Continuous fetal monitoring?

jmetzler05 · October 2012

I was just told I'll be required to have CFM for my planned VBAC. With my first, I had CFM due to low fluid level and concerns for DS heart rate. I was unprepared for how much it interfered with my labor, as certain movements would cause a disruption and I was stressed out that if I didn't make sure it stayed connected they would just do a c-section.

Does anyone have any advice for getting around that requirment, like asking for 20 min every hour instead? I think this time I will talk to the nurses sooner and make sure if it disconnects briefly but repeatedly it won't increase my chance for c-section...just so I can feel less anxious about that.

Was anyone able to still go in the tub with monitors on? The nurse I asked at the hospital tour said I could, but didn't seem too sure so I'm going to be asking again.

hailyf · October 2012

Most places are going to make you have CFM if you are attempting a VBAC. Good news is, most women are successful. If it is a telemetry monitoring system, you can totally get in the tub with them on. GL mama.

sbevmc09 · October 2012

My MW is also requesting CFM as I'm a VBAC. However, it will be a telemetry monitoring system like PP mentioned so I'm not relegated to the bed and I will be able to be in the water with it.

On one hand I know the risks of CFM, on the other hand I recognize that they're wanting to keep a closer eye on VBACs. Additionally, I actually feel like I'd rather have the CFM done this way instead of having to be stuck in a bed for 20mins every hour hooked up to the usual monitoring. Best case scenario would certainly be if they could just check in as they wanted with a handheld doppler, but that's not an option to me at this time.

katsue0xo · October 2012

"I do not consent" and talk to your doc. Make sure he/she is on board. By using informed consent you are saying that you are educated on all of the"risks" and choose not to have that particular procedure done on you. Just labor at home as long as you possibly can- right till the very end. Also, refer them to ACOG's stance on the issue:

https://www.vbac.com/acogs-revised-vbac-guidelines/

The risk of uterine rupture with one prior low-transverse uterine scar is low, 0.5% to 0.9%.
About 60 to 80 percent of women who labor after a prior cesarean have a VBAC.
Most women with one prior cesarean with a low-transverse uterine scar should be counseled about VBAC and offered a trial of labor.
Women with a twin pregnancy, an anticipated big baby, with two prior cesareans, and women who do not go into labor at term can still plan a VBAC.
With a breech, women can choose to have an external cephalic version (ECV) after the 37th week, an effective procedure that may turn a breech into a head-down position.
Care providers should discuss the risks and benefits of VBAC and routine repeat cesarean with their patients early in pregnancy and document it in their medical record.
The ultimate decision to plan a VBAC or to have a routine repeat cesarean should be made by the patient in consultation with her provider.
Providers or hospitals who cannot or will not provide care for women who want to labor for a VBAC should refer women to VBAC supportive physicians and maternity centers.
Women can request an epidural for pain relief in labor

amandaleigh1 · October 2012

I had to have CFM due to being induced. I used the telemetry type of monitors in the tub. I honestly preferred having the telemetry on all the time to having to get up and get monitored every 20 minutes-- I was in the tub for 5 hours and made it thru transition in there. The monitors stayed in place pretty well on me, so they did not have to mess with me much. At one point, they did hook me up to IV fluids because they though the baby was too hot from the water, but that was temporary and I did not care much since I did not have to get out of the tub.

nosoup4u · October 2012

Definitely find out and/or request the have a set of telemetry monitors. I labored with CFM in a tub during my first labor bc they had telemetry units.

CFM is standard in hospital VBACs, you can ask to sign a AMA, but that could put you in a hostile environment. You might want to ask this on the VBAC board also, because someone might have more info about not having CFM during a VBAC.

Your other options are to show up pushing, which I ended up doing. But they still strapped that monitor to me (at least, the part that tracked DS's heart), and jabbed me with an IV. Sigh. You could also take a LOT of bathroom breaks.

Talk to your provider about your concerns about moving around in labor.

hth and good luck!

disneycrazy2011 · October 2012

where I live once you walk through the hospital doors consent automatic because you choose to come to the hospital, there is NO cosent form for what is anything that is standard. The only consent forms that are signed are for surgery, blood transfusion, DNR's and anesthesia (only general and epidural/spinal or some form of regional block), not local like for a tear during delivery or IV sedation like Stadol or Nubain. Also if you sign anything involving AMA for yourself you MUST LEAVE, once you sign AMA anything the hospital will no longer provide ANY care to you. If you sign AMA anything for your baby, refusal of vit K, or the eye ointment, refusal of formula if a medical need for it, take your baby home before PEDS s gives an actual discharge order, ect,children and youth will be notified at once and you will now have an open case. So make sure you check out exactly what AMA is for your particular hospital and what happens if you refuse things because every hospital and state is different.

I dont mean this to scare you but so you are fully aware of your hospitals/states laws and policies. It may seem simple to say " I do not consent" but everyone should know all things that can happen.

Good luck with you VBAC!!!! I hope you have a wonderful birth experience with no complications.

nosoup4u · October 2012

disneycrazy2011:
where I live once you walk through the hospital doors consent automatic because you choose to come to the hospital, there is NO cosent form for what is anything that is standard. The only consent forms that are signed are for surgery, blood transfusion, DNR's and anesthesia (only general and epidural/spinal or some form of regional block), not local like for a tear during delivery or IV sedation like Stadol or Nubain. Also if you sign anything involving AMA for yourself you MUST LEAVE, once you sign AMA anything the hospital will no longer provide ANY care to you. If you sign AMA anything for your baby, refusal of vit K, or the eye ointment, refusal of formula if a medical need for it, take your baby home before PEDS s gives an actual discharge order, ect,children and youth will be notified at once and you will now have an open case. So make sure you check out exactly what AMA is for your particular hospital and what happens if you refuse things because every hospital and state is different.

I dont mean this to scare you but so you are fully aware of your hospitals/states laws and policies. It may seem simple to say " I do not consent" but everyone should know all things that can happen.

Good luck with you VBAC!!!! I hope you have a wonderful birth experience with no complications.

Really?

I'm pretty sure hospitals can't kick women out if they're labor. Do you have a link that fully cites this as your hospital's policy?

I've refused various standard newborn procedures and DCFS was never called. With my older son, we refused to let them put a feeding tube in him, and no one was called.

littlemac1117 · October 2012

disneycrazy2011:

I dont mean this to scare you but so you are fully aware of your hospitals/states laws and policies. It may seem simple to say " I do not consent" but everyone should know all things that can happen.

Uhh....no. There may not be consent forms for every little thing, but..no. If you say "I do not consent to this", they cannot do whatever it is to you. If they do, say, insert an IV or catheter after you have refused your consent, they can be charged with assault/battery. I think you should educate yourself further on your rights as a patient.

OP, FWIW I am also a VBAC patient and my hospital has telemetry monitors that can go in the tub (thank goodness!!). Like other PPs said, the constant telemetry monitoring sounds better to me than having to be in the bed for 20 minutes every hour. Good luck to you with your VBAC! I wish you an easy successful labor

thetwistedwillow · October 2012

Home birth. ;-)

disneycrazy2011 · October 2012

Actually the doctors do have every right to refuse to treat you if you will not accept the treatment/interventions they recommend and that you have to sign out of the hospital against medical advice and are free to go home or to another hosptial if you do not like the care being offered.

I never said that a nurse or doctor would continue to do a procedure if you refuse because a pt can try to sue for assult/battery but they have every right to have you sign a refusal form ( so you cant sue when something bad happens to you and or your baby because you refused certain things) and refuse to take care of you because you are going against medical advice.

Hospital policies are not on the public website, if a pt wants them they can be printed off for them at their OB appointments because you can only access them as an employee.

It may depend on the state, but the peds has every right to call C&Y as they see fit. It might depend on the hospital/ped/and state you live in

jmetzler05 · October 2012

Thanks ladies, I hadn't thought about those 20 minutes NOT being telemetry and that would definitely be worse to be stuck in bed. Glad to hear some positives that many of you could labor in the tub, etc. I'm trying a new midwife practice and hospital, and I'm more comfortable talking to them, asking questions, and overall I trust them to be on my side with wanting a VBAC so that should help.

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