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Discussion Starter · #1 ·
Hi all! I'm new to these boards. I had my first baby in 1991 as a c-section. Then in 2004, I had a successful VBAC. I'm pregnant and due 12/2/06 and hoping again for another VBAC. I had a doula last time and also this time as well.

My question pertains to hospital policies regarding wearing the stupid monitoring belt, sitting in the tub, etc. I refuse to have a home birth because my VBAC daughter was born not breathing and thank the lord we were in a hospital as they were able to resuscitate her (although it took almost a minute with tubing, etc.). Also, because of the c-section eons ago, I would like to be somewhat monitored in case of emergency.

We live in Seattle which I consider to be a pretty progressive state and I'm lucky that the hospital is not so pro-section. Anyway, I digress. Last time we went in 2004 (and I'm guessing things haven't changed much), they INSISTED that I have an IV. The reason given for that was my previous section and in case there was an emergency. Incidentally, the reason I had my c-section had nothing to do with failure to progress. They also insisted that I wear that darn monitoring belt to hear the fetal heartbeat although there was no indication baby was in distress or having any problems whatsoever. In fact even though she was born with the cord wrapped around her neck, they never once mentioned that her heartbeat had gone down. The belt wasn't working properly and the nurse had to keep fiddling with it and adjusting it constantly. It would then start beeping when it got off track. This continued for hours and hours while I was in serious labor and in pain - not wanting anyone to be fooling around with my midsection! It was more than irritating. I also vaguely remembering them telling me that I could only walk around for 1/2 hour at a time as I needed to come back then and get on the belt again. Seemed ridiculous to me at the time and I desperately NEEDED to walk.

In addition to this, they allowed me to get in the tub with the belts on, however, they refused to allow me to turn on the jets. Again, citing the previous c-section. Seemed a weird reason to me, but again, I'm not knowledgeable about these things that much. In all other areas, this hospital is the best hospital in Seattle for delivering babies. They do everything else that we want like provide squatting bars, keep baby with you at all times (the baby even wears a monitoring alarm belt on it's ankle so no one can take the baby!), etc. Not one person mentioned to me that maybe I would feel better with an epidural, they all read and stuck to my birth plan and in all other ways I had an excellent VBAC.

Any advice for these issues this time around? I do realize that I am the patient and have the ultimate say so in matters concerning my health and I can refuse to do anything I don't want to do. My doula even suggested that I have the IV for emergency cases. I think her exact words to me were she had never heard of the hospital allowing someone who had had a c-section to not have the IV. The most important thing to me this time around is the darn belt and sitting in the tub with the jets on. Is it really necessary to wear the monitoring belt the entire time you're in labor? What about the jets? Has anyone heard of this? Thanks!

Carrissa
 

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Quote:

Originally Posted by Carrissa
Is it really necessary to wear the monitoring belt the entire time you're in labor? What about the jets? Has anyone heard of this? Thanks!

Carrissa
I haven't heard of the monitor and the jacuzzi jets thing. Perhaps the vibration or something could interfere with the reading of the monitor?

BUT, it is not necessary to have the monitor the entire time that you're in labor...even though the nurses and doctors may tell you it is necessary. It hasn't even proven effective in improving fetal outcomes when studies are done on it's usage. Intermittent monitoring has proven to be just as effective as CEFM.

If you find yourself in the tub this time and want to turn the jets on, take the monitor belts off. You may have to fight them a little on this, but like you said you have rights and your right is to refuse anything that you don't want.

If you haven't already, I suggest reading The Thinking Woman's Guide to a Better Birth by Henci Goer. Excellent book and I especially love the part in the book about EFM. She doesn't bash anything, she has just gathered the facts and lays it out straight. She has info in there about IV's and such too. It's a really easy read, I'm not a big book reader myself but I enjoyed this one a lot.
 

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From my understanding, after researching the subject of uterine rupture, fetal brachycardia (slow heartbeat) is actually the best indicator of impending uterine rupture, not maternal pain. That's why they want to monitor you constantly. The jets might cause an issue with the monitoring; I don't know.

For me, when I finally went to the hospital with my VBA2C, it was a matter of attaining a happy medium between what I wanted and what would make them comfortable. To that end, I happily consented to the IV and the internal monitor. They weren't big issues to me, really, and it made the staff happy and more willing to work with me than they may have been otherwise.

What I would do is to pursue the one issue that I felt the most strongly about, and give in on the rest of it. Unfortunately, I don't have the technical knowledge or experience to answer the jets/monitor issue. You'd be well served to ask your doctor about it, or call someone in L&D for the info. Well-informed is well-armed, as they say.

Oh, & FTR, a midwife has resus equipment with her at a person's home.
 

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Hi! I just attempted vbac at Evergreen. I live in seattle, too. I assume you're talking about birthing at Evergreen.

So here's my experience that's relevant to your questions: I did have to wear the belts all the time, and hated them! They just felt too tight, and they were always messing with them. But they are telemetry belts, so you can walk all around the maternity center. They aren't connected to anything. So that's cool.

Also I was able to get in and out of the tub whenever I wanted and I could have the jets on. Funny, though, I almost never used them because I wanted quiet during contractions.

I did have to get a heploc. They were quite firm on this one, but you know, I really DO NOT remember it during labor at all. It didn't bother me in the least. And I did end up needing it, unfortunately... but that's all another story.

Hope this helps you. PM me if you want.
 

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I'm an L&D nurse in Seattle, and we do CEFM with VBACs (including me this October). The reason we will sometimes not use the jets is that they do interfere with the monitors. Showers don't, though, and we have a lot of moms who rent the big tubs, which are just fine with monitors.

We've been using big belly bands instead of the belts for about a month, and they work very well, especially with women who are bigger (they look like the belly bands you can get to hold up your prepreg pants unbuttoned, IYKWIM). Also, if you have a big old pair of maternity panties, that will help hold the monitors on.

Monitors have to be continuously watched anyway, so have your nurse turn off the "no signal" alarm. The purpose of an alarm is to say something's wrong, you know? Well, if you're WATCHING, you'll know, and no need for the alarm.
 

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Just a couple of things...

Carrissa said:
I refuse to have a home birth because my VBAC daughter was born not breathing and thank the lord we were in a hospital as they were able to resuscitate her (although it took almost a minute with tubing, etc.). Also, because of the c-section eons ago, I would like to be somewhat monitored in case of emergency.[\QUOTE]

Most, if not all, hb midwives are trained in resuscitation and carry oxygen, tubing to suction and revive a wee one who may need assistance in taking their first breath. Second, in this case, it's typically less of an emergency (emergent, not emergency) situation as the hb midwife will leave the unbilical cord still attached so the baby is still receiving oxygen from the mother - most hospitals cut/clamp the cord right away.

If you really and truly want to be monitored closely your best bet is still a midwife. Instead of being attached to a monitor and monitored (along with several other women) from the nurses' station you will have the undivided attention of your midwife (and most likely your midwife's assistance).

I just wanted to point out some misunderstandings as far as homebirth is concerned. What you've said is among a large body of misinformation out there that continues to perpetuate the myth that those who have a homebirth are risking the lives of themselves and their babies by not giving birth in the hospital. There are risks/dangers to hospital birth as well, just take a look at the 16 yr old who was killed at a hospital in Wisconsin this month when they gave her an epidural through her IV by mistake! I'm not saying this to say that you should have a homebirth - if you feel most comfortable in the hospital, by all means please labor/birth there. Your best bet at a successful VBAC is still where you feel most comfortable.

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Last time we went in 2004 (and I'm guessing things haven't changed much), they INSISTED that I have an IV. -snip- They also insisted that I wear that darn monitoring belt to hear the fetal heartbeat although there was no indication baby was in distress or having any problems whatsoever. In fact even though she was born with the cord wrapped around her neck, they never once mentioned that her heartbeat had gone down. The belt wasn't working properly and the nurse had to keep fiddling with it and adjusting it constantly.
You have the LEGAL right to refuse ANY medical intervention that you want to - PERIOD. If you don't want an IV or don't want CEFM, feel free to refuse - you have that right. Regardless of whatever statistics they want give you, it's your right. If you feel more comfortable with those types of interventions, then by all means accept them, but if you feel like they will be a distraction then feel free to tell them "NO!" as firmly as you wish!


I would strongly encourage you to get to know your legal rights as a pregnant woman before entering the hospital to give birth. You can find that information lots of places, but the easiest way to find it is to head on over to www.ican-online.org. There's TONS of information there, including stats related to the two items you have asked about. Feel free, to join the email list as well, if you'd like. It will feel a little bit like drinking from a fire hose, but if you'd like to see the other side of the coin or if you want to arm yourself with statistics - it's for you! :0)

Best of luck in having a memorable birthing experience, in a good way!
 

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Discussion Starter · #7 ·
First I would like to thank everyone who has replied thus far. For those who are in Seattle, it's not Evergreen that we are birthing at, but Swedish Hospital. I should have clarified this in the beginning.

Second, I don't know what CEFM stands for. Can someone please explain?

Third, to the L&D nurse who replied about the large belly belts - are they using those at Swedish now? I could walk around with mine without it being attached, however, mine was dysfunctioning and not working properly which caused all kinds of headaches for me and the nurses who were helping. I had to have it constantly fiddled with, it was not working the majority of the time I was there and they weren't able to get a replacement.

I was told that I could not get in the shower as a VBAC. I was also told that if I wasn't a VBAC I could turn on the jets. It had nothing to do with the monitor working or not with the jets on. It was simply because I was a VBAC. Has this procedure changed?

Fourth, thank you for the clarification - it was a hep loc -which then turned into an IV because they started pushing pitocin. I have had 2 LEEPs on my cervix in the past and unbeknownst to the interns, the scar tissue on my cervix was preventing me from dilating. At 30 + hours of labor, my dilation was still at zero. Thus, the push for pitocin about 15 hours into it and still nothing. FINALLY my OB examined me and then said she knew what was going on. Suffice it to say, I was extremely pissed that I had to go through all that labor (and I would say hard labor) with Pitocin and no one could figure out it was a scar tissue thing. They broke open the scar tissue and I immediately dilated from 0-4 cm. and within one hour had pushed the baby out. Needless to say, I will make sure this doesn't happen to me again.

I will definitely check out the ican website. I am an attorney (now a SAHM) and feel very comfortable with my legal rights and getting what I want and what is best for myself and the baby.

Also, the nurses were almost constantly there next to me reading the monitor. They almost never stepped out and were reading them very carefully the entire time. Perhaps that is another VBAC issue?

I'm wondering if there will be any leniency this time around considering a) my c-section was 15 years ago and b) I already had one successful VBAC in 2004. Anyone know this?

Thanks much!
Carrissa
 

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You really want to have a VBAC? At Swedish? First Hill or Ballard campus?

No offense, but Swedish is notorious for their non-VBAC, non-natural-birth-friendly practices. It's not for nothing that their section rate approaches 40%, and the vast majority of laboring women have epidurals.

ask if they can show you ANY reason why the jets on the tub would in any way affect your scar. They can't, because it doesn't.

Why can't you shower as a VBAC? Do they have special scar-dissolving water?

Swedish has an entire c-section TEAM, for pete's sake, that does four scheduled sections every weekday. You will probably be "allowed" to labor, but having worked in a very similar hospital outside Seattle, you will make the nurses and the on-call doc as nervous as hell. We used to have to put our VBAC patients in a room directly across from the OR. It was saved just for them.

Look, I don't want to poo all over Swedish (okay, maybe a little bit). But their practices are in general not supportive of VBAC. Question everything. Ask for reliable studies showing you reasons why you can't have a shower/use the jets/not eating in labor/etc., etc. Get a doula, if you don't have one.

I believe in hospital VBACs, and I will be choosing to have continuous electronic fetal monitoring (CEFM) for myself, as well as a saline lock (not an IV running -- no reason to have that). But there's what I see as reasonable caution and there are ridiculous, unsubstantiated rules that have no scientific basis.

As far as the age of your scar -- it makes no difference. That you've had a successful VBAC implies a strong scar, but most hospitals just have a universal VBAC (actually, they call it TOLAC) protocol, and your specifics don't matter.

About the belly bands -- you should be able to just use a regular belly band (I think they're called Bella Bands -- you can get them online or at Village Maternity) -- just remember to grab it before you go because it makes your postpartum pants fit better. Also, make sure to ask for a telemetry unit, because I don't think Swedish has them for every labor room.

GOOD LUCK!
 

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CEFM (Continuous electronic foetal monitoring) is NOT shown to improve outcomes but it does increase c-sec rates. With any birth, and your birth is *just* a birth even though you had surgery once upon a time, the more gear attached to your labouring body the less likelihood you have of pushing out a baby in a healthy way. That goes for first time mamas and those having subsequent babies and those who've had previous surgery. Try these for some facts and tell the hospital a big no to their dangerous and unfounded notions.

http://www.joyousbirth.info/articles/vbacjustbirth.html
http://www.joyousbirth.info/articles...tyofscars.html

http://www.gentlebirth.org/archives/vbacjjg.html
Read the rest at the link.

Quote:
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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I would encourage you to check into the midwives at the Center for Women's Health at Evergreen... they are awesome, and have about a 80-85% vbac success rate. They were SO supportive of vbac, I could be in the tub w/ the jets on, in the shower, etc. Nobody ever mentioned epidural to me, I labored all naturally for 20+ hours. I was one of the few that did not have a successful vbac, but my situation was unique, I believe, and the important thing was I still felt supported and believed in. My midwife was truly awesome and so were the nurses.

Just a plug for them
, as I have heard similar things about Swedish as Maxmama.
 

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Quote:

Originally Posted by AugustineM
I would encourage you to check into the midwives at the Center for Women's Health at Evergreen... they are awesome, and have about a 80-85% vbac success rate. They were SO supportive of vbac, I could be in the tub w/ the jets on, in the shower, etc. Nobody ever mentioned epidural to me, I labored all naturally for 20+ hours. I was one of the few that did not have a successful vbac, but my situation was unique, I believe, and the important thing was I still felt supported and believed in. My midwife was truly awesome and so were the nurses.

Just a plug for them
, as I have heard similar things about Swedish as Maxmama.
Group Health Central has the same VBAC success rate, and very very cool midwives and OBs.
 

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You could always arrive at the hospital really late in labor, like when you are pushing! You might avoid all the monitoring, IV, etc and just push. It might seem strange, but if there isn't time , they won't focus on all those extras. Also, talk to your doc about a plan of monitoring. You do not need continuous monitoring.
 

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Originally Posted by Mama Coltrane
You could always arrive at the hospital really late in labor, like when you are pushing! You might avoid all the monitoring, IV, etc and just push. It might seem strange, but if there isn't time , they won't focus on all those extras. Also, talk to your doc about a plan of monitoring. You do not need continuous monitoring.
Eh, don't bet the farm on it. At Swedish they'll try to shove the IV in as the head comes out if they have to, and nobody gets out of there without monitoring (I'm not entirely sure they do intermittent auscultation at all).
 

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I was hooked up to a monitor most of the time. However, the cords were about 6 feet long, and they disconnected from the machine easily so I could go to the bathroom, which I did as often as possible. I spent quite a bit of time sitting on a birthing ball beside the bed playing hangman with the doula. It wasn't so bad.

If you want to be able to get in the water, you could hang out at home for a while in the tub before you go in.

My OB said that she had seen a rupture where the only indication of the rupture was the fetal heart rate going down, so it seems to be pretty important.
 

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I am appalled that they gave you pitocin. Pitocin has ruptured unscared uteri. I would not put myself under the care of doctors that think thats ok.
I would question your doc on this.

I agree with the PP about reading "A thinking womans guide to a better birth" and try "Silent knife" and also "VBAC Compainion".

I have had 2 natural non intervention VBACs. One in a hospital with intermitant monitoring and one in a birth center with a midwife and I must say I prefered the latter. I also showered and sat in a tub with jets for both births.
Good luck!
 

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Quote:

Originally Posted by AngelaB
I am appalled that they gave you pitocin. Pitocin has ruptured unscared uteri. I would not put myself under the care of doctors that think thats ok.
I would question your doc on this.
I'm actually fine with pitocin for augmentation and even for induction. It raises the rate of UR from 5/1000 to 8/1000 (per my perinate; the studies in the literature correlate pretty well with this from what I've seen). In terms of absolute numbers, that's still extraordinarily small.

I'd MUCH rather take the slightly increased risk of rupture with pit over the known risks of a section.
 

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I was given a very low dose of pitocin during my vbac attempt. My midwives said they wouldn't induce with pitocin but would give a very little bit to augment labor since my water had broken and I was on the clock.
 

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How about the snowball effect of interventions introduced with pitocin. (even though the docs wont admit to this)Obviously you would have to have an IV with confines you to bed on your back, with monitors and no fluid or food intake. Dont you think that that alone ups your risk of c-section? YOu will be put on a clock, the docs clock not the babies, which also raises your risk of c-section.
When you give birth on your back your pelvis is up to 2 cm smaller then if you were in an uprigh position. So what risks do pitocin really have if you consider the big picture.
I had 40 hours of labor, left the hospital AMA to get off their clock and came back a day later to push for 2 hours. He was big so he came out slow!

AugustineM,
I had PROM and I did nipple stim for about 15 hours to get things going and it worked. I had to continually try to keep contrax going, but my midwife never suggested pit only antibiotics after 24 hours. (with my 3rd ds, my second vbac)
~Angela~
 

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Yes, I agree, pitocin is not ideal at all, that's for sure! I don't know if I would agree to it again -- I was just letting the OP know what happened to me. It often does have negative consequences, I think.
 

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Originally Posted by AngelaB
How about the snowball effect of interventions introduced with pitocin. (even though the docs wont admit to this)Obviously you would have to have an IV with confines you to bed on your back, with monitors and no fluid or food intake. Dont you think that that alone ups your risk of c-section? YOu will be put on a clock, the docs clock not the babies, which also raises your risk of c-section.
When you give birth on your back your pelvis is up to 2 cm smaller then if you were in an uprigh position. So what risks do pitocin really have if you consider the big picture.
I
Depends on where you are. I'm very tired of pit being universally demonized. it's a TOOL, and like any tool, can be misused.

On my unit, we do not restrict women on pit to bed. We do not require them to be on their backs. We do not deny them food or fluid. We also do not put them on a clock. We frequently have three or four-day inductions for maternal or fetal indicators, including PROM (our current record is over 100 hours ruptured, and she had a beautiful vaginal birth).

Please don't confuse hospital policies with issues specifically related to a medication. They're not the same. Pit can be and is used very effectively to prevent section on our unit.
 
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