[cricketsmomma]

My mw gave me a copy of the hospital's standard vbac protocol. I am having a vbac (thinking positive here!) next month.I have a fantastic mw but I really don't trust her back-up docs, the ones who I feel forced me into a c/s last time without even going into labor.
Here's what the protocol says:
lots of stuff about required IV access, pitocin only for augmentation/induction, OR staff & ansthesiologist in the building, etc... but this is the line I wondered about:
Internal scalp electrodes and intrauterine pressure catheters are frequently utilized in vbac candidates.
I just didn't like the sound of that. Now some things have a reason that's based on true need - for example, I've had lots of people tell me that it is good to have an IV with a hep lock in place because in the event of disaster it's difficult to get a line in quickly since veins can collapse. Ok, I don't like that but it sounds like a valid reason. But I DON"T like the idea of scalp monitoring! Is there a valid reason for this?
I've thought about homebirth, but we live an hour from any hospital in the middle of nowhere without some basic necessities like hot water or a toilet... plus I adore our mw, who can only deliver at the hospital. I just wish she didn't have these docs...
any advice?

 

[hikingmommy]

Yikes! I'd be worried about that, too. I remember reading a study a few years ago that found no benefit from internal monitors. I imagine they're quite restrictive - I can't imagine moving around with a monitor stuck on baby's scalp. I'd also worry about the increased risk of infection with people sticking their hands up there. Can you get more clarification? Is this something they'd require? Can you have a birth plan refusing it that they'd honor?

 

[geiamama]

Quote:

Originally Posted by cricketsmomma Internal scalp electrodes and intrauterine pressure catheters are frequently utilized in vbac candidates. I just didn't like the sound of that... But I DON"T like the idea of scalp monitoring! Is there a valid reason for this? any advice?

The reason I was given was that it is more acurate than a lap band monitor and that it allows you to move around but they come loose!!! When I was in labour with DS I was told that I needed a c-section because the baby's heart had stopped. It turned out that actually the clip had slipped off his head and the connection had stopped. I'm sure that it won't happen to you but just bear it in mind.

 

[cathicog]

Once those monitors are in(and the internal scalp one is screwed into the baby's scalp, and can cause infection(assuming the top of the baby's head is what get's touched- sometimes it's not) the ability to move is restricted. Please read "Obstetric Myths vs. Research Realities" by Henci Goer, and she goes into deep research on this very topic. Internal monitors have not been shown to produce better outcomes on healthy moms/babies, but only more surgery.. If you need monitoring, a nurse with a fetoscope can do just as good a job, maybe better. And the lack of mobility can cause problems in and of itself. If the baby is in a slightly wonky head position, being on hands and knees, or being up and moving around, can get him in a better position for birth. Monitoring, on the other hand, is like putting a harness or a leash on a mom- once it's on, it's hard to get off.(not impossible, just hard.). The best bet for a VBAC, usually, is to either plan a homebirth, or wait til the last minute and go to the hospital. But then you might run into problems with the staff. They don't like surprises.

 

[Angelorum]

I thought I remembered reading in Henci Goer's book that one of the best indicators of uterine rupture is the fetal heart tones, and so many vbac policies include what the hospital thinks is the most accurate way of fetal monitoring. Of course, the accuracy/superiority of internal electronic fetal monitoring is highly debatable, but it's the coolest piece of technology the hospital has for checking fetal heart tones, so they have to pull it out for the scary and dangerous vbac

 

[doctorjen]

Just to play devil's advocate for a moment: there is some evidence that the earliest sign of uterine rupture are subtle heart rate changes. It can be difficult to keep an external monitor tracing well - especially is mom is moving, while internal monitoring means you can move without readjusting the monitor (although if telemetry is not available, you can only move as far as the end of the wire - we have telemetry in my hospital and folks can be anywhere on the unit, in any position) If continuous monitoring is needed, having internal monitoring makes it easier to move freely, since the external monitor is not constantly slipping around and making it hard to trace the baby.
External contraction monitoring can tell ONLY when a contraction is happening, not the strength of it, so in the rare case augmentation is being considered, having an internal contraction monitor (IUPC) can accurately show intrauterine pressure and make sure the uterus is relaxing adequately between contractions, so if pitocin is considered, an internal monitor is more accurate for making sure too much isn't given.

Having said all that, it should be absolutely mom's right to choose her monitoring method, and to choose to accept or refuse any change in that during labor, and of course to expect that her care provides will fully explain any intervention they wish to perform

 

[cricketsmomma]

Quote:

Originally Posted by doctorjen it should be absolutely mom's right to choose her monitoring method, and to choose to accept or refuse any change in that during labor, and of course to expect that her care provides will fully explain any intervention they wish to perform

I just don't want to refuse something that is really essential. My problem is that the back-up docs, in fully explaining anything, always put a spin on it and I have a hard time sorting out fact from opinion/fiction. And I imagine it'll be much worse when I'm in labor!
I'm interviewing doulas so I can hopefully have some help with this. My mw isn't allowed to give me her opinion, since the docs are the ones who back her malpractice insurance and essentially her career. So usually I can tell if she just gets quiet...

I just have a major issue about screwing something into a baby's head! Hospitals are so known for infections anyway, why make it even easier to introduce one?

 

[mellowyellowmama]

This is why I would labor at home until as late as possible!

 

[pastrygirl]

I had an internal scalp monitor during my last birth, before my c/s... I hope beyond all hopes that I never "need" that again. It didn't even occur to me that they might strongly suggest it for a VBAC. We haven't talked that much about it yet since I'm only 16 weeks.

 

[kltroy]

Ok I may be the odd one out here, but it seems to me that a policy stating something is "frequently utilized" doesn't mean it's required, or that your HCP will want to use it.

Talk to your MW. Ask her under what circumstances she would think this is a good idea. Ask her how often she uses internal monitors - is it routine or just when the situation warrants it (like they can''t seem to get a good tracing with a strap around your belly and there is cause for concern with the baby). There are some legit and good reasons to do it, but "because you are a VBAC" is not one of them.

Continuous monitoring is somewhat par for the course and, having had it for my VBAC, I didn't think it was all that bad. Although I couldn't go for a walk (because the cords to the monitors were only about 10 feet long), I didn't really want to when I was well into active labor, so I parked my butt on a birth ball next to the bed and stayed there for several hours.

Other women in my ICAN group have reported that they did have an internal monitor for whatever reason, and that it was actually less annoying than the strapped on ones because it didn't keep slipping out of place.

Either way, if ANYONE ever even MENTIONED the possibility of a c-section because they were worried about the baby I would 100% ask for an internal monitor to confirm that whatever they were seeing was, in fact, real.

 

[murphysaangel]

Quote:

Originally Posted by kltroy Ok I may be the odd one out here, but it seems to me that a policy stating something is "frequently utilized" doesn't mean it's required, or that your HCP will want to use it. Talk to your MW. Ask her under what circumstances she would think this is a good idea. Ask her how often she uses internal monitors - is it routine or just when the situation warrants it (like they can''t seem to get a good tracing with a strap around your belly and there is cause for concern with the baby). There are some legit and good reasons to do it, but "because you are a VBAC" is not one of them. Continuous monitoring is somewhat par for the course and, having had it for my VBAC, I didn't think it was all that bad. Although I couldn't go for a walk (because the cords to the monitors were only about 10 feet long), I didn't really want to when I was well into active labor, so I parked my butt on a birth ball next to the bed and stayed there for several hours. Other women in my ICAN group have reported that they did have an internal monitor for whatever reason, and that it was actually less annoying than the strapped on ones because it didn't keep slipping out of place. Either way, if ANYONE ever even MENTIONED the possibility of a c-section because they were worried about the baby I would 100% ask for an internal monitor to confirm that whatever they were seeing was, in fact, real.

: ALL of that!

 

[mamatolevi]

It does't matter what their policy is. You can say NO to all of it. They will fight you on some of it and you likely will need to have your husband say it, too. Ultimately they cannot do anytyhing to you without your consent.