Did you prefer external or internal fetal monitoring?

[mamathellama]

Hi!
I'm planning a vbac and my dr prefers continuous (or mostly continuous) fetal monitoring. The standard way would be with the external EFM belts to track fetal heart rate and contractions. The other way to do it is with the internal thing attached to the baby's scalp (can only be done once somewhat dilated and water broke). One of my friends had external for part of her labor and they were having a problem getting good readings so they put in an internal one. She said she actually was more comfortable with the internal one because it was easier to get up and move around. With the external belts, they kept slipping out of position and losing the heart rate.
Usually I would be wanting less intervention, but is this a case where the internal monitoring would allow me more mobility? I know the internal monitoring also carries a higher risk of infection, I'm not sure if there are any other issues.
Thanks!

[aprilv]

others may have more knowledge about this topic, but i am under the impression that this internal monitor device is actually sort of screwed into the baby's scalp. obviously this would break the skin, thus the increased infection rate. i would think that would be painful for the baby. for this reason, i would prefer the external, if it had to be continuous. i had the external, yes it was annoying, but if you move and it slips, they can just come in and fix it. the reason your doctor says it must be continuous may be that it makes it easier for her or the nurses, not because it's better for you or your baby (of course, there may be another reason i am not aware of, in which case you might not have an option). it wouldn't hurt to tell her YOU prefer intermittent monitoring; afterall, it it YOU giving birth.

[AlexisT]

Ask if telemetry monitoring is available. this would allow you to get up more, and it would be my first choice if I needed continuous monitoring for some reason. I hated cEFM when I needed it done.

Internal, well, maybe, IF I had SROM--would not have AROM to do it.

[Mommal]

Originally Posted by AlexisT

Internal, well, maybe, IF I had SROM--would not have AROM to do it.

Yes! As soon as your water breaks, your provider will probably give you 24 hours (at most) to give birth. After that, most OBs believe the risk of infection is too high, and they will push hard for a c-section. Not too many moms have the strength to refuse a c-section when their OB is claiming that their baby may die as a result. Also, if you have AROM, and then your labor slows for some reason, your provider will probably mention the 24 hour time limit and push for some sort of intervention to speed your labor up. All interventions carry an increased risk of c-section and some of the more common labor augmentation drugs (think Pitocin) also carry increased risk of uterine rupture, which is the big danger when you VBAC.

I am also under the impression that internal monitors are screwed into the baby's scalp. Not very nice for the baby, and definitely more likely to cause infection than external monitoring.

As aprilv said, you can tell your doc that you are not comfortable with continuous monitoring. Your doc may not be happy with intermittent monitoring, but this is your birth. You can do it your way.

[KD's Momma]

The probe IS screwed into the scalp of the babe - I actually have a bump/scar on the top of my head from when a probe was screwed into my scalp when my mom delivered me. It hurts if I hit it with a brush when combing my hair. I would not choose this method - personally. Plus I wouldn't want to add to the risk of infection. The belts can be moved around and should be to keep from marking your skin.

[thixle]

Yep, it is an electrode screwed into your unborn baby's head. Definately not pleasant for baby. Risk of infection jumps for mom because your water must be broken and foreign objects shoved in you... It was done to us, but against my knowledge or consent. The doc walked out of the room after "checking" and I saw wires hanging out of me. Yes, you *might* have some mobility, IF they strap the wires to your leg, otherwise, it is pulling/ripping the baby's scalp.
I would refuse constant monitoring and agree to intermitant. You know, or throw a fit and "accidentally" let the EFM bands slip off until they just agreed to let me be...

[alegna]

I would not allow continuous monitoring without a reason (and vbac isn't a reason)

It does not improve outcomes.

I can't think of any situation where I would allow internal monitoring.

-Angela

[mikayla's mama]

Internal monitoring is risky, infection like everyone else already mentioned plus the thing screws into the baby's head which also carries risks. I really don't see you able to be more mobile with the IFM, actually it seems you would be less mobile.

I had internal fetal monitoring, intrauterine contraction catheter and uterine flushing maching all hooked up in my uterus and it sucked for me and the baby. Plus, I had to have the preventative antibiotics of course which made me feel awful. Then the pitocin and non-working epidural.... wish I knew then what I know now. It's a slippery slope, if they force you to monitor I'd go with the belly belt.

[sapphire_chan]

Doesn't AROM mean that there's more risk of bad positioning? For a VBAC I'm kind of surprised they'd even suggest internal monitoring. Of course, I also wish I was surprised that they seem to be inclining towards a protocol that has you on your back--harder to birth, causes fetal distress, etc, etc.

Oh, and if they do suggest internal monitoring, ask them, nicely, to screw one into their own scalp(s) first. And then report back on the looks on their face(s).

[honeybee]

When the EFM slipped while I was in labor with ds1, my doula just held it in place while I moved so it wouldn't start skipping. I should've insisted on the intermittent monitoring. But my birthplan had already been derailed with an unexpected IV and antibiotics, so I thought I HAD to have the continuous EFM. So, I just ended up having to go to the bathroom a lot, and disconnected the monitor to do so (my doula let the nurse know so they wouldn't freak out).

Would an internal monitor require a catheter? Otherwise, you'd be peeing on the wire, right? I just can not see how an internal monitor would give you more freedom of movement. Seems counter-intuitive to me.

[holly6737]

The only fetal monitoring I prefer is intermittent and of course external. Anything else is overkill, even in a vbac situation. And NO NO NO NO NO to AROM for placement of internal monitor.

I've been a doula at a birth where the woman was forced to stay in bed only after she had the internal monitor placed. The fear was that it would come out or become misplaced and then no more continuous readings that can be monitored from the nursing station.

[nashvillemidwife]

If continuous EFM strapped to the bed or internal monitoring were my only choices, I would go with internal. I used to think there was no way in hell I'd let someone screw something into my baby's head, but then I saw enough of them done to know that describing it that way is a big of exaggeration. It barely penetrates the skin, just enough to hold it in place, and I don't believe it is deep enough for the baby to really feel it considering how shallow it is and the "trauma" the baby's head is already experiencing from being squeezed and molded to fit through the pelvis. Yes, there may be a tiny risk of infection, but that does not outweigh the risks of needing an epidural or ultimately forceps or c-section that result from not being able to get out of bed.

[azjen43]

My (somewhat limited) understanding is that the internal monitor is a much more reliable and accurate way to monitor the baby's heart rate and blood oxygen saturation....External EFM is pretty notorious for its high rate of false positives in regard to "non-reassuring fetal heart tones."

That being said, it is more invasive, increases risk on infection, and, in my experience, limits mobility as well. So... unless there was a really good reason, I wouldn't consent to it.

However, if I was being told I needed a c section based on external fetal monitoring, I would probably ask to have the internal done to get a "second opinion" on the baby's heart tones, etc.

(Oh, yeah, and the wire is well insulated and grounded, so no danger of getting electricuted while peeing! )

[PassionateWriter]

Originally Posted by alegna

I would not allow continuous monitoring without a reason (and vbac isn't a reason)

It does not improve outcomes.

I can't think of any situation where I would allow internal monitoring.

-Angela

i just read a bunch of risks associated w/ this a few days ago in The Thinking Woman's Guide to Childbirth. Do you have that? If not, I highly recommend it esp. for a VBAC.

[katsam]

I had to have an internal monitor for a couple of hours or so before I delivered. It was a weird situation where ultrasound had shown a possible heart defect and my homebirth got derailed. Anyway, because of my situation they were very worried about the strain of labor on my baby, when her heart rate started to look iffy on the the external monitor they switched to the internal. Once the internal was placed it showed a normal heart rate the whole time, so I was glad for this because everyone was nervous with the external. I could move around the bed and get on the birthball during the time the internal was in place. I'm not sure if I could have walked or not.
Anyway, I probably would not have consented if it was not for this situation, but I could feel the C-section vive in the room so I consented, and I am glad I did because the internal did give accurate normal readings.

[sapphire_chan]

Originally Posted by nashvillemidwife

It barely penetrates the skin, just enough to hold it in place...

That's definitely good to know.

I'm having trouble picturing how it wouldn't hinder walking around though. I mean, I'd think it'd be really really bad to move the wire? Plus, there's still also the problem with AROM.

[Defenestrator]

The wire is pretty flexible and meant to bend and it is attached to this thing that is taped to your thigh. The cable comes out to attach the machines from the spot on the thigh. It is pretty sturdy.

I agree that EFM by telemetry is the best choice if you have it for continuous monitoring. The internal isn't too bad, though, if you water is already broken.

[jennica]

I had both when Ds was born. The eternal sucked, it was around my belly and made me feel constrained. It was constantly being adjusted and moved and everyone was always frustrated with it. I felt like I couldn't move with it on. The internal, I didn't notice at all once they placed it, and everyone finally relaxed about the stupid monitor once I got that one. Since I didn't notice it, I moved about more normally and never gave it a second thought. However, my labor went fast, and I was pretty much confined to the bed, so I have no idea how it would be dealing with it all day and going to the bathroom with it in, or moving anywhere away from the bed. Also, I'm pretty sure that Ds would choose the external one given the choice. I never did find the spot though that the monitor was attached to, and the way it is usually described, you would think I would see something like that. The weirdest thing about it was when he was born and seeing a wire attached to, and then unscrewed from his head.

[yarngoddess]

I've had 4 babies. My first was external, second was external held in place by an inexperienced nurse. My third and fourth was external, then internal.

I would rather shove bamboo shoots up my fingernails than do an internal monitor again EVER. I had HORRIBLE HORRIBLE HORRIBLE PAIN from the monitor. Every time the stupid cord moved it sent wayves of pain through my vagina up to my belly button. They said "If you get the epidural it won't do that" and I ALREADY had the epidural (no flames- I have medical conditions) and this pain from the stupid monitor was Breaking Throught an epidural. Seriously.

My 4th was delivered UC in a hospital while they were arguing over the stupid Internal Fetal Monitor! HEHEHEH I can still hear the nurse screaming at me that I can't have the baby RIGHT HERE! ON THE BED!! WITH NO DOCTOR!!! He was out on the bed before anyone could react. I ended up yanking out the fetal monitor prior to his delivery- it hurt that bad.

As for the baby's. My 3rd looked like a Klingon (from star treck) she had a broken nose(as broken as it can be at that age-swollen, black and hurt to touch) and her head was COVERED in minor SCRATCHES(that took weeks to heal, and she would cry when we touched her head for about 3 months )!!! we think that was from the monitor, or when my water was broken(with a finger condom hook thingy). My 4th had this triangle prong mark that was scabed over for about a week- and because he was a little preemie and VERY jaundiced it didn't heal for almost 2 weeks! Kept getting "almost" infected.

My "opinon" is to get a second opinion. If you have a Doc that's already INSISTING on something- you have one that will push you to do things you DON'T want when you ARE in labor. I also STRONGLY encourage you to find a Doula. I had a very nice on for my 4th, she was very inexperinced and didn't know what a woman that's BODY is pushing sounds like. I had a kind of out of body experience and remember thinking "OMG!! I'm PUSHING- can't you HEAR that in my VOICE??" Doula's will often WORK with you on a fee schedule- or reduced it if you need it. Have you looked for any Midwives in your area? Been to Finding your tribe?

I hope you find a middle ground to work with your Doctor and hospital- but DO it NOW, and get it in writing and signed by your Doc. Once you get to the hospital, even if you and your doc have something "agreed" upon, the hospital staff can say "Sorry- your doctor didn't put that in your orders, and Dr so and so is here tonight." and you either Fight then- in labor (something I cannot do, heck I can't talk at all!) or you leave. Not really great choices. Habing a good Doula in your corner will help Filter the Nurses- who are more of an issue than the OBGYN's who are only there for the actual DELIVERY, not the pushing or the labor. Really.

Congrats! I send you MANY happy vibes of Smooth, Gentle, Calm labor/delivery vibes.

[Girlprof]

I had to be induced with my second birth due to extremely high blood pressure. They had wireless monitors, both external and internal, so if my BP had been lower, I would have been able to walk around. We did eventually switch to an internal because in order to keep the damn external in place, I had to lay in an uncomfortable position. The internal didn't end up being as bad as I expected. I didn't need any other wires or contraptions. It keep the heart rate steady so nurse's worry went down. I had a wireless one so the MW just strapped the little pod thing to my leg. My baby did have a small red mark on her head.

Of course, in a normal birth, I wouldn't have any of that. But with a medical reason for it, the internal monitoring didn't turn out to be as bad as expected.