VBAC (vaginal birth after c-sect) and CEFM (continuous electronic fetal monitoring) - Mothering Forums

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#1 of 10 Old 07-20-2013, 08:28 PM - Thread Starter
 
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Greetings all,
My wife is due Oct 2013. OB is supportive of VBAC. Wife has one child in Apr 2009 through c-section which was an extremely disappointing experience. She has her heart set on a VBAC. However, through our research we found that different positions and mother movement is important to help the labor progress. OB wants wife strapped down to the bed with CEFM. She wants to keep tabs on the baby's heartbeat but this would mean my wife is stuck in bed in the supine position (laying on back).

Any thoughts? Anyone give vaginal birth in purely supine position with no movement? How do I convince the OB on a compromise? Is one hour on, one off CEFM feasible?
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#2 of 10 Old 07-20-2013, 11:34 PM
 
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My understanding is that CEFM hasn't been shown to be more effective than intermittent fetal monitoring, but I admit that it's been awhile since I've done the research, and I am not aware of any new studies.  It's possible that this is the requirement that your OB has to make VBAC more acceptable, since it does seem VBAC is going away in many hospitals and practices. I don't know what the statistics are for CEFM with VBAC.

I gave birth vaginally the first time (in 1999) with an epidural and all the rest: CEFM, catheter, blood pressure cuff, amnio infusion, so I had lots of tubes going in and out.  I was not able to walk around at all, and as the epidural went on, I could not move my legs at all and was basically on my back. I finally got the doctor to turn the epidural down enough so that I could move and feel to push.

My plan was to labor at home as long as possible, and then go in, but my water broke at 4 am and then I had back labor and nausea with each contraction. Once I got to the hospital, I wanted to walk around, and they said fine, just let us get a 20 minute strip, then you can go.  Well, every time the belt moved and they lost the heartbeat, they had to start over again.  I never got up off that darn bed.  The pain of the back labor was just not what I had envisioned labor pain to be like, and it made me so nauseated, which was difficult, so I just wanted the epidural to be done with all that.

I think it really depends on how labor starts and how long you can stay at home.  If the doctor is talking about CEFM, does she want your wife there right at the start of labor?  Do you think she is thinking induction?

My second birth was a homebirth, and I actually spent a lot of time just lying on my side.  I did stand and move around, and do the hip shake thing, but I couldn't leave my bedroom for a silly reason, so I never got to walk around outside, which was my plan. 

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#3 of 10 Old 07-21-2013, 08:59 PM - Thread Starter
 
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I believe OB is more concerned regarding uterine rupture. She does not seemed worried about the baby because first labor was completely normal. CS indicated because "the cervix arrested in dilation" at 22 hrs after hospital admission. No other signs of distress. Our plan is to drive to the hospital at 5 min-apart contractions. The OB is completely against induction for any post CS labor (to include RCS) due to the extra-strong contractions they cause and thus increased risk of rupture. With all else considered, I personally feel like CEFM is the only real "obstacle" that may inhibit a "successful" VBAC. I'm trying to keep this to myself, as wife seems very optimistic. We have an OB appt this Saturday, so I'll see if I can work out some sort of compromise if labor is progressing "normally." This OB is very supportive and I feel like she wants to personally and profressionally see a VBAC happen. Thank you for your story. With hindsight, do you believe your back pain and nausea would have been alleviated with some movement?
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#4 of 10 Old 07-22-2013, 09:02 AM
 
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First, congratulations! 

 

I am also hoping for a VBAC later this year. For the past 3 yrs I have done lots of reading about VBACs and while there is question about the necessity of CEFM, many VBAC-supportive hospitals and OBs still require it. However, they usually require it once the mom is a certain # of cms dilated...so in other words, not immediately upon admission (except for the usual 20-min strip  at triage).

 

For my upcoming birth I was happy to find a hospital that had telemetry equipment. This equipment is wireless so I will be able to walk the halls and get in the shower/tubs while still being monitored. This has significantly relieved my concern about being able to move. (With my first my water broke at the start of labor, so the hospital had me bed bound and I believe this was the main reason we ended up with a cesarean birth.)

 

Unfortunately, even very VBAC-supportive hospitals do not offer telemetry, but you might want to see if you can find one nearby.

 

HOWEVER, with all that said, from the many birth stories I have read, you can still have a very positive VBAC birth with CEFM.  First, do not make the mistake I made, when the nurse told me I could not get out of bed even to use the bathroom, I believed her instead of simply saying I accept the risk and I am going to the bathroom like a normal adult. The nurse had me try to pee in a bedpan, which I simply could not do...so my bladder got really full, and a full bladder slows labor. I should say that if the water has already broke, there is a small risk of chord prolapse if the baby's head is not already engaged. Chord prolapse is a serious, emergent complication.  In my case, the head was fully engaged so there was no real risk of chord prolapse.

 

So assuming your wife gets up and goes to the restroom often to empty her bladder -- which helps with the laboring process! -- she should take her time and enjoy the time off the monitors.  If she has you or a doula to help her in the restroom, then the nurse should not have to be there to rush her back to the monitors.

 

Most importantly, check out this inspiring photo gallery of VBAC women laboring on CEFM.  As you will see, the mother does not have to be stuck in bed on her back:

 

http://www.icanofatlanta.com/?page_id=159

 

Hope this helps! And congratulations again!

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#5 of 10 Old 08-09-2013, 03:23 AM - Thread Starter
 
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earthwalker: thanks for the motivating post. The unit at Raffles hospital has you strapped down to the bed. They have one mobile unit but that's it. The doc is adamant regarding CEFM. From what I can tell, she's actually one of the most  VBAC-supportive of the OBs in Singapore, and wife wants to birth in a hospital. So it's a balance of the options out there and this is the best one. Plan is to arrive at the hospital LATE - not sure if 5min dilation is late enough? OB said past 6-7 hours, the hospital would not "allow" her to continue to push. From everything I've researched, is this the best thing to do? Give a 6-hour time limit, then cut open the mom? All else equal - no signs of fetus/mother distress - is there any rationale to a prescribed time limit before the CS?

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#6 of 10 Old 08-09-2013, 06:14 AM
 
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Crossing my fingers that you all get access to the telemetry unit.

 

Another thought is this is peanut ball for sidelying position.  http://betterbirthdoula.org/peanut-ball-and-epidurals-tips-for-doulas/

Also, asymmetrical positions, if helpful, can be done while lying down..... alternately drawing one knee or the other up.  Sitting up in bed with the back of the bed supporting.... both knees up, like a sitting squat, or one knee up, one knee down.  Pelvic rocking and pelvic circles in bed.  Walking around the hospital before checking in.  Perhaps a doula experienced with VBAC and laboring on CEFM? 

 

Also, is it after six hours of labor in the hospital or six hours of pushing? 


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#7 of 10 Old 08-09-2013, 08:24 AM
 
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Around here, I've heard of doctors compromising on a couple of minutes of monitoring with a handheld dopler after each contraction. It's a bit more work for the hospital staff, but it gives the mother freedom of movement, while still providing the information on how the baby recovers from contractions. I had an HBAC and that's how my midwife handled it too. For my labour, lying down was not an option during contractions, but that varies from woman to woman, and labour to labour.
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#8 of 10 Old 08-09-2013, 09:50 AM
 
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I had a successful vbac 2 years ago under similar circumstances to yours.  There was only one ob/gyn in town that would do vbacs; he was very upfront about his parameters and those included: natural start to labor before 42 weeks (he wouldn't do ANY pitocin or the like for vbacs), baby had to be in position (no breach and he wouldn't attempt to turn a vbac baby), and I had to go to the hospital right away and be continuously monitored.  I was worried about that, but he was my only shot, so we went for it.  Eventually I had an epidural during labor because I was so uncomfortable on the bed and attached to all of the equipment, but everything worked out!  Best of luck!

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#9 of 10 Old 08-10-2013, 12:12 PM
 
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The research on IA vs cEFM is for low risk pregnancies--not VBAC. FWIW, NICE in the UK recommends that EFM be offered in VBAC deliveries, and unlike the US, EFM is not standard of care for a low risk delivery (there is a set of criteria under which midwives should switch from IA to EFM)

 

In VBACs, EFM is more effective than IA at detecting early signs of uterine rupture. So the doppler idea will not work if this is the concern of the OB. It's easier to see the changes with continuous monitoring and graphing. 

 

ETA: I don't think the evidence is solid, either way... but I think that even though the likelihood of uterine rupture is small, the potential consequences are catastrophic. It may not be completely necessary but it's also not unreasonable, if you see what I mean. 

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#10 of 10 Old 10-08-2013, 07:39 AM
 
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I just delivered my 4th baby, 3rd VBAC.  This was by far the hardest delivery because my dr insisted on cEFM.  It's hard not being able to move around but it can be done!  Every hour to hour and a half I insisted on going to the restroom, even if I felt like I didn't need to.  Just to get up and stretch/ walk.  Also the peanut ball was a huge help!

 

Wishing the best outcome for you and your sweet babe :joy


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