Fetal Monitoring

smilelari

If I am giving birth in a hospital is there any chance that I'm going to convince them to monitor via doppler instead of EFM?

I know this probably varies by hospital, but am I right in thinking chances are pretty slim?

ToledoDeux

I forget - are you having a MW?  If so, there is a chance, since you will see her much more often during labor than you would an OB. OBs leave the monitoring to nurses, and I can't see them agreeing to a doppler over the convenient hands-off method of EFM.

This answer is to make me feel better, too - since I haven't asked my MW about this yet. 

smilelari

Nope.  We're having an OB as there are no MW associated with the hospital we prefer

angluvsammon

It will depend on what other interventions you have. If you are induced, have Pitocin to help the labor along or any type of pain meds, you will have a EFM. If you are able to avoid those things, you should be able to convince them to not let you have the EFM. Will you have a doula? A doula would be able to help advocate for you. Honestly, with my first, the IV (for antibiotics for GBS) and the EFM were the worst part- they made things much more uncomfortable.

smilelari

angluvsammon:

It will depend on what other interventions you have. If you are induced, have Pitocin to help the labor along or any type of pain meds, you will have a EFM. If you are able to avoid those things, you should be able to convince them to not let you have the EFM. Will you have a doula? A doula would be able to help advocate for you. Honestly, with my first, the IV (for antibiotics for GBS) and the EFM were the worst part- they made things much more uncomfortable.

Yep   I have a doula.  You have made me hopeful

high_hopes

It is typically hospital policy to use EFM (I'm a NICU nurse). I'd highly advise you to use the EFM....I've seen way too many asphyxiated (oxygen deprived) and therefore neurologically damaged babies as a result of parents refusing fetal monitoring. Obviously this is your decision, just please be informed!

::steps off soapbox::

Kathy02912

Why are you hoping to avoid EFM?

vthunstrom

For those that are interested in making an informed decision please do your research.  Don't assume something is just because the dr says so.

 https://www.childbirth.org/articles/efmfaq.html

"I just wanted to add that ACOG (the national organization for OB/GYN's in the US) has the official policy statement that intermittent fetal monitoring is just as safe and effective as continuous. Their recommendations are a 20 baseline strip, then once every 1/2 hour (for 60-120 seconds!) in first stage, and every 15 minutes in second stage, as long as everything looks normal."

Constant fetal monitoring exposes baby to yet more radiation and has historically increased c-section rate.

 

I would be surprised if an OB allowed but ask him/her. Remember they cannot MAKE you do anything.

high_hopes

vthunstrom:

For those that are interested in making an informed decision please do your research.  Don't assume something is just because the dr says so.

 https://www.childbirth.org/articles/efmfaq.html

"I just wanted to add that ACOG (the national organization for OB/GYN's in the US) has the official policy statement that intermittent fetal monitoring is just as safe and effective as continuous. Their recommendations are a 20 baseline strip, then once every 1/2 hour (for 60-120 seconds!) in first stage, and every 15 minutes in second stage, as long as everything looks normal."

Constant fetal monitoring exposes baby to yet more radiation and has historically increased c-section rate.

Huh....funny, because ALL of our moms at the hospital I work at (except the ones who refuse monitoring) have EFM...& we don't have a 100% c-section rate. I'm sorry if I'm not willing to take a risk that could potentially neurologically damage my child. Besides, there are many cases that need c-section intervention. Enough said - if you've seen what I've seen, you'd change your mind.

MAtoNC

High Hopes,

With regard to constant fetal monitoring (which I will have to be on if I am induced), can mom change position? Is she confined to the bed?

TwoBecomeOne2007

I guess I do not see the problem. Why would you NOT want a simple monitor to check the status of the life you have carried for 9 months? It is non invasive and just wraps around your stomach. Things can go wrong very quickly and this may catch it.  You can move around. They may let you take it off to get out of bed. The only one that is invasive is the internal fetal monitor (attached to baby's head) which also has its place in monitoring a woman in labor.

Also, there is no radiation in a EFM. It uses same technology as a doppler or us.

ToledoDeux

smilelari is not talking about EFM versus NO monitoring. 

Home births (which are very, very safe, contrary to what some would have you believe) use dopplers or even fetoscopes for intermittent fetal monitoring during birth.  Somehow home birth midwives have an excellent safety track record without seeing the need for overkill continual EFM.

Here are two great reasons to resist the use of continual (or any) EFM: it limits mobility, and it creates a "crisis" out of normal changes in fetal HR during labor - which can lead to other "emergency" interventions.

Mrs.tlcS

high_hopes:

vthunstrom:

For those that are interested in making an informed decision please do your research.  Don't assume something is just because the dr says so.

 https://www.childbirth.org/articles/efmfaq.html

"I just wanted to add that ACOG (the national organization for OB/GYN's in the US) has the official policy statement that intermittent fetal monitoring is just as safe and effective as continuous. Their recommendations are a 20 baseline strip, then once every 1/2 hour (for 60-120 seconds!) in first stage, and every 15 minutes in second stage, as long as everything looks normal."

Constant fetal monitoring exposes baby to yet more radiation and has historically increased c-section rate.

Huh....funny, because ALL of our moms at the hospital I work at (except the ones who refuse monitoring) have EFM...& we don't have a 100% c-section rate. I'm sorry if I'm not willing to take a risk that could potentially neurologically damage my child. Besides, there are many cases that need c-section intervention. Enough said - if you've seen what I've seen, you'd change your mind.

Who said a 100% c-section rate?  Going from 30% to 31% is an increased rate.  FWIW, evidence in the research suggests (over and over and over again) that use of continuous EFM, actually EFM in general, does not improve maternal or fetal outcomes when compared with auscultation.

I'm sorry if I'm not willing to take a risk that could potentially neurologically damage my child.

As far as that statement goes, well.... you're just a piece of work.  You go ahead and have your picture perfect birth where all your interventions have zero risk.  I hope it works out for you - honestly, I do.  But I'm going to go ahead and think you're a nutbag.  

 

smilelari

Toledo is right on. Studies have shown that monitoring with doppler is just as effective as EFM and in fact reduces the number of unnecessary c-sections.  In the case of someone hoping to go drug free mobility becomes very important and EFM does limit mobility.  If you read very many birth stories, people will describe the 20 minutes of fetal monitoring as agony as compared to the other 40 minutes (in the case of intermittent EFM).  Considering that it's just as effective, doesn't reduce mobility and lessens my risk of an unnecessary cesarean, I would prefer the doppler over EFM

Mrs.tlcS

TwoBecomeOne2007:

I guess I do not see the problem. Why would you NOT want a simple monitor to check the status of the life you have carried for 9 months? It is non invasive and just wraps around your stomach. Things can go wrong very quickly and this may catch it.  You can move around. They may let you take it off to get out of bed. The only one that is invasive is the internal fetal monitor (attached to baby's head) which also has its place in monitoring a woman in labor.

Also, there is no radiation in a EFM. It uses same technology as a doppler or us.

Those monitors slip.  The baby moves.  They don't accurately represent what's happening in labor.  They don't improve outcomes (either fetal or maternal).  For low risk labors, intermittent monitoring (whether EFM or auscultation) are equally effective at catching potential problems.  You can move around IF they have telemetric EFM, OR if you're being monitored intermittently.  If they don't have telemetry, you could be confined to bed, either continuously or for short periods of time.

 

smilelari

Mrs.tlcS:

TwoBecomeOne2007:

I guess I do not see the problem. Why would you NOT want a simple monitor to check the status of the life you have carried for 9 months? It is non invasive and just wraps around your stomach. Things can go wrong very quickly and this may catch it.  You can move around. They may let you take it off to get out of bed. The only one that is invasive is the internal fetal monitor (attached to baby's head) which also has its place in monitoring a woman in labor.

Also, there is no radiation in a EFM. It uses same technology as a doppler or us.

Those monitors slip.  The baby moves.  They don't accurately represent what's happening in labor.  They don't improve outcomes (either fetal or maternal).  For low risk labors, intermittent monitoring (whether EFM or auscultation) are equally effective at catching potential problems.  You can move around IF they have telemetric EFM, OR if you're being monitored intermittently.  If they don't have telemetry, you could be confined to bed, either continuously or for short periods of time.

 

 

ToledoDeux

I will also add to the discussion that my hospital assured me last time, during my hospital tour, that they had telemetric EFM, which would assist me in staying mobile.  Lo and behold, these were not functioning when I went into labor. 

I flat-out refused to be on continuous EFM - and since I was delivering with a midwife, it was relatively easy for them to agree to intermittent.  Even that was sometimes agony.  Why should it take 20 minutes on a monitor to get a fetal HR?  Those are 20 minutes that you are pretty much immobile, because the damn things slip so easily even with no movement.  I was actually scolded by a nurse for moving during a contraction, and causing it to slip. 

I fully understand the desire to have monitoring via doppler instead - the difference between EFM and doppler is not a safety concern, it's one of convenience for the staff.  When they have a lot of patients, I can understand the efficiency of monitoring on EFM from the nursing station, rather than hand-held doppler use - but I'm the one in labor, and I'm only concerned about advocating for me, not the staff.

Mrs.tlcS

Toledo..... Love.  That is all.

ToledoDeux

Mrs.tlcS:

Toledo..... Love.  That is all.

 

TwoBecomeOne2007

but if you think hosptial staffing allows for nurses to doppler the HB every 5-10 minutes you are very wrong.

Do what you wish.

ktang

I think people are mixing up two concepts: 1) continuous monitoring vs. intermittent FHR auscultation, and 2) the MEANS of monitoring (EFM vs. doppler).  The EFM *IS* a dopppler, just attached to a strap. 

People are right that the data shows that continuous monitoring has not shown any differences in cerebral palsy, or other major outcomes (some difference in seizure rates, but these are usually not long-term problems).  There is an increased rate of C/S.  So *LOW-RISK* labors are fine w/ intermittent auscultation, after an initial 20 minute strip. 

How the intermittent auscultation is done is not a big deal - we use the EFM to do the intermittent auscultation, instead of a hand-held doppler, since the EFM's are in each room, and we only have one hand-held doppler.  No difference!  You are not strapped down, the RN listens for a minute, you're free to move.  

I am unfortunately in the position, like the previous poster who is a NICU nurse, of seeing REALLY bad outcomes including fetal deaths and cerebral palsy, from women who were undergoing intermittent auscultation, which looked totally fine, and the baby come out terribly.  I've also seen babies on continuous monitoring with sudden catastrophic decelerations, and bad outcomes, that wouldn't have been picked up if you were only monitoring every hour. These are VERY rare, and obviously the exception to the rule.  But I think once you've seen something like that, you never forget it - and you will take any sort of monitoring, intervention, etc to prevent it, including having a C/S if medically necessary. 

courtney_lynne

Personal ex. here.

 With my son, I was put on Pitocin b/c I wasn't progressing, well them they insisted I had to be on a EFM. Well I was dialating but my son (my first) wasn't dropping (well duh! I was flat on my back!). My mom (an RN) requested a Telemetry monitor, and I got up and walked around, I had him less then a hour later. I would suggest from personal ex. that you do either intermittent or tele monitoring. Studies show both are fine, and it is much more comfortable to be up and walking around during a drug free labour then laying down.

 

Courtney

ToledoDeux

ktang:

I am unfortunately in the position, like the previous poster who is a NICU nurse, of seeing REALLY bad outcomes including fetal deaths and cerebral palsy, from women who were undergoing intermittent auscultation, which looked totally fine, and the baby come out terribly.  I've also seen babies on continuous monitoring with sudden catastrophic decelerations, and bad outcomes, that wouldn't have been picked up if you were only monitoring every hour. These are VERY rare, and obviously the exception to the rule.  But I think once you've seen something like that, you never forget it - and you will take any sort of monitoring, intervention, etc to prevent it, including having a C/S if medically necessary. 

I wonder how many of these dangerous decels happened in labors that were augmentation and/or epi-free, though.  

It's odd that medical professionals on here never recommend against interventions that have been shown to cause more fetal distress, such as routine pit use.  But any intervention that MAY prevent a bad outcome in a very rare instance (regardless of its own inherent risks) is seen as somehow essential - and anyone who resists it in their own labor is implied to be selfish or cavalier.

Mrs.tlcS

ToledoDeux:

I wonder how many of these dangerous decels happened in labors that were augmentation and/or epi-free, though.  

It's odd that medical professionals on here never recommend against interventions that have been shown to cause more fetal distress, such as routine pit use.  But any intervention that MAY prevent a bad outcome in a very rare instance (regardless of its own inherent risks) is seen as somehow essential - and anyone who resists it in their own labor is implied to be selfish or cavalier.

Because, Silly Goose, it just doesn't happen.  Don't you know that no practitioner would ever try to stress a labor? 

And, I would like to clarify something from earlier in the post.  I don't think interventions and people who choose to take interventions are nutbags (I had a highly interventive birth, though I guess that doesn't prove anything ).  I think that anyone who thinks that a mother would intentionally endanger the life or well-being (either by accepting or refusing interventions) is just all kinds of wrong. 

smilelari

TwoBecomeOne2007:

but if you think hosptial staffing allows for nurses to doppler the HB every 5-10 minutes you are very wrong.

Do what you wish.

Why would they be checking every 5-10 minutes?

The standard for intermittent monitoring is once every hour

And, of course, if I were on pitocin for any medically necessary reason the whole game changes.  I am assuming a normal, non-augmented labor.  Of course, the truly medically necessary reasons for pitocin are few and far between when compared to how often it's actually used