Internal EFM

FrecklesInside · November 2012

Hi all, not sure if this is the right place to post, but want to get some opinions from some bumpies on this matter and thought this board would be a good place to go.

My baby and I receive care through a women's medical group (all women practice) that has OBs and midwives. I see both the OBs and the midwives even though I've asked to have a midwife for my birth. The birth will be at a hospital. The situation isn't ideal for my husband and me, but it is what worked for us for this pregnancy.

I asked the midwife I saw after my a/s this past week a series of questions that I've been waiting to ask until we were a bit farther along. One of the questions was about electronic fetal monitoring. She told me that they insert a monitor into the baby's scalp and assured me this was a good standard practice. She didn't give me any other information. I'm reading varying literature right now on natural birth and went home and read up on different types of EFM. My gut feeling is that unless the baby or I are at risk, EFM is highly unnecessary, and that while internal monitoring can be more effective than external monitoring, it restricts you to the bed. My midwife reassured me that I didn't have to stay in the bed and that even though I am giving birth in a hospital (not ideal for me!), my practice encourages natural birthing, so on and so forth. This practice of internal EFM does NOT seem to go along with the rest of their philosophy and MY philosophy on birth.

What do you all think? I'm doubting there is anything I can do about this if it is standard practice at the hospital I'll be giving birth in, but I would like to argue about the necessity of it and refuse it as best as I can...

Sorry for the long post and thanks ladies!

sbevmc09 · November 2012

First, I would definitely prefer an external monitor to an internal one as a matter of practice. Obviously a situation may arise where an internal is better, but I wouldn't be comfortable going to that right away.

Second, I was unaware that you can move around freely with an internal monitor. I could be wrong about that, but I've never heard of it.

Third, you're right, standard continuous EFM is contraindicated and it's not something you have to submit to.

You don't have to submit to ANY procedures that you're uncomfortable with. This is YOUR body and YOUR birth and you need to be with a provider whose opinion you can trust so you're not fighting them the whole time.

Honestly, I would be a little concerned if this was their stance. Also, I would be careful about assuming that a MW within the practice is going to be more natural birth friendly than any of the OBs. Just because they have CNM after their name doesn't mean they subscribe to the traditional midwifery model of care.

How have they answered your other questions (or have you asked others)? For example, things like, what will they do if labor appears to stall? Will you be "on the clock" once your water breaks? Do they routinely practice AROM? Etc. There are other questions you can ask that will give you a clearer picture of just how supportive they are, but maybe you've already done this

bdutton0005 · November 2012

From what I've read they usually don't do this unless there is a reason as in they think the baby is having issues that the external monitor isn't picking up. Also as PP said I don't think you can get up if they have you hooked to this, with external they do have some wireless options.

I would ask about it again at your next appointment maybe she misunderstood what you were asking about.

tokenhoser · November 2012

Continuous, routine, internal EFM = dealbreaker for me. I'd find a new provider.

Take a look at the internal monitor... they screw it into your infant's scalp. It's pretty grotesque. It WILL restrict your movement, which is a problem if your goal is a med-free birth.

I would talk a bit more with them. Is this a hospital policy they will support you opting out of, or a practice policy that they won't happily change? If it is their policy, run. Actions speak longer than words about what their philosophy really is. EFM is not supported by studies to improve outcomes... in fact, exactly the opposite has been found.

oliversmommy32912 · November 2012

This would be a serious deal-breaker for me. If this is their standard practice then what other sorts of unnecessary interventions are their standard practice? I don't see how a cord dangling from your vagina wouldn't restrict your movements even if you are allowed out of bed. They also have to break your water to insert the monitor and they actually screw it into your baby's scalp. While I think internal monitoring is a wonderful thing for babies who need extra attention I absolutely do not think it should be the standard of care for every patient. This sends up major red flags for me. Sorry. I would find a new provider.

annabelle.27 · November 2012

Dealbreaker for sure.

sschwege · November 2012

tokenhoser:
Continuous, routine, internal EFM = dealbreaker for me. I'd find a new provider.
Take a look at the internal monitor... they screw it into your infant's scalp. It's pretty grotesque. It WILL restrict your movement, which is a problem if your goal is a med-free birth.
I would talk a bit more with them. Is this a hospital policy they will support you opting out of, or a practice policy that they won't happily change? If it is their policy, run. Actions speak longer than words about what their philosophy really is. EFM is not supported by studies to improve outcomes... in fact, exactly the opposite has been found.

All of this!

And as Oliversmom said, they will have to break your bag of water to do an internal monitor. Another problem in my mind!

AmyRI · November 2012

tokenhoser:

Continuous, routine, internal EFM = dealbreaker for me. I'd find a new provider.

Take a look at the internal monitor... they screw it into your infant's scalp. It's pretty grotesque. It WILL restrict your movement, which is a problem if your goal is a med-free birth.

I would talk a bit more with them. Is this a hospital policy they will support you opting out of, or a practice policy that they won't happily change? If it is their policy, run. Actions speak longer than words about what their philosophy really is. EFM is not supported by studies to improve outcomes... in fact, exactly the opposite has been found.

Ditto.

aylafsu88 · November 2012

tokenhoser:
Continuous, routine, internal EFM = dealbreaker for me. I'd find a new provider.
Take a look at the internal monitor... they screw it into your infant's scalp. It's pretty grotesque. It WILL restrict your movement, which is a problem if your goal is a med-free birth.
I would talk a bit more with them. Is this a hospital policy they will support you opting out of, or a practice policy that they won't happily change? If it is their policy, run. Actions speak longer than words about what their philosophy really is. EFM is not supported by studies to improve outcomes... in fact, exactly the opposite has been found.

Totally agree. We saw an internal FM in our Bradley classes and there is no way I would let them put that is my LOs head. From what I read they usually do EFM unless there is an issue or the external monitor isn't picking up LOs heartbeat. I would ask your midwife about this again as it seems contradictary to a natural non-invasive birth. If they require that you have an internal fetal monitor I would find another practice.

julyjennifer · November 2012

It's not clear to me whether what she told you was that they routinely do internal EFM for all births, or whether she described what internal EFM is when they do happen to do it. I'd be surprised if it was the routine practice, and like the others would dig further with them if that was the case.

At the hospital where I had #1, their protocol was to do internal EFM in certain circumstances, like when meconium was in the amniotic fluid (which was my case).

I still had a natural birth, but I was also fully dilated by that point so was only pushing by then which didn't require a ton of movement. But, when I was standing on the bed trying out the squat bar I did step on the wire and accidentally pull it out. Of the baby's scalp. I was like "ohhh, now my baby will have TWO holes in its head..." and my husband didn't understand what I was talking about because he didn't know how it worked. Sure enough, there were two little tiny scabs on my daughter's scalp after she was born. Anyway, sorry for the rambley story. I guess I wanted to say that you can still have a natural birth and move around with an internal monitor, but I think it would be harder if you had the internal monitor placed earlier in labor when you were trying to move around a lot.

Worth following up with your provider for more clarification, or taking it as a red flag if you already know how she meant it!

Jdunk2008 · December 2012

I'm a nurse at a large hospital in the Midwest. We only use internal fetal monitoring if we have issues picking up fetal heart rate. If you are a big gal, it is likely that you will end up with this because of the excess adipose tissue around your abdomen making it hard for the EFM to read FHR (This is really one of the only reasons that we use it). You can move around with an internal monitor-as a nurse I would just ask you to be careful to not hook it and pull it out. If you are being induced or given a medication that could put your baby in stress they will want to monitor your baby closely to make sure there are no negative affects to your baby. I understand wanting a natural birth and you have the right to refuse anything you don't need. Just make sure you discuss it with your healthcare provider. I would also find out if you are actually going to get a midwife for your delivery. If they are in a group and they only have a doctor on call, you might not end up with what you want in that situation either.

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