Refusing Continuous Fetal Monitoring - Mothering Forums

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#1 of 50 Old 08-07-2006, 09:29 PM - Thread Starter
 
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So what would happen if you refused the continuous fetal monitoring that they insist upon doing for thirty minutes after you arrive at the hospital?

This is the issue I have with it. It is general knowledge that your blood pressure is different if you are lying down, sitting up, standing, or moving around. Likewise, contractions feel different based on what position you are in. In order to be monitored with their little machine that gives them their nifty printout, you have to lie down on a bed and not move for fear that the sensors will fall off and the nurses will come down to your room all in a huff to re-place them. But in reality, all that CFM is doing is telling them how the baby handles contractions you have while lying down and not moving. It doesn't tell them how the baby does when you're moving around, on your hands and knees, or in whatever position feels best at the time. And instinct would tell me that the baby would do best in the positions the mother tolerates best.

I have no problem with them running up and down the hall with me monitoring how the baby is doing (if what I want to do is run up and down the hall). Basically, it's fine with me for them to monitor the baby's heartbeat as long as they follow what position I want to be in rather than forcing me to be in a position that is convenient for them (like having to deliver on my back with my feet in stirrups).

So what would happen if I refused the monitoring? What are my options in regards to the issue of fetal monitoring?

Tana, wife to Steve (5/02), mom to Ben (7/03), Joey (10/06) and Caroline (9/09)
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#2 of 50 Old 08-07-2006, 10:45 PM
 
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I would discuss these concerns with your mw/ob/care provider and the hospital staff- sooner than later. You do have a right to refuse many procedures..... these are such the procedures that contributed to me wanting and having a hb. ( they also have the right to act crabby and bitchy and mess up the vibe imo)

i like common sense!duh.

btw my son is your sons age- 6-25-03.... and dd was born last november....

good luck!!!! that is one procedure of many i would be refusing....
hugs and congrats!!!!!!
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#3 of 50 Old 08-07-2006, 10:56 PM
 
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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.
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#4 of 50 Old 08-07-2006, 11:06 PM
 
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Consent is a dodgy thing in the hospital system. For lots of women saying no doesn't mean NO it means "Ok so we'll send other people in to pressure you" or "We'll do it anyway and who cares if the woman screams?!" There is no scientific evidence to support CEFM but a lot of evidence that it causes unnecessary c-secs. Theoretically it's *your* body and it's assault if they put something on or in you without your express permission. In reality, this is hard to prove and pretty meaningless when you're in strong labour and unable to fend them off. If you can't give birth safely at home where none of these things are an issue, make your wishes VERY plain ahead of time and even then only use the hospital as a pushing venue. We know that the later you go in labour the fewer interventions are possible and being in the hospital no longer than the space between when they like to do VEs reduces your chances of stuff happening significantly. Take a doula with you who is experienced at running interference to distract the staff, give them a birth plan and have it attached to your record so it's pulled when they hear you're coming in, take more copies and attach them to the door of the room, the head of the bed and hand them out like party invitations. Your mental health, and the physical/emotional health of you AND your baby are too important to risk to the lottery of the hospital system so you need to take steps to protect yourself. You may fluke excellent staff but it's likely you won't. Be prepared! Or just give birth at home where no one has machines that go ping and there's no OR lying in wait to swallow you up...

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Most hospitals require you to have an IV and an external or internal fetal monitor. These inhibit mobility, and make you feel like there's something wrong just by their being there. Obstetricians believe that these monitors provide a more accurate record of the baby's heart rate, thus guaranteeing safer outcomes by providing the opportunity for quicker intervention. The monitors do provide very detailed information, but machines can and do malfunction, showing distress where there is none. A. Prentice and T. Lind surveyed monitoring trials and reported their conclusions in the journal Lancet in 1987. They found that "many mothers will have operative deliveries for "distressed" babies who show no such distress at birth" (Korte and Scaer 111). These researchers also noted that Van den Berg et al. reported that 71-95% of babies diagnosed as distressed during labor show no distress at birth. In other words, the monitor provides a "false positive" up to 95% of the time, and ! ! mothers undergo all the risks of surgery for nothing (111).

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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#5 of 50 Old 08-07-2006, 11:13 PM
 
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have you considered a homebirth mama?
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#6 of 50 Old 08-07-2006, 11:14 PM
 
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I didn't present to the hospital (intentionally) until I was at 8 cm and belly dancing around the room, so a "good" CFM strip was laughable. I allowed my (very wonderful) nurse to do her thing for the first few minutes, and let her get a print-out of some good contractions...and then I told her that I was taking it off and she could spot-check the baby's heart rate periodically.

She simply smiled and said "That's all I need to hear you say. I can't do anything against your will." We smiled at each other. I let her do what her job required, and she let me do what I needed to do.

Just my experience and thoughts. The belt was slipping off with my movement around the room, and no way was my labor going to focus around keeping that silly thing on. I know the dearth of supportive research behind the CFM bit, but I was okay with a few token minutes of it when I knew my baby and I were just rocking it out together.

Mama to A 8/05 and S 11/06
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#7 of 50 Old 08-07-2006, 11:15 PM
 
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It's not true that you need to lie down for EFM. Anyone who tells you that you do isn't very good at keeping babies on the monitor. We continuously monitor moms on pit walking around on telemetry and get very good at it.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#8 of 50 Old 08-07-2006, 11:26 PM
 
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I had no problem with refusing the initial monitoring when I got to the hospital with ds. I told them I wanted to get right in the tub and they had about 5 minutes to do their thing, a nurse took one look at my face, saw that I was concentrating very hard on what I was doing -- having a baby! -- and she listened with a handheld doppler for a few minutes and off I went. They wrapped the end of the doppler in plastic and checked me in the tub a few times, but never bothered me about getting out of the tub for monitoring and were good about maneuvering around me to get a reading instead of asking me to change positions when I didn't want to.
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#9 of 50 Old 08-08-2006, 12:06 AM
 
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I haen't read replies but I wanted to say that if nothing else, external monitoring CAN be done while you are moving around, you just can't go to teribly far from the thing. You can ask if you can do it via telemetry too. (sorry for such a brief answer, kids climbing on me)

Namaste, Tara
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#10 of 50 Old 08-08-2006, 12:10 AM
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Quote:
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.
: Me, too. Even refused the c-section, so they shot me in the arm and knocked me out. :
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#11 of 50 Old 08-08-2006, 12:23 AM
 
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In theory you CAN refuse everything but you've heard from pps how well that goes. Honestly, short of a major emergency I will never birth in a hospital. It's just too risky for everyone.

-Angela
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#12 of 50 Old 08-08-2006, 12:33 AM
 
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I'm never going to test this theory, but here's my thoughts.

The monitoring is hospital policy, in all likelihood. Talking to your care provider ahead of time will not get the policy changed, in all likelihood. A nurse runs the risk of getting written up.

So, my theory is thus: don't sign the general hospital consent form. Have a durable healthcare power of attorney made for your dh or whomever you wish to have the power to sign a consent form should you be knocked out/passed out/whatever. Basically, then, in theory, you'd have to sign a separate consent form for everything.

However, my theory is also predicated on the idea that you don't talk about this ahead of time, and then you're in labor, and then they can't deny you care. Since you haven't signed any 'consent' forms, though, then they're open to suit or legal charges... this is my theory. I don't know how it would really play out and honestly I think homebirth would be a heck of a lot easier! I realize that it may not be an option for some reason though, so. This is what I've pieced together in my head from reading various thoughts and suggestions in several places.

Kash, homeschooling mommy to Gillian (8/5/00) and Jacob (3/23/05)
and Brigid Eleanor (11/20/08)
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#13 of 50 Old 08-08-2006, 12:49 AM
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umm what's stopping you from taking the belt off and walking around. If you are in active labour they can't really kick you out now can they?
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#14 of 50 Old 08-08-2006, 01:27 AM
 
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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.
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#15 of 50 Old 08-08-2006, 01:31 AM
 
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Quote:
Originally Posted by Pandora114
umm what's stopping you from taking the belt off and walking around. If you are in active labour they can't really kick you out now can they?
I tried this. Just to go to the bathroom and I wasn't even in active labor, my water just had a "hole" in it (from the sOB doing a vag. exam at her office that morning). The nurses(2) scurried in, chastised (sp?) me for taking it off, put it back on and tucked me back into bed. They said I "needed" to keep it on to monitor the baby. I'm sure it was just "hospital policy" bs that they come and bully you into.
I would definately try for a hb if I were the op. It's what I'm doing next time for sure! Otherwise, get someone who'll fight for you. I've found it's very hard to fight them while you're in labor and they've had so much practice.

Jessika, wife to Turbo, mommy to Codi (12/04), Kayce (8/08), Colten (10/10), and a new little stork-suprise.gif coming 12/13 .

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#16 of 50 Old 08-08-2006, 01:35 AM
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Originally Posted by Codi's Mama
I tried this. Just to go to the bathroom and I wasn't even in active labor, my water just had a "hole" in it (from the sOB doing a vag. exam at her office that morning). The nurses(2) scurried in, chastised (sp?) me for taking it off, put it back on and tucked me back into bed. They said I "needed" to keep it on to monitor the baby. I'm sure it was just "hospital policy" bs that they come and bully you into.
I would definately try for a hb if I were the op. It's what I'm doing next time for sure! Otherwise, get someone who'll fight for you. I've found it's very hard to fight them while you're in labor and they've had so much practice.
So I'd look at them, take it off and say "Yeah whatever, get this thing off of MY body"

I'd keep taking the damn thing off. I'm not joking. It's my body, it's just velcro. Screw them.
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#17 of 50 Old 08-08-2006, 01:36 AM
 
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I echo the above posters that you can be monitored in any position (even underwater if they have the appropriate monitor). If you refuse monitoring, it will most likely be used against you if something God forbid were to happen to you or the baby during delivery (even if it were later found to be an error on the staff's fault and nothing to do with the heartrate during labor). That responsibility is something you have to know ahead of time that you're willing to take.

However, for the most part, hospital policy usually trumps your refusal. That's why I ended up with pitocin against my wishes, which ended up causing a lot of (most likely preventable) problems... As long as you're in their building, they will end up doing what they want unless you have it signed ahead of time by your OB that it's not necessary. Or unless you say "I do not consent to continuous monitoring while on my back and any attempt to do so against my wishes will be met with questioning from my lawyer"

~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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#18 of 50 Old 08-08-2006, 03:08 AM
 
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Not to hijack--but has anyone had the internal fetal monitoring, and what positions were you able to achieve with it?

VBAC mamma of two little Vikings
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#19 of 50 Old 08-08-2006, 11:11 AM
 
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Originally Posted by hajenkatt
Not to hijack--but has anyone had the internal fetal monitoring, and what positions were you able to achieve with it?
I don't think there's any situation where I would allow internal monitoring. Not exactly what you asked, but my thoughts....

-Angela
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#20 of 50 Old 08-08-2006, 04:36 PM
 
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Quote:
Originally Posted by Pandora114
umm what's stopping you from taking the belt off and walking around. If you are in active labour they can't really kick you out now can they?
I did that when it was still external. I had to piss and had call light on for an hour, they'd told me I was not to get up. so I waited. finally yanked it off and went and the bitch came back in. she screamed at me and at my family for "allowing" me to do that. shortly after, they broke my waters and did an internal. against my will


they cna and will punish you for what they think you're doing wrong. you're not in much of a position to argue at the time
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#21 of 50 Old 08-08-2006, 04:58 PM
 
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This is why this time I'm having a homebirth.

I had it the CEFM with both girls pretty much and tried to get out of it with DD2 but it didn't work. I do have in my hospital birth plan (aka don't let backup MedWives know I *am* doing a HB) that I will not consent to being monitored laying down (which they will 'allow' ) and only one "strip" done upon admission and Doppler after that. But I also have in that birthplan that I plan on spending as much time laboring at home as possible too (yeah, laboring all the way at home )

Heather
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#22 of 50 Old 08-08-2006, 10:51 PM
 
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Originally Posted by hajenkatt
Not to hijack--but has anyone had the internal fetal monitoring, and what positions were you able to achieve with it?
From an L&D nurse perspective, internal monitoring is BAD! Do not allow it. Not only are you truly tied to the bed (unlike external monitoring), it is attatched to your baby's head, which can leave a mark, easily get infected, etc. We never use internal monitoring with a patient whose going natural. That would be an oxymoron
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#23 of 50 Old 08-08-2006, 11:10 PM
 
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We only use scalp clips (nternal monitoring) if there's a problem, so walking around is not likely then anyway. But I guess it could be done.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#24 of 50 Old 08-08-2006, 11:19 PM
 
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Quote:
Originally Posted by bhawkins
From an L&D nurse perspective, internal monitoring is BAD! Do not allow it. Not only are you truly tied to the bed (unlike external monitoring), it is attatched to your baby's head, which can leave a mark, easily get infected, etc. We never use internal monitoring with a patient whose going natural. That would be an oxymoron
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)

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#25 of 50 Old 08-08-2006, 11:32 PM
 
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Originally Posted by AllyRae
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)
You hit it on the head, sister. I think there is a time and a place for high-tech intervention. Technology can save lives; I can name babies who I know have been (I am also a nurse). God willing, were I in the situation where I needed it, my baby would be saved by it, too.

...But high-tech devices as a universal precaution (and I love that phrase!!) -- nope. Can EFM/IFM be used inappropriately? Absolutely. But I decline to categorically write off its use in every situation. (Flames welcome.)

I knew I was having a normal birth. My care providers knew it, too, and there was no d@mn way I was wearing that belt. But I don't think it's evil in every circumstance.

Mama to A 8/05 and S 11/06
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#26 of 50 Old 08-09-2006, 01:11 AM
 
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As an L&D nurse, I would never write off internal monitoring. There are times when it's the only way to identify a true decel from monitoring issues with EFM. I'd MUCH rather have a scalp clip that wasn't needed than a c-section that wasn't needed.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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I was told that bc I am going VBAC that I have to have an internal monitor. I DO NOT WANT ONE, but the OB I saw gave me the whole spiel (sp?) about how external monitors are not accurate at all and that VBAC patients have internal monitors.

Oh, and I have to pee in a bed pan and laboring on my back is better than laboring sitting down in a rocker. Needless to say, all my good vibes about my VBAC crashed that day...god I hope she is not on call that day...

VBAC mamma of two little Vikings
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#28 of 50 Old 08-09-2006, 01:25 AM
 
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Quote:
Originally Posted by hajenkatt
I was told that bc I am going VBAC that I have to have an internal monitor. I DO NOT WANT ONE, but the OB I saw gave me the whole spiel (sp?) about how external monitors are not accurate at all and that VBAC patients have internal monitors.

Oh, and I have to pee in a bed pan and laboring on my back is better than laboring sitting down in a rocker. Needless to say, all my good vibes about my VBAC crashed that day...god I hope she is not on call that day...
Total crap. Ask for data showing that EFM isn't accurate for VBAC, and then ask why it's used for other laboring women if it's so inaccurate. A scalp clip can be put in in fifteen seconds if you need it. Also, there's NO reason to keep a VBAC on bed rest. It's just a good way to encourage another section. We don't treat our VBAC patients any differently from anyone else, except that they have EFM instead of auscultation and get a hep lock. Otherwise, they walk, they tub, they do whatever they want, and our success rate is the best in the city.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#29 of 50 Old 08-09-2006, 01:31 AM
 
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Originally Posted by maxmama
Total crap. Ask for data showing that EFM isn't accurate for VBAC, and then ask why it's used for other laboring women if it's so inaccurate. A scalp clip can be put in in fifteen seconds if you need it. Also, there's NO reason to keep a VBAC on bed rest. It's just a good way to encourage another section. We don't treat our VBAC patients any differently from anyone else, except that they have EFM instead of auscultation and get a hep lock. Otherwise, they walk, they tub, they do whatever they want, and our success rate is the best in the city.
I agree and the more I have reflected on what she said the more irritated I have become. This is the ONLY practice in the entire city that takes VBAC patients, and my primary guy has been awesome. I have been trying to meet all the other "faces" but will go back to him next week to repeat some of my hard core questions bc I am not groovin' on what she said. I have no problem with the hep lock, but hell if I am going to be stuck on my back. I want to labor at home as long as possible, but we are SO far out in the wilderness that I am afraid I will either go in too early or have the baby on the side of a cliff.

Does anyone have a web resource on different positions for laboring that I could print out and take with me?

VBAC mamma of two little Vikings
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#30 of 50 Old 08-09-2006, 01:42 AM
 
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Oh mama.... I hope you find something.... I am not sure....
Someone will know tho. YOU are the mom. You can refuse anything. Please do. Switch providers if you can.
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