CFM - needed or not

[chie96]

Hello - I am newly pg w/ #2 and want to VBAC. With my 1st I had a CNM, but ended up with a c/s after 23 hours of hard back labor (DD was posterior) and a cervix that would not dialate past 3cm. We decided early on that we would not to go with the same CNM, but the ones I have interviewed just don't "feel" right to me. Plus, the OBs they work with require that all VBAC patients be on constant fetal monitoring in labor. I tried a midwifery center one town over. Two of their four backup OBs also require CFM in labor - and those two also require laboring moms to do so in the hospital and not in the center.

I have always said that I want a VBAC - that I do not want CFM so I have the freedom to move about during labor, etc. But I have to admit that I am really starting to wonder why it is that I can only find one care provider (a male OB who comes highly recommended by several friends, one of whom VBAC 4 of her 6 kids) that does not require the CFM. I really wonder if I do need the CFM ( almost everyone else seems to think so). God forbid something went wrong - I could never forgive myself. If something is going to go wrong - w/o the CFM how would anyone know?

With DD I ended up on CFM after 11 hours of unmedicated labor. Her hr was dangerously low when it should have been high and very high when it should have been low. If she wasn't being monitored, we would not have known this.

I don't know - I am just scared. Does anyone have any thoughts?

[zombiemommie]

I will post my recent experience. This is how it went with me:

I birthed at a modest sized, suburban hospital with an OB residency program. the hospital is "progressive' in that they USED to have an alternative birth center which was closed due to lack of interest (!!) and the hospital supports natural birth, has birth balls, jacuzzi tubs, and has recently had several completely natural bradley water births.

I decided to use a CNM group, all of the 3 in the practice are former L&D nurses from that particular hospital who went "solo" after getting CNM. I heard good things via the grapevine about them. They are still a tad "medwife" but the best alternative I had vs. a home birth, KWIM ? There was no birth center around to use so it was them, an OB, or homebirth.

I was told this: if you labor and deliver naturally, there is no need for CFM or any other interventions as long as the baby and mother are not showing indicators of distress. You will not be treated any differently than a not-VBAC patient. A 20 minute initial strip, then 10 miutes of monitoring every hour. If you have an epidural, receive pitocin, or have any other interventions like IV pain medication, all bets are off and you need the CFM.

I went into labor and after 24 hours awake with every 6 minute contractions all 24 hours and then 2-3 minutes (we thought I was in transition) went to the hospital. I was not required to even have an IV. Not even a saline lock. They couldn't get a good 20 minute strip, so they sat there (my midwife) and held the monitor on my belly for 15 minutes while chit-chatting and said "good enough". I was only 4 cm and my labor "arrested" when I got there (from every 3 minutes to every 8-9 and did not pick back up). They said I could stay and wait (no way), stay and get my membranes ruptured and get some gentle Pit (I refused), I could go home and try and get it togethe, or I could stay there for a few hours, get some Morphine IM (a shot) which they said would help me get some needed rest and either my labor would pick back up, or it wouldn't and then I could go home. I had a 2 year old at home and knew I would not rest there, so I picked the Morphine option. I told them I didn't want to be monitored, I didn't want anybody bothering me, I wanted to sleep, and I didn't want an IV. They agreed. I got a shot in my butt, I went to sleep for 4 hours, woke up with contractions every 6 mintues, and went back home. They came in to check the heartrate once an hour, just to get a number, by doppler, not a strip. They didn't bother me at all. I was very very surprised.

I came back into the hospital AGAIN after 36 more hours of every 6-8 min extremely PAINFUL (for me) and intense contractions which lasted 2-3 minutes each. I hadn't slept for days, I was not able to keep it together mentally anymore. My CNM told me that her covering OB and she herself were concerned over the length and intensity of my contractions and the potential effect of that on my scar ("we are concerned about the integrity of your scar after 50 hours of contractions"). I agreed to come in to the hospital for gentle Pit. I was so dejected. I gave in mentally thinking well if they do the pit, then they might as well give me the epidural etc etc. I got to the hospital and was STILL 4cm (talk about pissing you off LOL) and I labored another 3 hours (getting watched occasionally) before getting the Pitocin. I was having some decelerations with every 3rd contraction and they thought that maybe there was a compressed cord. It went like this: I got an IV. I got the epidural. It was lovely after 50 hours. Really. Then, they broke my water and there was some meconium. "old" meconium, not fresh. I wonder if it was from the epidural LOL. Then, as soon as my water was broken, my contractions immediately "got it together" and became every 2 minute, extremely strong, but there were lots of decels. They asked if they could use internal uterine monitor, I said yes, then they wanted the scalp monitor on the baby because of the decels, I said yes. Then they wanted an "amnioinfusion" because there was more meconium and they thought it would help dilute the water and buffer the cord. I dilated EXTREMELY RAPIDLY going from 4 to 10 in about 1 1/2 hours, and the baby flew down the canal. I had to push like a rotisserie chicken, rotating. Push, turn to the L. Push, turn to the R because of the heartrate plummeting. I pushed for 20 mintues and had the baby with the NICU there to suction the living hell out of her. Apparently, AFTER the birth I found out there was an ungodly amount of meconium and my placenta was stained green. Baby was not stained tho. The actual delivery part (pushing and delivery) were very stressful because they were getting that "tone" (the concerned sound to their voice) and kept making me turn, turn, turn and wanted me to push gung ho. The hospital nurse was VERY concerned and i learned later she kept asking my midwife if she should call the OR for a section because of the decels etc. My midwife kept saying to her "things are just fine". Whatever. I was fine with all of the above under the circumstances. I would not have been fine if I was in labor for 12 hours, came in, and was pressured to be hooked up and interventioned to death.. The granola part of me wonders if the mec came from the intervention, or from a long, prodromal labor, or from the morphine. Part of me wonders if the cord was indeed stuck and my body was going really slow just to be kind to the baby. Then part of me says it doesn't matter, I'm glad she was okay, and I had my VBAC. It was the VBAC of my nightmares (in regard to intervention) I planned a completely natural VBAC, but it was the VBAC I got, and I did the best I could for as long as I could and then had to trust my midwife for guidance because at that point, I needed guidance, KWIM ?

I feel my CNM group was very VBAC and natural birth friendly, and then there was the "medwife" thrown in at the end. Its not like they hijacked a completely natural birth that was flying along *normally* by wanting to do this and that against my will. They sat back and let me go those 52 hours before wanting me in the hospital. I was having a prodromal labor pattern and they practice with OB consultation and there are guidelines and laws when you are having a CNM so I guess they did what they had to do (or suggested what they thought was best). How would it have been at home ? I don't knwo. Maybe fine with no meconium, maybe hairy. I am fine with it. Maybe if there is a next time it will be more to my liking. But I cherish this birth because I got to feel that little baby slide out and I worked hard to get there and I am happy.

[dotcommama]

You do not need constant monitoring any more than any other mother in labor does provided, as zombiemommie, that you don't have pitocin or an epidural.

If you were to rupture you'd know it, again as long as painkilling drugs were not numbing you. My midwife assures me that you would not need a monitor to tell you this - you'd be in pain very different from a contraction and you'd know for sure.

As far as needing the monitor for the baby - just b/c you're having a VBAC doesn't mean the baby needs to be monitored any more than any other baby being born. They don't need to have you strapped down constantly to be sure the baby is okay they can use a Doppler intermittently as they probably do for all other normal vaginal births.

Could you talk to one of the OB’s that you like and ask them why they feel constant monitoring is necessary? Can you ask them if they would still support you in a VBAC if you refused to be monitored in this manner? Maybe you could work out a birth plan that you both would be comfortable with, like I won’t be strapped to a monitor the whole time, but I will agree to 20 minutes when I first get in and you can then check the baby with a hand help Doppler once an hour (or whatever).

I think they are just working against you if they strap you don’t and don’t allow you the freedom of movement during birth. IMHO this is just bound to lead to very painful contractions, epidural and maybe another c-section.

[RainCityMama]

The only reason CFM is 'required' for an unmedicated birth is to protect the care provider - A monitor strip holds up in a court of law even though statistically it has been proven that it doesn't increase the likelyhood of a good outcome for mother or baby.
Statistics show that women who are monitored are more likely to receive unnecessary interventions as well as c-sections then women who are not hooked up to CFM.

That said, you could request to be monitored every 30 minutes and if everything looks fine then take a break from it.
Ask about a telemetry monitor which would allow you to move around. Even though your hospital may 'require' it doesn't mean you have to comply, you have every right to refuse treatment if you feel strongly about it - they are working for you, you are paying them - enough said.

Have you considered a home birth? If it is something you are comfortable with I would highly recommend it - the best part about my HBAC was that I could move to any room I wanted and do whatever it took to deal with the work of labor without anyone 'telling' me what I had to do.

Good luck to you and feel free to PM me if you want any more info on home VBAC!