VBAC and Internal Fetal Monitoring

[Heathermhill]

Had my first baby natural, second C-section.
I got preggers when my second was only 9 mo old.
I really like my OB, she is always supportive of my natural choices. But she told me early on that I would need internal fetal monitoring. That is how they do it at the practice... <sigh>
I've been reading about this and am feeling pretty uncomfortable about it. I really want a water birth and she says I can't because of the monitoring.
I am more nervous because of the close pregnancies and being of advanced maternal age at a ripe 37 ! I don't want to jeapordize my delivery because I want to walk around and shower... and I don't want a wire stuck in my baby's head! I haven't really discussed it with her yet, and I really respect her thoughts, but...
What are your thoughts?
thanks so much, from a worried Mama!

[kltroy]

Everyone's different, but I would personally agree to continuous fetal monitoring - which appears to be pretty standard hospital policy for VBACs (as long as they had a telemetered system so I could move around). Every group of MWs that I interviewed for my upcoming VBAC mentioned this. But I would NOT agree to internal monitoring - which I've never heard of as a requirement. This is incredibly invasive and there's no reason to do it. I would double check with your OB and clarify that she was talking about internal vs. continuous fetal monitoring. I know lots of people here wouldn't even agree to continuous fetal monitoring - for me, I'll pick my battles, and as long as it doesn't cramp my style much, there are more important things for me to argue about.

[tarajean56]

The OB I started with told me the same thing right from the start as well. His exact words were, "don't think you are going to be a hard ass and come in saying you won't have internal monitoring, because I require it."

I am now with a midwife.

I was also not comfortable with a wire screwed into my baby's head. Furthermore, your water will have to be broken in order to insert the monitor, and from what I've read, internal monitoring usually means you are stuck in bed. Personally, I think there are way more complications and other interventions that could/will result from internal monitoring, especially considering the supposed benefits. If I were VBACing in a hospital I would agree to intermittent external fetal monitoring, but that's all.

Good luck!!

[mommy2naomi]

I would only agree to intermittent external fetal monitoring but if it was me, I wouldn't see an OB. I would go to a midwife or a family physician before seeing an OB for the birth. Just my opinion though...

[elisent]

I've been trying to decide on monitoring, too. I hate the external monitor. Even with my births before my c-section intermittent monitoring was required but ended up being almost continuous. They would say ten minutes but not show up when they said they would. Near the end of labor baby's heart rate would go down slightly with contractions which freaked them out so I had to leave it on.

The hospital here doesn't have telemetry monitors. If labor is especially difficult and they insist on strapping me to the bed I might agree to an internal monitor. I've heard you get a bit more freedom of movement with those. That would only be if my water had already broken. Always before I was horrified at the thought of the sensor for the baby's head, but now I'm thinking it would be better than ending up with a repeat c-section.

[Storm Bride]

Originally Posted by tarajean56

I was also not comfortable with a wire screwed into my baby's head. Furthermore, your water will have to be broken in order to insert the monitor, and from what I've read, internal monitoring usually means you are stuck in bed.

When I transferred with Aaron, an internal monitor was put in (I didn't know what they were doing, actually - she just called it an electrode, and I was pretty far gone with exhaustion), and I wasn't restricted to bed. I was actually surprised - I'd pictured an internal monitor as being something bigger, somehow. In terms of mobility, it was a non-issue.

I will say, though - I found it very uncomfortable. I'd been in labour for quite a while, and my vagina was feeling very sensitive (extra blood flow, I guess) and every time I moved, I felt like the wire was scraping me. In a very strange, roundabout way, I think that extra distraction contributed to me losing my baby. I was trying to focus myself and figure out what I wanted to do, and at that point, I couldn't, because there was just too much going on (including intense, long, frequent contractions). The wire aggravated that, and I probably would have asked them to do the section sooner if I'd been able to figure out what was going on. I'm not going to blame the monitor, but it didn't help in that respect...

[JessicaS]

You can always shop around and try and find a different practitioner. The first place I went to does have midwives but they require continuous monitoring so I chose not to continue seeing them.

It isn't so much that I object to monitoring to such an extent that I would refuse such care, but that who knows what you'll want during labor and what makes you comfortable. Personally I would want the option of getting in the tub and moving around a lot.

To me it was about limiting my labor options more than the monitoring in itself

Is there a birth center in your area?

[thorn]

I wouldn't agree to internal monitoring. I probably would have agreed to continuous external if I'd had telemetry, but my doc didn't push it so I had intermittent anyway.

[pampered_mom]

I wouldn't agree to internal monitoring. I'm not too keen on the idea of a wire leading up inside of me...seems like too convenient of a method of transmission of bacteria, etc.

[mom2tillie]

I see that someone else mentioned that fact that they will have to break your water in order to do internal monitor. That is a contraindication to VBAC in my book, so I wouldn't agree to it. Once your water is broken you are on the clock and I think that sets you up for more intervention.

I also think you need to bring this up sooner than later with your doc so that you can assess the situation and make a compromise (external continous) or find another provider.

[Benji'sMom]

There's an internal monitor that doesn't get screwed into the baby's head. Did they say which type they require? Honestly, with external monitors if you try an "all fours" position or even side lying, or many other positions, the monitor can move around and they loose the signal. It's annoying to have them come in the room all the time because of that. It's easier with the internal, I could move around more that way. So personally I would rather have the interal from the beginning. But if you are uncomfortable with it please look for another doctor because it should be your decision. You need to be totally comfortable with your doctor/midwfie/whoever. You have to trust that person and be able to talk to them about things you like or don't like, and you shouldn't just be dictated to.

[Heathermhill]

Thanks so much for your posts so far.
I have a nervous husband who wants a repeat C-section (don't get me started) So going to a birth center isn't an option sorry to say. And with a few of my increased risk factors I feel that being in a hospital is the best place for our family...
Having said that, I want my body to do what it's supposed to do and I DONT want my waters broken.
I don't mind monitoring off and on, and go ahead and monitor during the pushing when I'm already sitting still. If there is a problem with the heartrate then fine, OK.
Another problem I have is how every doc is different. I went to a specialist early on and asked about the monitoring and he said they don't do it. I hate to not have the birth I want because my doc is covering her as$. Although I really like my OB, I think she was great with my first two deliveries, even though the c-section one was just a mess in all ways.
Better yet, I could just labor at home or get a room near the hospital and just waddle over there right before I push
If a rupture is going to happen, WHEN is it most likely to happen, I would assume it's during the pushing phase right? <sigh>
I live in FLA, I have half an urge to drive over to that birthing center where "house of babies" is filmed and have Shari delivery for me!

[oregonbound]

I wouldn't agree to internal fetal monitoring just because with my 2 VBACs my water broke just before birth and I have heard that contractions are way worse once your water has broken, so I would worry about having to labor through really bad contractions for a really long time if my membranes were ruptured early. Both of mine were hospital VBACs, with the first I was able to do intermittent monitoring and that was fine, with the second, they insisted on continuous external monitoring, and I still got on my birth ball and up on all fours or whatever I needed to do, they just had to come in and reposition after ever contraction. I remember joking with my husband because after a big contraction was over, I would hear the footsteps coming down the hall. You just have to keep a sense of humor about the whole thing. If I had it to do over again, I would have just gone to a birth center with baby #3, but my husband was against it so I birthed at the hospital.

oh and another thing, one of my friends had the internal monitor and they lost the baby's heartbeat and did a crash section only to find out the monitor came undone.

[green_momma2007]

Originally Posted by Heathermhill

Thanks so much for your posts so far.
I have a nervous husband who wants a repeat C-section (don't get me started) So going to a birth center isn't an option sorry to say. And with a few of my increased risk factors I feel that being in a hospital is the best place for our family...
Having said that, I want my body to do what it's supposed to do and I DONT want my waters broken.
I don't mind monitoring off and on, and go ahead and monitor during the pushing when I'm already sitting still. If there is a problem with the heartrate then fine, OK.
Another problem I have is how every doc is different. I went to a specialist early on and asked about the monitoring and he said they don't do it. I hate to not have the birth I want because my doc is covering her as$. Although I really like my OB, I think she was great with my first two deliveries, even though the c-section one was just a mess in all ways.
Better yet, I could just labor at home or get a room near the hospital and just waddle over there right before I push
If a rupture is going to happen, WHEN is it most likely to happen, I would assume it's during the pushing phase right? <sigh>
I live in FLA, I have half an urge to drive over to that birthing center where "house of babies" is filmed and have Shari delivery for me!

I'm in almost your same situation. My husband would prefer a RCS, but he's been good about supporting my decision to VBAC. I wont meet my attending doctor until later in the pregnancy ( I'm 20 weeks right now) so I don't know how they are on fetal monitoring. In any case, I plan on laboring at home as long as possible, so that way I can avoid most interventions for at least the first half of labor.

[kltroy]

Originally Posted by oregonbound

and another thing, one of my friends had the internal monitor and they lost the baby's heartbeat and did a crash section only to find out the monitor came undone.

..although hindsight is 20/20 in a case like this. If they lost MY baby's heartbeat (and couldn't seem to find it again) I'd probably want the kid OUT as fast as possible too. I don't think I'd fault the presence of the internal monitor in this case - though the whole story sounds unfortunate.

[Nate'sMama]

It is my understanding that, in the very unlikely event of a rupture, it can happen at any time. More well versed VBAC mamas will let you know for sure.

Most hospitals insist on monitoring VBACs, but I think it's over the top to insist on internal. I would refuse. I have agreed to monitoring with telemetry. I understand that I can refuse this too and I probably will from time to time. I however have a very supportive OB and MW.

The internal monitor was the last step before my section so, personally, they're not getting another one of those inside me

You owe it to yourself and your DH to keep talking to him about it, if he'll do some of the research even better. I think it will be better for you if he's less nervous.

I agree with a pp about also talking to your ob sooner rather than later. I am sure you can come up with some sort of compromise that you can deal with...and then come in pushing!!!

Good luck with the ob, your DH, and your VBAC!!

[JessicaS]

Originally Posted by Heathermhill

Thanks so much for your posts so far.
I have a nervous husband who wants a repeat C-section (don't get me started) So going to a birth center isn't an option sorry to say. And with a few of my increased risk factors I feel that being in a hospital is the best place for our family...
Having said that, I want my body to do what it's supposed to do and I DONT want my waters broken.
I don't mind monitoring off and on, and go ahead and monitor during the pushing when I'm already sitting still. If there is a problem with the heartrate then fine, OK.
Another problem I have is how every doc is different. I went to a specialist early on and asked about the monitoring and he said they don't do it. I hate to not have the birth I want because my doc is covering her as$. Although I really like my OB, I think she was great with my first two deliveries, even though the c-section one was just a mess in all ways.
Better yet, I could just labor at home or get a room near the hospital and just waddle over there right before I push
If a rupture is going to happen, WHEN is it most likely to happen, I would assume it's during the pushing phase right? <sigh>
I live in FLA, I have half an urge to drive over to that birthing center where "house of babies" is filmed and have Shari delivery for me!

Your best option then might just be to stay at home until the last minute. You might consider getting a doula to be with you during that time.

[pampered_mom]

Originally Posted by abimommy

You might consider getting a doula to be with you during that time.

Or a montrice as they can monitor FHT. If you don't have any in your area you may consider contacting an hb mw to see if they have suggestions or would be willing to function in a similar capacity.

Also, have you approached your dh about just going to interview an hb midwife? That way he can her whatever questions he may have. It may make a difference, but it may not. I figure it's always worth a shot!

[Storm Bride]

Originally Posted by kltroy

..although hindsight is 20/20 in a case like this. If they lost MY baby's heartbeat (and couldn't seem to find it again) I'd probably want the kid OUT as fast as possible too.

When they lost Aaron's heartbeat, they placed a new monitor. Then, they brought in an ultrasound. Then, the called for the crash section. He was stillborn. I'm not blaming anybody because it's my own fault that I didn't manage to get out "do the c-section" as soon as they lost the heartrate (I have a real problem talking in the hospital, and it was especially bad when I was labouring so hard)...and it might have been too late, anyway. But, yeah - if they lose the heartbeat, I'm for a crash section...

[AngelaB]

I personally would not do the internal monitoring however I have consented to intermitent monitoring and the nurse always held the monitor to my belly and they have been very calm and nonintrusive, I believe I was pretty lucky though.
Fetal monitoring is an art and not just a science and it does require alot of interpritation and not just looking at readouts. Alot of the policies may be coming from the hospital and not the doctor directly. I would look around for other care givers and also give your dh as much info on safety of homebirth and the risks of being in the hospital. "the thinking womens guide to a better birth" is a great starting point. You can have a great birth in the hospital but its alot of work and assertiveness to get what you want given the attitude towards vbac these days.

I think that its a really a crap shoot as to what is a necisarry intervention and what is not in a possibly fatal situation. Its become worse now that birth is seen as a dangerous and scary event that when the time comes to actually take desperate measures it is often downplayed or on the other hand the whole birth is treated as an emergency and then becomes a self fulfilling prophecy. If birth were seen and treated as a normal natural event in mainstream medicine and OBs were used in high risk or surgical situations then the c section rate would go down drastically and when a babies heartrate is lost there is no time spent running other test because they are not sure. They are not sure because the technology is widely overused and people are suffering because of it.

There are in my opinion far more risks to a pregnancy then a uterine rupture. The likely hood that there will be a placental abrutpion is greater than a uterine rupture yet we are made to fight and suffer and endure hardships because we are considered "high risk" Its totally bogus. yes ruptures occur but the odds are in our favor. Life is high risk and all we can do is weigh the odds, use our logic and try not to live in and operate based on fear.
Ok off my soap box.
Angela