
Well, I'd love to have a hb, but I'm due in a month, but we live an hour from the nearest hospital, so I don't think I'd feel comfortable doing it... I also can't imagine I could find a midwife who would take me with only a month to go. And I really do like my midwife - it's the hospital staff I'm more worried about.

I think my biggest concern is never being sure when an intervention is being proposed because it's necessary, and when it's suggested just because of medicalization of childbirth. And even harder after having a cesarean to know what's safest.
post #10 of 71
Can you write up a birth plan and present it to the staff the second you walk in there so they are fully aware of your wishes?
post #11 of 71
Haven't read all the other post...

I did the intermittent monitoring with my last birth. The nurse I had knew I was knowledgable and prepared for birth. I went to the hospital in advanced labor and was handling it well. I did refuse continous monitoring. I did agree to the intermittent monitoring. As long as they saw everything looked good on a piece of paper.... they were happy. Plus, they knew they had my cooperation if anything out of the normal happened. Once the monitoring showed some signs of distress (after the doctor was verbally abusive and tried to forcefully break my water after I told him not to). But when I calmed down, so did my DD. I was "allowed" off EFM once again. Also, I most uncomfortable when on EFM. But having my doula hold the thing in place while I tried to get in a better position helped.

The reason they want to use continous monitoring is a decrease in the fetal heart rate is the first sign of uterine rupture. In case of an emergency, they can get you to the OR ASAP. But I would venture to say if you are truly in tune with your body, I think you would know when something feels different. But it does give the doctors a sense of them doing their job. (Remember, they think they have to save/ deliever you from birth.) And if something out of the ordinary did happen... they would have that silly strip of paper to prove they were doing what was "necessary".

Position of the baby is very important. Don't wait till labor begins to get baby in a good position. Here is an article about optimal fetal positioning: http://www.homebirth.org.uk/ofp.htm Spinningbabies.com always has great info also.

Have a wonderful birth!
post #12 of 71
Ditto what the others said. "Hospital policy" never trumps your right to autonomy nor your ability to give informed refusal for any intervention as a pregnant and laboring woman. Period.
post #13 of 71
If your last baby was a c-section b/c of fetal positioning, I'd highly recommend chiropractic care between now and delivery so that this baby can get into the best birthing position. Check out www.icpa4kids.org to find a chiropractor near you, and look for one that knows Webster's technique, a technique specific for pregnant women.

Good luck to you. I agree with the pp about trying to see if you can do intermittent monitoring as long as there are no concerns on the strip, but depending on the hospital, it could be a hard sell.
post #14 of 71
Technically you can refuse things but it's not very easy while in labor and there can be a lot of scare tactics used. Can you go to a more supportive place or do HB?
post #15 of 71
I comprimised on 2 things, a forearm insertion heplock and intermitant fetal monitoring done by a nurse not a strappy belt thing. She even monitored me while I was in the tub and it wasnt intrusive at all.

I felt like the hospital staff was ok with the compromise. Ask about water proof monitors, I know they make them since I had intermitent monitoring in the tub at the birth center as well.

You can refuse anything but do it before you are in labor. Your ability to stand up for yourself while in labor land is difficult and hard to stay in a good pattern. I went and talked to the head of labor and delivery nurse and gave loads of copies of my birth plan and signed all waivers well before labor started.

Of course all copies of my birth plan mysteriously disapeared but I brought extras and we did have to ask for anouther nurse once but the second one was a doll!!
post #16 of 71
That's a tough situation to be in. I would be doing what you are if I were in your situation. WHen I chose a Hbac, one of the biggest factors is that I live in the city so the hospital was only five minutes away.

I would study about birth as much as possible, what all the interventions are etc. Have you checked out http://www.midwiferytoday.com That is a great source of info.

Do you have a doula?
post #17 of 71
It is also my hospital's policy to have CFM during VBAC births. Both times I clearly stated my wishes to my OB to remain mobile throughout the birth. I said I would agree to CFM only if I had a telemtry unit made available. When I went into labor with each of my VBAC's (I have had 2), the Dr.'s on call agreed to intermittent monitoring only despite hospital "policy".

I agree with everything PP's say: consider a homebirth, hire a doula, find out if they have telemtry units at the hospital, labor at home as long as possible and finally, if you end up strapped to the monitor go to the bathroom as much as possible. Good luck! I wish you the best.
post #18 of 71
Thread Starter 
Originally Posted by studentmama View Post
That's a tough situation to be in. I would be doing what you are if I were in your situation. WHen I chose a Hbac, one of the biggest factors is that I live in the city so the hospital was only five minutes away.

I would study about birth as much as possible, what all the interventions are etc. Have you checked out http://www.midwiferytoday.com That is a great source of info.

Do you have a doula?
I haven't gotten a doula, because what I really really want - and what I wanted with my ds (the previous cesarean) is to be ALONE in labor. I know this sounds crazy, but I just have no desire to have anyone there at all. So adding another person into the mix just doesn't seem for me. I always wonder if I had just "braved" it and walked off into the field to have the baby last time if he wouldn't have gotten "stuck" at all. I just feel like a really private person, and with both my 13 year old and my son, in labor I felt like I just got really into my own head or something. With ds, I barely made a sound the whole time, and never wanted to talk to anyone or ask anyone for anything. I just wanted to sit in the tub and deal with my feelings myself. And I almost felt like I was "supposed" to be in more pain than I actually was experiencing because I had my husband and a friend and the midwife and the nurse all standing around focusing on me, and I really didn't like it. Does this sound insane? Seems like "most" women really want people there - I don't know...

Anyway, with ds, I was reading all these stories about women who had solitary labor and childbirth, but being an hour away from a hospital just was too scary for me. And still is, because there's really no way for me to be sure if the baby would have been ok if I had just done what I wanted, or to know that there won't be a very real problem with this one, because no one seems to be really clear on why ds got "stuck" - they say it may have been just a fluke, or it may have been a problem with his size - so if I have another baby of similar size, the same thing could happen.

I'm thinking at my next midwife appointment, I'm going to tell her that I'm willing to do the intermittent monitoring - or even do constant monitoring for the first hour I'm there and then take the monitor off and switch to intermittent if everything is normal. I feel like the more medicalized things get, the more it's all going to get into my head and psyche me out of a normal birth. Wish I lived closer to the hospital - I'd just go ahead and stay home!
post #19 of 71
Have you considered a homebirth with a midwife? Many are willing to leave you alone and stay in another room. But you'd still have someone there for your concerns.

good luck!

post #20 of 71
Thread Starter 
I can't do homebirth because I'm in VA and it's basically been criminalized here - so the midwives who take the risk generally aren't willing to take VBAC's unless you've already done one - because they're already breaking the law, so...

My husband actually just suggested going down to the Farm in TN, because they supposedly will take short-notice folks sometimes, but I'm not sure I want to go so far... I've been reading Ina May's Guide to Childbirth, though, and they have a 98% VBAC rate! Just wish we had options like that where I live.:
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