continuous fetal monitoring

EMLDF · March 2015

Hello - I'm due mid-May with baby #2. Baby #1 was born via C-Section because she was breech. I am planning a hospital VBAC with a midwife group. Today at my midwife appointment, I was told again that because its a VBAC, CFM is required, as well as IV access. This particular midwife said no exceptions. Another midwife in the practice told me they could be a somewhat flexible. With this type of CFM, I can only move within a small area and no water at all. So - I guess my question is - how limiting is this? Does anyone have advice on how to best handle labor with these restrictions? My general plan is to avoid epidural for as long as possible (as well as most other interventions), although I am fine with having an epi towards the end if I want one.
I'm trying not to get bummed about this but I hate what seems like a completely arbitrary restrictions.
I'm open to all suggestions as to how to make this work (except looking for different care providers).
Thank you!

Wering · March 2015

Couple of things to suggest:

1) Labor at home AS LONG AS POSSIBLE. Once you get to the hospital, your "clock" starts and CSection ticks closer and closer. Also, you have the ability to walk and move and do what you need to do without CFM at home. If you are truly concerned about not making it in time, you can still arrange to go to the Drs. and have them check you to make sure you haven't progressed too much. Just DON'T go to the hospital until you are ready.

2) Find out if your hospital has waterproof monitors. Some hospitals do - and more and more are getting them based on requests.

3) See if you can negotiate "quick breaks" from CFM - 20 minutes here or there to take a shower, take a quick walk, etc. Find out just how "continuous" continuous needs to be.

One final thing to consider - getting an epidural can make you more comfortable, but could very well result in an additional CSection. The epidural is going to be what limits your movements moreso than the CFM. At least on CFM you can have a birthing ball beside the monitors and move on that/get out of bed. Once you've had the epidural, you're toast for movements.

EMLDF · March 2015

Wering said:
Couple of things to suggest:
1) Labor at home AS LONG AS POSSIBLE. Once you get to the hospital, your "clock" starts and CSection ticks closer and closer. Also, you have the ability to walk and move and do what you need to do without CFM at home. If you are truly concerned about not making it in time, you can still arrange to go to the Drs. and have them check you to make sure you haven't progressed too much. Just DON'T go to the hospital until you are ready.
2) Find out if your hospital has waterproof monitors. Some hospitals do - and more and more are getting them based on requests.
3) See if you can negotiate "quick breaks" from CFM - 20 minutes here or there to take a shower, take a quick walk, etc. Find out just how "continuous" continuous needs to be.

One final thing to consider - getting an epidural can make you more comfortable, but could very well result in an additional CSection. The epidural is going to be what limits your movements moreso than the CFM. At least on CFM you can have a birthing ball beside the monitors and move on that/get out of bed. Once you've had the epidural, you're toast for movements.

Thanks so much!!
I will definitely ask if they have the waterproof monitors. I only learned of them after I started researching CFM yesterday. I assume they don't since the midwife specifically said I can't shower, but it doesn't hurt to ask. And yes, the first midwife I talked to about CFM basically said I could do that (#3)... you know... woops I got lost in the shower on my way to use the bathroom... hopefully I get her or another flexible midwife. And yes, I definitely agree and understand about the epi, which is why I want to hold off for as loooong as possible (and ideally not have one). I just don't want to totally rule it out

kristaelaine86 · April 2015

I don't know I am pro CFM as it is only one of the signs they can monitor for risk of uterine rupture. I had VBA2C with my last pregnancy and they let me walk around for the first hour or so then I had the CFM. My labour was only four hours but I didn't find it to be a big deal. Depends how long you are in labour though I suppose.

ryemo · April 2015

I'm a doula and a VBAC mom myself (this will be my 2nd VBAC). You can move a fair amount around the bed, and moms tend to hover there anyways. You can unplug to pee and then stay on the toilet for a few contractions. I've seen dozens of VBACs and all but one involved CFM.

That said, PP gave great advice. Stay home as long as possible! A doula can help you do that.

laurasuzanne2006 · May 2015

Personally if I need to go to the hospital I would just remove the monitor Myself. Unfortunately research does not show better outcomes with cfm

laralisle · May 2015

Interesting debate. I'm worried about this too. I feel that it was the long periods of fetal monitoring (just because they kept saying they needed 20 mins of solid heart beat and the dang thing kept falling off ) that bound me to the bed for so long and contributed to my eventual c section. I knew I needed to be up and walking and they kept saying, "just a few more minutes." So yes, I'm staying home longer this time and secretly looking for a midwife that will take my insurance who will just do the whole thing at home with me, provided nothing comes up between now and then. I know they have rules at the hospital that are there to protect mom and baby, but I feel confined by them. My c section was a fluke positioning issue. I don't like being treated like a special case.

edan3579 · May 2015

But you are being treated like a special case because you are a special case... Though the chance is still small, you are at an increased risk of rupture, even if your 1st section was because of a positioning issue (mine was too). And speaking from experience, if you are one of the few who rupture, you will want to be as close to the OR as possible. If I was at home when I ruptured instead of 2 doors down from the OR, I would definitely not have my baby, and my older child would likely be without a mom also...The rules are not in place to make things annoying. They are there because rupture does happen, and when it does it can be catestrophic if the doctors don't act quickly.

laurasuzanne2006 · May 2015

Research does not show better outcomes for continuous fetal monitoring

edan3579 · May 2015

I was replying to the comment about not wanting to be treated like a special case, and pointing out that, CFM or not, if you do rupture, your baby's chances of surviving are much higher if you are right there at the OR...time is of the essence. I am not trying to be difficult, I just am part of a group of rupture survivors, many of whom had poor outcomes for their children.... Hearing the guilt of these women is heart breaking.

Obviously it is a very personal decision but I just feel the need to speak up and remind people that, while unlikely, someone has to fall in the statistic and rupture...I was considered a really great candidate for a VBAC and am confident, that, given the information available to me, I made the best choice...stuff happens though. I was in the OR and baby was out on a matter of minutes. Otherwise I would not have my sweet boy now... No doubt in my mind.

Geekchick921 · June 2015

Wow. I don't think I've logged into/posted on TB for well over a year but this inspired me.

cEFM has not reduced the incidence of cerebral palsy, this is true. This is what the goal was when cEFM first started and, now that we see it hasn't really brought the rate of CP down, has led us to realize CP happens antenatally. Babies with CP may often be born by C-section, but that's likely because those babies are compromised to begin with and are less likely to tolerate labor.

However, cEFM DOES decrease early neonatal mortality, probably preventing deaths as a result of hypoxic ischemic encephalopathy. Seems like a better outcome to me.

All that being said, the debate about whether everyone NEEDS continuous monitoring is still up for debate, but that is for the lowest risk women. We all have a scarred uterus. Like it or not, that takes us out of the "lowest risk" category, even if the rest of our pregnancy has been completely uncomplicated. Prolonged decels and fetal bradycardia are present in nearly 80% of uterine ruptures, far more common than other symptoms like vaginal bleeding and severe abdominal pain. Rupture can kill babies, and the recommendation is a decision to incision time of less than about 17 minutes to give baby the best chance of being born alive and neurologically intact.

If you have a supportive provider and a good nurse, being on continuous monitoring will not be a big deal. My first birth was not like that, but when I VBACed my son (with a different provider at a different hospital) I spent the first several hours of my hospital stay on a birthing ball next to my bed, still on the monitor. It was night and day compared to my daughter's birth.

And to be clear, you should go to the hospital when your doctor or CNM recommends, regardless of whether you have a doula or not.

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