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#31 of 50 Old 08-09-2006, 03:24 AM
 
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The question is why is EFM used on ANYONE because it doesn't work!

See above...

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In a groundbreaking study done by Dr. Albert Haverkamp to assess the worth of external fetal monitoring, the results of a study group of 483 mothers showed that among those who had an external fetal monitor, the cesarean section rate was 2 1/2 times as high as it was in the group which had auscultation. However, there was no corresponding increase in the rate of problems for the monitored babies (Jones 15-16). These results surprised Haverkamp. Several other studies have verified this outcome. The EFM does not make your baby safer; it simply increases your risk of having surgery, which in turn, greatly increases your risk of injury or death, as described above. Another EFM study even found that the monitor did not improve neurological health outcomes for premature babies (Korte and Scaer 111), who certainly fit the definition of high risk, which is what the monitor was designed for originally!
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#32 of 50 Old 08-09-2006, 09:26 AM
 
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Originally Posted by AllyRae
Um... : As an L&D nurse, you should realize that there are reasons to allow internal monitoring. It was the "do not allow it, it's very bad" mentality that echoed through my head as my son's heart rate was crashing and I finally had to stop refusing the internal monitor. As a general practice, no, that wouldn't be the choice, but there is a time and place for it (medical professionals really do have to learn what that time and place is though rather than using high tech devices as a universal precaution)
I do realized there are reasons to allow it. However, I do not understand why you received internal monitoring when your son's HR was crashing. If you could see it crashing with EFM, why did the scalp lead need to be used? The only times I've ever seen internal FM useful is with morbidly obese pts, where using EFM is extrememly challenging.
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#33 of 50 Old 08-09-2006, 10:16 AM - Thread Starter
 
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I think monitoring is appropriate and necessary if you are having an augmented birth or if you have taken any pain medications because your hormones are no longer in control and they need to make sure THEY don't do something wrong.

It's the routine "you have to be on the EFM for 30 minutes when you arrive at the hospital" that I have a problem with. I just wrote on my birth plan why I think the information gained isn't useful or necessary (IFM is fine with me as long as they follow me and don't make me pick a position that suits them), and then I was quite honest and said that I will tolerate very little if any such monitoring. They can consider themselves warned.

Unfortunately, where I live, a midwife attended homebirth is illegal, or believe me, I would be having one. I am fully prepared for an unassisted birth, but if DH is home when I birth, he is terrified of birth and I do not think I will be able to relax sufficiently with him around. So I am also preparing for a hospital birth where DH, at least, will be more relaxed.

I had both external and internal monitors with ds. I had the external when I first got there and through the night because they gave me morphine for prodromal labor. Then in the morning I ended up with an epidural because I was still 3 cm and reached the end of my tolerance for pain. I remember that stupid EFM just kept falling off every time I moved, even if I thought it was an "innocent" move. The IFM didn't have that problem, though at that point, they were moving me.

I just dread CFM, but every doula tells me that it's hospital protocol and there's no way I'm going to get out of it unless I get there when I'm 8 cm (which is my plan anyway, but we all know how plans go with birthing).

Tana, wife to Steve (5/02), mom to Ben (7/03), Joey (10/06) and Caroline (9/09)
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#34 of 50 Old 08-09-2006, 10:26 AM
 
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Originally Posted by bhawkins
I do realized there are reasons to allow it. However, I do not understand why you received internal monitoring when your son's HR was crashing. If you could see it crashing with EFM, why did the scalp lead need to be used? The only times I've ever seen internal FM useful is with morbidly obese pts, where using EFM is extrememly challenging.
I asked those same questions too--they said they thought it was just the monitor not catching the baby because it kept slipping (I didn't think it was slipping, but that's what they said). So, they tried the internal (which they claimed was malfunctioning because his HR was in the 60's on it... : So, they reinserted a new one and it went up to 90...they claimed "oh, look, it was just a bad monitor!" when even I know that sticking *2* leads into a baby's head stimulates them because it stresses them out).

But anyhow, yeah. And I'm not obese (I'm pretty petite and even 41 weeks pregnant was only 158 lbs). But then again, there's not a whole lot that happened during those 5 hours that I actually agree with, obviously... Then again, I wish you were my nurse that day because it sounds like you probably would have done a crash c-section instead of fiddling with the stupid IM leads...

~Brandon Michael (11/23/03), Jocelyn Lily Nữ (2/4/07, adopted 5/28/07 from Vietnam), Amelia Rylie (1/14/09), & Ryland Josef William (9/7/05-9/7/05 @ 41 wks). 
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#35 of 50 Old 08-09-2006, 10:37 AM
 
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I had an IFM, you can't move AT ALL. Well I could tailor sit or lie down. It was done without even informing me and against my consent because I was taking off the EFM and PO the staff. And not every hospital has telemetry so it is not true that you can always walk.
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#36 of 50 Old 08-09-2006, 12:28 PM
 
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Quote:
Originally Posted by AllyRae
I asked those same questions too--they said they thought it was just the monitor not catching the baby because it kept slipping (I didn't think it was slipping, but that's what they said). So, they tried the internal (which they claimed was malfunctioning because his HR was in the 60's on it... : So, they reinserted a new one and it went up to 90...they claimed "oh, look, it was just a bad monitor!" when even I know that sticking *2* leads into a baby's head stimulates them because it stresses them out).

But anyhow, yeah. And I'm not obese (I'm pretty petite and even 41 weeks pregnant was only 158 lbs). But then again, there's not a whole lot that happened during those 5 hours that I actually agree with, obviously... Then again, I wish you were my nurse that day because it sounds like you probably would have done a crash c-section instead of fiddling with the stupid IM leads...
Wow! That's so sad that they wasted precious time putting on scalp leads when they should have just been getting your baby out
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#37 of 50 Old 08-10-2006, 02:14 AM
 
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Originally Posted by arlecchina
well...they forced me. I said no to all of it, ESP the internal monitoring, but they completely ignored me. was the only time in labour I kicked and screamed and threatened to sue...water breaking, detal monitoring. they honoured nothing.

then again I had a very horrible experience all around - so I dont know if what I say is anything typical although I have heard as bad and much worse.
That was my experience too. I spent my first hour or so at the hospital fighting and crying and begging and they were total jackasses. If I had only known then what I know now I would have sued their asses (acually I wouldn't have been there in the first place but you know...)
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#38 of 50 Old 08-10-2006, 11:56 PM
 
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i had a hospital birth with OB & doula, and consented to the initial test strip and intermittent after that (though i was only in the hospital less than 4 hours before delivering). i had talked to the OBs at length about it, and the compromise we came up with was that the monitor would be hand-held to me. the l&d nurse was actually an amazing woman - a very soothing presence and totally respectful of my birth plan... so i didn't mind in principle, but the pressure on my belly was sending me into constant contractions... but since she was staying with me she could take a little break if i just couldn't take it, and then get back to it when i was ready. still... next time i want to go without the EFM entirely... it sounded ok before i knew what labor would be like for me, but it was just a painful part of the experience even despite the very sympathetic nurse.

oh, and i was sitting up for it.

the one good thing i will say about it is that it became very motivating to feel the nurse have to check lower and lower on my belly for the baby's heartbeat! but there were plenty of other indications that labor was going great for me.

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James 12/04 & Cecelia 4/07
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#39 of 50 Old 08-11-2006, 12:16 AM
 
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However, for the most part, hospital policy usually trumps your refusal.
That's why interviewing your care provider and hospital very carefully is so important.
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#40 of 50 Old 08-11-2006, 03:18 AM
 
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As a doula, I once RECOMMENDED internal fetal monitoring for a high risk patient. She had far more mobility than with an external monitor because she had to lay perfectly still in the position of their choice. It became ridiculous. CFM was completely appropriate for her, given her multiple medical conditions, so I suggested an internal monitor.

She had lots more options, and was able to sit, lie, rock, and stand next to the bed. All in all, it worked out well.

I suprised myself by recommending it, but felt it was a decent suggestion, and stand by it. You never know. Every intervention has a purpose in some way if used appropriately.

Alison
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#41 of 50 Old 08-11-2006, 10:54 PM
 
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I switched mid-pregnancy from an OB to a mid-wife in the same hospital (insuarnce would nto pay for home or birth center birth). I had two doulas. I had discussed all my wishes ahead of time extensively. The mid-wife and senior doula told me to leave my birth plan at home, as it annoys staffers. (I should NEVER have listened to that).

Anyway, my water broke before labor started at home, and was heavily meconium stained. That threw all of my plans out the window, as I had no idea what to expect or who to believe, as I had not studied that scenario.

The evil b*tch of a nurse at the hospital insisted on doing an IV immediately and hooked me up to every monitor known to man. I got the IV taken down to a hep lock, and got up and kept taking off the monitors so I could move around. We *told* her we were going to do that and she kept coming back in and having a fit. The mid-wife came down after several hours (I was way pissed about her taking so long to come see me), and she basically told me if I didn't accept pitocin to get my labor going better and accept the monitors, that she would turn me over to an Ob for a c-section. I still don't know if that was justified or not. Was the baby in danger due to the meconium? My birth ended up beign attended by two mid-wives and 3 doulas! After 3 and 1/2 hours pushing, she came out and was not breathing, had to be intubated. So, I will never know if all the interventions in my birth were necessary or if they just made the birth experience miserable for me. I do know that using mid-wives prevented what would have been a c-section with a doctor. They also respected my desire to not have an epidural or episiotomy.

Also, since they "strongly suggested" I leave my birth plan at home (and my birth was horrible), my baby was also violated with stupid things like eye goop and Vit K. If I ever have another child, it will be AT HOME.
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#42 of 50 Old 08-11-2006, 11:13 PM
 
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First of all, in the absence of orders, your nurse has to follow protocol. It sounds like your midwife dropped the ball here by not coming in promptly and/or amending standing orders.

Second, with thick mec most providers don't allow intermittent auscultation. There are a lot of reasons, but many of them boil down to liability. It's unrealistic in current American health care to think that providers will/can divorce themselves from awareness of liability issues.

Third, meconium is a sign either of stress or of maturity (post-dates babies will almost always have mec). Thick mec does tend to push the pink flag toward red, though.

Intubation can do two things for mec babies: they can be suctioned "deep" (below the cords), and, if apneic (not breathing), they can be ventilated. They're not really related to each other, except that babies who have been stressed (and thus have mec) are more often apneic than babies who are not. (The suctioning is of questionable value to prevent meconium aspiration syndrome, but if mec is visible below the cords then they are more likely to have MAS.)

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#43 of 50 Old 08-11-2006, 11:28 PM
 
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my baby was 12 days past due date and no meconium.
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#44 of 50 Old 08-11-2006, 11:30 PM
 
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Quote:
Originally Posted by wannabe
That's why interviewing your care provider and hospital very carefully is so important.
ummm.... really?
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#45 of 50 Old 08-12-2006, 12:07 AM
 
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Originally Posted by Emilie
my baby was 12 days past due date and no meconium.
Post-dates in our hospital is 42+ weeks. They almost always have mec, but in that case it doesn't mean much.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#46 of 50 Old 08-12-2006, 12:11 AM
 
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that is great 42 plus! wow- that is surprising! in a good way.
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#47 of 50 Old 08-13-2006, 04:41 AM
 
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Any misspellings or grammatical errors in the above statement are intentional;
they are placed there for the amusement of those who like to point them out.
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#48 of 50 Old 08-13-2006, 10:28 AM
 
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Originally Posted by wannabe
What reason do they give for not monitoring you in whatever position you adopt? I mean, what's the point of telemetry if you're in one spot?

Yes, the monitors might need more adjustment, but that's their job, not sitting in the nurses station having tea and biccies. They're supposed to be kneeling next to you in the shower holding the monitor on as you try and get the water on the sore spot. But you do need to stay within a certain distance from the base station - for me it was the whole floor of the hospital.
Unfortunately, in the roughly ten hospitals I work in in my area, one...MAYBE two (but I believe the "maybe" is a no) has telemetry monitors, and they're reserved for the midwifery patients who're using the one room with a bathtub.

Many of the nurses I've worked with do their BEST to get a "strip" with the mama in her favorite position, but have a very difficult time doing so. In the end, with all of the distraction of people and belts and being still "just until they FIND the baby" six or seven times for different nurses, they mostly just acquiese to the 20 minute strip on their back or side, just to earn the other 40 minutes with nobody bothering them. The hospitals refuse to use the doppler, as it then disallows them from putting a paper record in the chart. THere is ONE birth center nearby which is attached to a hospital that DOES use doppler, and boy is a breath of fresh air. Frankly, as they can't refuse you, from the point of view of a woman who provides labor support and is SICK of watching mamas be bullied just because the LAWYERS need a paper record? Don't DON'T sign the general consent. Go in with a RESCINDMENT of general consent if you've already signed one. THen, procedure by procedure, be a pain in the a**. Say, "sure, you're more than welcome to get twenty minutes of the baby's reactions to my contractions...IF you can get them while I'm in a comfortable position. The minute I'm uncomfortable, I change position, period, whether it's good for your lawyers or not" Nope, you certainly won't be making friends. But, as long as they DO check the heart tones for a few contractions once an hour and the baby is fine, that's what matters. NOT that it's on paper. That's for THEIR convenience and legal safety, not for the baby's health and safety.

Mama to two awesome kids. Wife to a wonderful, attached, loving husband. I love my job-- I'm a Midwife, Doula and Childbirth Educator, Classes forming now!

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#49 of 50 Old 08-13-2006, 12:59 PM
 
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Originally Posted by courtenay_e
Unfortunately, in the roughly ten hospitals I work in in my area, one...MAYBE two (but I believe the "maybe" is a no) has telemetry monitors, and they're reserved for the midwifery patients who're using the one room with a bathtub.

Many of the nurses I've worked with do their BEST to get a "strip" with the mama in her favorite position, but have a very difficult time doing so. In the end, with all of the distraction of people and belts and being still "just until they FIND the baby" six or seven times for different nurses, they mostly just acquiese to the 20 minute strip on their back or side, just to earn the other 40 minutes with nobody bothering them. The hospitals refuse to use the doppler, as it then disallows them from putting a paper record in the chart. THere is ONE birth center nearby which is attached to a hospital that DOES use doppler, and boy is a breath of fresh air. Frankly, as they can't refuse you, from the point of view of a woman who provides labor support and is SICK of watching mamas be bullied just because the LAWYERS need a paper record? Don't DON'T sign the general consent. Go in with a RESCINDMENT of general consent if you've already signed one. THen, procedure by procedure, be a pain in the a**. Say, "sure, you're more than welcome to get twenty minutes of the baby's reactions to my contractions...IF you can get them while I'm in a comfortable position. The minute I'm uncomfortable, I change position, period, whether it's good for your lawyers or not" Nope, you certainly won't be making friends. But, as long as they DO check the heart tones for a few contractions once an hour and the baby is fine, that's what matters. NOT that it's on paper. That's for THEIR convenience and legal safety, not for the baby's health and safety.
Actually, that doesn't meet standards for intermittent auscultation. In active labor, babies are to be auscultated every 15 minutes, with a baseline every 30-60 minutes and post-contraction auscultation every 15. In second stage, the new guidelines are to auscultate every five minutes, which essentially means continuously. 20 minutes every hour doesn't meet criteria for evidence-based practice. there used to be a distinction between high and low-risk moms, but not anymore. A hospital that's getting a strip every hour isn't meeting its monitoring/documentation burden anyway.

If it's truly, as you say, about baby's health and safety, then a once-an-hour strip doesn't cut it.

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#50 of 50 Old 08-13-2006, 06:57 PM
 
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Quote:
Originally Posted by wannabe
That's why interviewing your care provider and hospital very carefully is so important.
Not really IME, Both my doctor and the hospital talked about how they were supportive of my natural birthing plans. It was a supposed "women's birthing center", with the new fancy LDRP rooms. My doctor said he had no problem with my natural birth plan and LeBoyer stuff and all that. But as soon as I showed up at the hospital the nurses did what they wanted, ignored what my doctor had told me he would do and acted nothing like the hospital had bragged about when I had gone on "the tour" months earlier. I don't believe that interviewing means crap. I guess I'm jaded.
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