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Can a Laboring Woman Refuse EFM?

post #1 of 28
Thread Starter 
To my understanding, her legal right to refuse procedures would (or at least should) trump hospital policies. If refusing EFM were in a woman's birth plan or verbal request, how likely is it that the staff would honor her wishes? What type of battle would ensue and, more importantly, could she win it?
post #2 of 28
Of course she *can* refuse it. She has the right to refuse EVERYTHING.

How it would go over would depend on the hospital.

-Angela
post #3 of 28
are you referring to being on those belly strip monitors? I had it in my bp that I didn't want them and never had an issue with it.
post #4 of 28
If it is standard in the hospital (and it usually is) I think they would probably fight you to the bitter end. They might even tell you that you might find better care at another hospital or location that would be willing to oblige your request (if you aren't in active/late labor) if only as a scare tactic. They'll also ask why you came to the hospital if you do not trust their policies and their 'expertise' in the matter.

To be honest, I think it would be pretty ugly. I know of women who have cleared very minimal intermittant monitoring with their doctor and still ended up battling with nurses and then having to have the efm because the doctor changed his mind after the harping from the nurses.

Do you know if the hospital you want to birth at allows this? I definitely recommend getting there very late in labor if you're trying to avoid it.
post #5 of 28
If the hospital feels that the decisions you are making for your body are not in the best interest of your baby they can legally have someone else appointed to make the decisions for your baby, and those can trump the ones you are making for your body.

The thought that they might be sued over a dead or sick baby is much scarier and more real to them than the thought you might sue them because you didn't get the birth experience you wanted.
post #6 of 28
This is a question that should be posed to the hospital the woman is intending on birthing at, well before the birth (in case a birth center or other hospital is in order based on the answer).
post #7 of 28
Quote:
Originally Posted by nashvillemidwife View Post
If the hospital feels that the decisions you are making for your body are not in the best interest of your baby they can legally have someone else appointed to make the decisions for your baby, and those can trump the ones you are making for your body.
While technically a possibility, this is actually VERY rare. They actually have to get a court order to do this.

Most often it's used to force a c-section. I doubt they could get one for EFM.

-Angela
post #8 of 28
Well, in my experience with my second born, I went to the hospital under the impression that I wasn't going to have to be monitored. Then when I got there, the nurse said that I needed it on for at least a little bit because the babie's heart rate was a little too high. A few minutes later, nearing transition, I took the belt off myself, saying to "GET this thing off of me!" The nurse helped me remove it when she saw and heard me fumbling with the stupid thing.

The stupidity of strapping a belt on a belly that is going through such intense work! Huh!
post #9 of 28
Quote:
If the hospital feels that the decisions you are making for your body are not in the best interest of your baby they can legally have someone else appointed to make the decisions for your baby, and those can trump the ones you are making for your body.

The thought that they might be sued over a dead or sick baby is much scarier and more real to them than the thought you might sue them because you didn't get the birth experience you wanted.
That. And before they do that, they will have every way of negotiating, smooth-talking, pleading, and insisting that you do XYZ... I've seen it...
post #10 of 28
This one can swing either way. I agree with a PP that you should discuss it up front BEFORE you're admitted, put it in your birth plan etc. This will give you a sense of how flexible the policy, if one exists, is. Much better to let folks know up front that you will be not wanting this than to throw a wrench into their system by surprising them.

Depending on whether you have a MW or an OB, this can change things too. Frequently you can reach a compromise, especially if you can get an L&D nurse on your side (this requires you to be nice to them, and maybe bring them donuts when you check in ). Maybe you can agree to wear the annoying belts 10 minutes every hour instead of all the time. If your MW is there all the time, she can usually use a doppler to check instead. Also, making sure you have a telemetered (wireless) EFM can make it much more tolerable even if you only have to wear it some of the time. The telemetered ones can usually be worn under water too, so it shouldn't stop you from using a tub/shower.
post #11 of 28
I'd say it fully depends on how flexible the hospital is and the comfort of the HCP. It can range from simply asking and having no trouble to begging, pleading, threatening to sue and being all but physically forced. It is definitely a matter to take up well before ever going into labour.
post #12 of 28
Thread Starter 
For the record, I'm referring to a friend and not myself.

Hypothetically, if a hospital is uncooperative about this, I'm wondering if it wouldn't be worth risking the SUP strategy (Show Up Pushing). By the time the hospital jumps though it's bureaucratic loopholes to exercise its coercive powers...the baby is born, and EFM becomes moot.
post #13 of 28
I refused it twice in a very conservative hospital. They brought me an AMA to sign, which I then revised, discussed with both my midwife and the charge nurse, and signed. I ended up "consenting" to a FHT check about every hour. I did have a doula client attempt the same thing, and her OB threatened to refuse to deliver her.
post #14 of 28
I would ask, why go to the hospital at all? Yes, a laboring woman can refuse anything she wants, but to paraphrase what we sometimes say here-if you don't want to ride the ride, then don't buy the ticket.

For my hospital birth clients, "minimal" monitoring means a twenty minute strip upon arrival at the hossy, followed by listening for a minute or two every half hour, and every ten minutes while pushing.

For my home birth clients, we listen with the doppler every half hour while in labor and every ten minutes while pushing.

If you're planning to flatly refuse ALL monitoring, you'll have a much more peaceful birth by staying at home.

I tell my clients that we can create a good hospital birth together, but there are a *few* procedures that are different between home and hospital birth. One is the twenty minute strip, another is admission bloodwork. Otherwise, my hospital is pretty laid back. My clients aren't "required" to have a heparin/saline lock, mom and baby never have to be separated, parents rarely get flak for declining baby meds.

Most hospital "policies" can be negotiated, but remember that these bizarre policies evolved in response to lawsuits and to what the medical establishment believes to be the best care. A client flatly, uncompromisingly refusing everything sets the stage for an adversarial relationship, and ends up being unpleasant for everyone involved.

As a few posters have said, this is something to ask your provider.

Walking into the hospital with suspicion and distrust will create a suspicious and distrustful birth environment. I've watched it happen, and it doesn't need to. Staying at home is a much better alternative to walking into the hospital expecting them to negate your every wish. If they do, you'll be angry; if they don't, all the energy you spent preparing to defend yourself could have been better spent on your labor.
post #15 of 28
I refused the 20 min strip on admittance. Yeah, they were irritated but they got over it. Once they got me into my labor room, I let the nurse check it briefly before I got in the tub. During pushing they were allowed to use the doppler every few minutes to check but I did not wear the belt.

It probably helped that I'm an active duty soldier and this was a military hospital and they literally cannot even say to you "Go somewhere else to give birth." They have to do what I tell them.
post #16 of 28
I agree with all of the pp here, and would also add that the level of flack you get about the refusal will depend on both the hospital itself (conservative vs. natural birth friendly) and how "high risk" you are considered before you even walk through the door.

As a VBAC, when I talked with my Doula about not wanting both the constant EFM and the IV, she said that I was going to have a tough time negotiating that based on the hospital's policies. She said they might go for the heplock vs IV, but the monitoring was going to be a bigger challenge (with my "timebomb" uterus, you know.)

Ultimately my DH & I decided to have an HBAC.
post #17 of 28
They started me on one but it became unbearable (anything touching my stomach) and i couldn't handle it. They tried using a hand held monitor but gave up on that too because I was moving around so much. It really depends on the hospital and the individual staff members that are working with you.
post #18 of 28
It depends somewhat on what the hospital is used to hearing and is definitely something you should discuss with your HCP well beforehand. I've never had a problem at my small hospital refusing IVs and heplocks and EFM and vit K and eye ointment, you name it... however, I've had clients at the same hospital that show up making demands and being very confrontational, and they are the ones who end up seeing the hospital lawyers; as a PP said, that sort of force is usually reserved for c-sections.
I think it is important for everyone to realize here, too, that not everyone can have a homebirth, so it is important to work on improving conditions for hospital births for those of us for whom the hospital can be a necessary evil (or just a matter of preference).
post #19 of 28
they couldn't get me with those things since I refused to get out of the jacuzzi......good midwife, but hospital would have done it I bet if I didn't have her....
post #20 of 28
Quote:
Originally Posted by Turquesa View Post
For the record, I'm referring to a friend and not myself.

Hypothetically, if a hospital is uncooperative about this, I'm wondering if it wouldn't be worth risking the SUP strategy (Show Up Pushing). By the time the hospital jumps though it's bureaucratic loopholes to exercise its coercive powers...the baby is born, and EFM becomes moot.
For sure, but EFM is small potatoes compared to the rest of the interventions they throw at you. But it is the first one. Well, that and vaginal checks.

I'd check it out with the nurses at the tour. People have also had lawyers court-appointed for their babies and forced c-sections when showing up pushing. It's a long shot and completely unethical and unconstitutional, but it has happened.
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