Internal monitoring?

angelina477

I had the big discussion this past apt with the OB about their "rules" for my VBAC. One concern I had was they do internal monitoring to detect uterine rupture. I am concerned that I will not be able to move around as I need to to labor. Anyone experience this "rule" or have it done?

Geekchick921

I have never heard that before.  I find it very odd that they'd go right to internal monitoring.  I was under the impression that is to be used only when you can't get a good reading with the external leads.  They also have to break your water for an internal monitor.  If the baby is still high, there's a greater risk for a cord prolapse, which you land you right in the OR.  Even if the baby's low, if you're anything like me it'll make your contractions instantly worse, and I personally wouldn't want my water broken too early for that reason, either.

Now, continuous monitoring is pretty standard for hospital VBACS, as annoying as it is, because fetal distress is the most reliable sign of uterine rupture, but I don't know why they'd go straight to the internal monitor.  

chicsub

I've heard of docs doing that, but honestly they were the high-intervention ones that weren't truly supportive of VBACs.  I had continuous monitoring with telemetry, but internal monitoring was never mentioned.

iris427

I would refuse that.  There was this idea that using internal monitors to detect pressure inside the uterus could point to early signs of a rupture, but studies showed it didn't actually work.  Geekchick pointed out all the downsides of internal monitoring--they have to break your water which increases your risk of cord prolapse and infection, plus it puts you on the clock.  If you don't deliver in time, you'll have another c/s simply because they broke your water before your body was ready.

Continuous external monitoring is standard for VBAC although some people have intermittent monitoring done.

What other rules does your OB have?  Do you know what their VBAC success rates and overall c/s rates are?  When I hear about unnecessary requirements placed on VBAC moms, it makes me wonder how open to VBAC the doctor really is.

 

kcvasquez

From doing a lot of readings and research on VBACs I have read that internal monitoring is almost a way to set a woman up for failure. Like a PP said they have to rupture your membranes, and depending on how dilated they are this will also put you on a "clock." There are other many things that will tell you or a doctor that uterine rupture has happened besides an internal monitor. Just remember while she says this is a requirement they cannot physically put the monitor in you or force you to have a c-section, especially if you're there in active labor. You have the right to refuse any and all things they tell you that you "have" to have. 

manbearpig31610

Personally, I don't mind the internal monitor. I absolutely would not let them break my water for that purpose but if it was already broken I don't have a problem with it. With my induction with DD#1 I had to have constant monitoring because of the pitocin and they eventually had to place an internal monitor because I was squirming and moving around so much the belts kept shifting and we couldn't keep LO on the regular monitor. Plus, I hated the feeling of the belts on my belly. It just really bugged me, while I was in labor. When I'm dealing with that much pain I have to be able to move around and while the internal monitor was akward at first it doesn't restrict your movement nearly as much as those stupid belts. I could actually get up, off my back, and that made such a difference for me. I agree it's not always ideal to have an internal monitor placed but I think it depends on the circumstances.

MeghanF13

I was told that I wouldn't be able to walk around because they would need to monitor for uterine rupture. They didn't say anything about it being internal monitoring, but made it clear I would be in the bed hooked up to monitors.

angelina477

Another doctor is not an option due to financial reasons. I am going to the clinic at our hospital. I studied hypnobirthing and am very familiar with all their bs rules and how they basically channel you to a c/s.  I just am so shocked that for a 1% chance of something happening they have so many rules. Just curious how widespread this practice is.  

iris427

manbearpig31610:

Personally, I don't mind the internal monitor. I absolutely would not let them break my water for that purpose but if it was already broken I don't have a problem with it. With my induction with DD#1 I had to have constant monitoring because of the pitocin and they eventually had to place an internal monitor because I was squirming and moving around so much the belts kept shifting and we couldn't keep LO on the regular monitor. Plus, I hated the feeling of the belts on my belly. It just really bugged me, while I was in labor. When I'm dealing with that much pain I have to be able to move around and while the internal monitor was akward at first it doesn't restrict your movement nearly as much as those stupid belts. I could actually get up, off my back, and that made such a difference for me. I agree it's not always ideal to have an internal monitor placed but I think it depends on the circumstances.

It's one thing to have an internal monitor under specific circumstances.  It's another thing to require them of all VBAC moms given 1) the downsides that have been pointed out and 2) there is no evidence that they are better at detecting a UR than the less invasive external monitors. 

catrinawaves

I had a similar conversation with an OB recently-I normally see only the MWs in the practice, but since I'm a VBAC they also wanted me to meet with the docs on occasion.

This particular OB placed a very strong emphasis on the possibility of an internal monitor, but didn't say it was a requirement. The MWs had previously told me that I would have to be monitored, but said it would be external and with a telemetric unit so I could still be mobile. When I met with a MW again for my last appt, she reiterated that, but did say that it might be possible for the internal monitor to be hooked up to the telemetry unit so I could still walk around. Being able to be mobile is very important to me, so this was a sticking point.

It doesn't surprise me how much of an emphasis they place on the possibility of a uterine rupture, since I work in the legal field, but I am always surprised that not once has anyone ever mentioned the risks of a RCS....

nosoup4u

MeghanF13:

I was told that I wouldn't be able to walk around because they would need to monitor for uterine rupture. They didn't say anything about it being internal monitoring, but made it clear I would be in the bed hooked up to monitors.

Ask if they have telemetry units. And even if they don't and you have continuous monitoring, that really doesn't mean you have to be in bed while you labor.

catrinawaves:

It doesn't surprise me how much of an emphasis they place on the possibility of a uterine rupture, since I work in the legal field, but I am always surprised that not once has anyone ever mentioned the risks of a RCS....

No sh!te! VBAC policies are pretty much there to make having a VBAC as difficult as possible...

angelina477:

Another doctor is not an option due to financial reasons. I am going to the clinic at our hospital. I studied hypnobirthing and am very familiar with all their bs rules and how they basically channel you to a c/s.  I just am so shocked that for a 1% chance of something happening they have so many rules. Just curious how widespread this practice is.  

I think it just depends on where in the country you are. Regions with high c-section rates have low VBAC, and vice versa. The hospital and MW group I went to is known for supporting VBAC, and my only restrictions were continuous external monitoring, and a hep/saline lock.

You could always look into finding a doula, or better yet a montrice, who can be with you at home, and labor at home until you are really far in labor. I think I'd flat-out refuse the internal monitoring, and sign an AMA form if they pushed it. External monitoring is a totally reasonable request on your part.