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sschwege
member
Anyone Have Experience Declining Procedures?
sschwege
member
I went to my regular MW appointment today and brought along my birth plan. I figured it wasn't going to be a big deal because I delivered DD at the same hospital two years ago and all of my requests were pretty much standard. I met a new MW this time, she is taking over for one of the usual MWs who is on maternity leave. Anyway, she looked it over and said everything looked fine except for my request for intermittent monitoring. She said that they do 20 minutes of continuous when you get to triage (same as last time), but then they will want me back on the monitors every 2 hours for 20 minutes, she called it a NST for the baby. I hated the continuous monitoring in triage last time, and it was pure heaven getting in the bath after that and never having to get out until I was ready to push. Provided everything looks good I want that same experience.
She could tell I was visibly upset to hear this and her response was, "Well, labor at home as long as possible, maybe by the time you get to the hospital you won't need it anyway." I always find that response funny because it's like you obviously don't see the value in these tests or you wouldn't be telling me to stay home. Anyway, I just said I will be willing to sign a waiver, but I don't want continuous monitoring unless it becomes necessary. She told me to let them know when I got to the hospital. I told her I didn't want to be arguing with people while I'm in labor and could she please get me something to sign beforehand. She told me she would have it for me at the next visit.
So frustrating, but anyway, has anyone had experience with declining medical procedures? Did they give you a hard time or leave you alone after you signed?
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Re: Anyone Have Experience Declining Procedures?
I definitely agree about picking battles. I'm still willing to do the 20 minutes in triage. But I don't want to have to get out of the bath every 2 hours and be on the monitors for 20 minutes. Plus I worry that since evidence suggests continuous monitoring increases the likelihood of c/s, is that increasing my risk as well?
Lying down made it torturous, the triage nurse discouraged me from even using the exercise ball next to the bed. She basically told me, 'Let's just finish this so we can get you off the monitors." Plus I ended up having to be on the monitors even longer than 20 minutes maybe more like 35 minutes because despite the fact that DD was moving it wasn't being picked up on the monitors. All I want is what I had a mere two years ago at this hospital.
I can't agree that this is a pick your battles type of situation when the argument is that other places require continuous monitoring so 20 minutes every few hours shouldn't be that bad.
I don't have personal experience, but can you request the intermittent monitoring be done via handheld doppler? That's generally the best option. A lot of practices/hospitals will want you on the EFM for 20 mins every hour or every 2 hours, which sounds like a complete PITA to me, but it's more because a) they don't want to deal with doing it with a handheld because it's more hands on (obviously) and b) they want a record to cover their butt.
Of course my suggestion about the doppler is if you're looking for a compromise or want them to check in on baby's heartrate in some way throughout labor.
ETA: Also, as far as increasing risk of C/S and that sort of thing, I wouldn't think that the 20 mins on the monitor every 2 hours will have the impact you're talking about of increasing your risks because it's still intermittent rather than continuous, which is the situation where they "see things" they become concerned about and move to a possibly unnecessary C/S. Now, keeping you confined to the bed could certainly have a negative impact in some ways, but as far as the usual concern with continuous EFM increasing chances of C/S I don't think it's applicable with the intermittent EFM.
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I completely understand. Don't worry about it. When I was in the middle of laboring my Dr wanted to put in an internal monitor. I didn't even look at her, just said "no" and continued to labor. (My Dr also wanted to intervene when I was stuck at 9.5cm for a long time. When she asked "do you want my professional opinion" probably rhetorically, I said "no" and again continued to labor as she dramatically walked out.) They can't force you out of the tub. Unless something is wrong and you say "yes" they can't do a thing about it.
Good luck!
I definitely want them checking the heart rate. What they did last time was my L & D nurse would come in every 15 minutes, turn off the jacuzzi jets, listen for 30-60 sec and then leave. So all I'm hoping for is what was standard two years ago in this same hospital for its low risk patients.
It's good to hear that perhaps being on and off the monitor will not have an impact on my risk of c/s. That's part of the reason I am stressing. Thank you.
But why shouldn't she decline the things that haven't been proven to be helpful to laboring woman? The US maternity system isn't very patient-centered, and I think having women decline the things that aren't necessary will send a message to the practice that they should rethink what they're asking for in labor.
Sschwege - I decline the ultrasound portion of a NST when I was pregnant with DS2, and they were nice about it. I had to talk to the MW so she knew I understood what I was declining, etc., but everyone was very polite and didn't push it once I told them I wasn't going to do it. Good luck! I think it's worth pushing back on. Don't they have telemetry there?
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Prime your partner to say "can you come back in 20 minutes to do that?".
And then just keep saying it. Let them use the doppler when ever they want, but I wouldn't bother with 20 minute tapes. I never had to do any long-term monitoring, but this may have been because I arrived fully dilated. I don't want to cut it quite that close this time.
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I'm an RN in the Midwest. See if the facility your going to has monitors they can put on you while your in the tub. We have what we call a telemetry unit that has the exact same monitors but they plug into a battery powered unit that is tiny (size if a large man hand).
While I absolutely think its your right to refuse I'm usually the person on the other end of this that's worried about your baby. The monitoring isn't just to make sure baby has a heartbeat it's to assess how baby is doing with and without contractions. We look at so much more than just a heartbeat-like the movement of the heart rate etc.
I would consider 20 minutes every 2 hours to be intermittent and wouldn't be overly concerned about it upping your c/s risk.
I would be concerned about the option of a telemetry unit... because then they can let you labor however you want while still doing continuous monitoring which is what you want to avoid.
For all monitoring except after my initial intake, I was allowed to kneel or stand instead of lay down. It did mean staying in 1 place but I was ok with that so long as I didn't have to lay in bed. I'm also fairly certain (although memory is getting foggy now) that they didn't do a full 20 minutes after the initial period - they listened to the heartbeat and saw enough variation that they were convinced baby was ok, then took them off.
All that said... I think using a doppler would be a reasonable compromise if you feel strongly about it.
I know it's unusual, which is why we loved this hospital so much. Last time which was only two years ago, I was in the hospital for 7 hours. I spent about 35 min on the monitors in triage and then the nurse came every 15 min with the doppler. So while I get that most hospitals do not do this, mine did. I'm frustrated that when I asked one of my MWs if anything had changed in two years in terms of policy she told me no.
Thank you everyone for your responses and keep them coming!
I will ask about telemetry monitoring, though if they had it I would assume my MW would have told me since my biggest problem was the idea of getting out of the bath.
I had DS1 in a hospital that "required" monitoring for 15 min of every hour. Getting out of the water/relaxation mode over and over again expending an insane amount of emotional and physical energy (albiet, I had a multi-day labor). I would try to delay it as much as possible and some of the staff got a bit comabtive. Ugh! If you feel the need to consent to monitoring, I second asking if they can check you with a hand-held, waterproof doppler. DS2 was born with CPMs out of the hospital and they checked him every now and then with the doppler.
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