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Continuous monitoring for VBAC?
Is there any way around this?


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#1 Tilly007

Posted 19 December 2012 - 09:29 AM

I am curently pregnant with my second after giving birth via emergency c/s to my DS 20 months ago.

I intend to try for a VBAC for this baby.

I have discussed monitoring with my OB.  He has indicated that it is NSW health policy that all VBAC labouring mothers are continuously monitored through labour.

I am yet to really discuss (negotiate!) this with him, as I want to be armed with all the information before I do.

Firstly, I did not realise it was policy that VBAC mothers are monitored continously.  I thought it was hospital policy or OB preference, but not department of health policy.  I am sure I have heard of women attempting VBACs at RPA not being monitored continously?

What will happen if I get to the hospital and decline continous monitoring?  (BTW, I am not opposed to monitoring as I realise there are risks for VBACs.  I just don't want to be monitored the whole time, particuarly as the hospital I am going to only has one wireless monitoring machine, so I'll likely be stuck to a bed the whole time).

Has anyone had any success in convincing the hospital/OB that intermittent monitoring is OK?

My OB suggested that I stay at home for as long as I can to avoid monitoring, which I will do anyway, but I really don't want to be monitored continuously the whole time when I get there.  I had an induction with my DS and all my plans for an active labour quickly disappeared after being hooked up to that damn monitor the whole time!

Edited by Tilly007, 19 December 2012 - 09:30 AM.


#2 bambiigrrl

Posted 19 December 2012 - 09:47 AM

You have the right to say no once you get there, and just have intermittent monitering every 10 minutes or so with a doppler. When i had my unsuccesful vbac (i will be trying again next time!) they said they wanted to hook me up for 15 minutes or so when i first arrived and then they would take me off if i wished. I even had the option to go in the shower for a while.

Trust me you have rights and they cant do anything you dont consent to once your there, and they certainly wont kick a labouring woman out of the hospital! They have a duty of care and you have every right to refuse certain things, you just need to be staunch about it cause they will try to pressure you. They will also try to insist you dont drink water or eat, and only give you ice chips, which is the worst thing you could do! What with the sweating, vomiting and diareahh you need to drink lots of water, if they try this one on you tell them where to go!

Also I would avoid a epidural if I were you, as mine caused not only my cervix to swell and go from 9 cm to 7cm, but i also developed a maternal fever which caused fetal distress. So that, coupled with being compleatly without energy due to no water or food, and of course labour for 14 hours, and then the swelling is why my vbac was unsuccesfull. I definatly believe that if i hadnt of gotten the epidural and drank more water, eaten food and kept active I would have had my natural birth. You live and learn hey! Hopefully next time i will have better luck!
Good luck with your vbac, I hope it is a wonderful experience for you!

#3 Guest_AllegraM_*

Posted 19 December 2012 - 09:54 AM

It is Queensland Health's policy too.

You can always refuse or negotiate intermittant monitoring but it would be best to discuss this with your Ob in advance, rather than in labour.

For my planned VBAC, my personal choice is to have the continuous monitoring, due to my small birth to birth gap (17 months). I believe this may increase my chances of having a repeat section as my hospital does not have wifi monitoring which means I will be attached to the bed with limited ability to move around and change positions. However, some studies show that thr uterine rupture rate is higher for 18 month or less gaps so I am covering my bases.

Only you know what you are comfortable with but I do think it would be best to have any arrangment in place in advance.

#4 whatnamenow

Posted 19 December 2012 - 10:07 AM

Oh and even if they do try to force you.  Lots and Lots of Bathroom breaks.  Spent my induction supposed to be continuously monitored but in reality spent almost as much time off as on by the time i took a contraction or 2  to get to the bathroom and a few more in there and then got back to bed, then waited for the midwife to come back ( i certainly didnt buzz them)...

#5 findingada

Posted 19 December 2012 - 10:36 AM

I didn't know there was a Queensland Health policy (or any other State policy for that matter). I had hand held doppler monitoring in between contractions with my VBAC 2 years ago in Queensland. My ob was against too much forward planning (which was fine with me) but agreed in principle that if everything was going fine that regular hand held doppler would be fine. I should mention my first birth was a c-section and I was in advanced labour when I had the c-section but there was no medical reason for my c-section. My VBAC birth was fast and no problems at all. I spent most of my time in the shower sitting on a fit ball. I also walked around, experimented with what seemed like thousands of positions (thanks to a very supportive midwife and doula), and my bub was out in no time (actually it was 5 hours from "Hmmm ... was that a twinge I just felt? I will just get breakfast cooked, pack up the kids to go to kindy, tidy the house, then ring hubby" to holding my little one.

#6 Soontobegran

Posted 19 December 2012 - 09:17 PM


OP you could ask if the hospital has telemetry monitoring which will allow you to move around quite freely. There are some Obstetricians whom are happy with intermittent monitoring so hopefully you'll be able to convince him and come up with a plan that suits you.




QUOTE (bambiigrrl @ 19/12/2012, 10:47 AM) <{POST_SNAPBACK}>
They will also try to insist you dont drink water or eat, and only give you ice chips, which is the worst thing you could do! What with the sweating, vomiting and diareahh you need to drink lots of water, if they try this one on you tell them where to go!


Just want to point out that this is not to try and be difficult but because if your VBAC doesn't work and you need a C/S it is better for your well being to not have a belly full of food so telling the staff where to go is a little silly. Ice chips are the most sensible thing to be consumed in active labour.
Women should not eat much when in labour anyway as digestion slows down terribly. It increases the chances of vomiting and as I just explained it can cause issues in the unfortunate event of an emergency c/s.


#7 Propaganda

Posted 19 December 2012 - 09:26 PM

You have the right to say "no," to any sort of hospital policy.

#8 Madnesscraves

Posted 19 December 2012 - 09:28 PM

QUOTE (soontobegran @ 19/12/2012, 10:17 PM) <{POST_SNAPBACK}>
Just want to point out that this is not to try and be difficult but because if your VBAC doesn't work and you need a C/S it is better for your well being to not have a belly full of food so telling the staff where to go is a little silly. Ice chips are the most sensible thing to be consumed in active labour.
Women should not eat much when in labour anyway as digestion slows down terribly. It increases the chances of vomiting and as I just explained it can cause issues in the unfortunate event of an emergency c/s.


I agree and was coming in to say this. I totally get where they are coming from. Ive been through a CS and only had water. I still almost threw up in theatre as they were taking my DD out.

#9 MoonPie

Posted 19 December 2012 - 09:32 PM

If you are comfortable with continuous monitoring, make sure you take regular, slow bathroom breaks. Not in an effort to be sneaky or anything like that, but being upright is a great and its so much easier to do it without monitoring belts on.

Good luck!

#10 Akeyo

Posted 19 December 2012 - 09:34 PM

I had a VBAC at RPA in the birth centre in Sept 2010. I was told by the MWs that hospital policy in the labour ward for VBACs was for continuous monitoring but in the BC they were left alone to do their own thing and only did intermittent Doppler monitoring. They only had one protocol they said they had to follow which was a cannula but with the help of my amazing doula I was able to decline it when the time came. I would strongly recommend hiring a doula to advocate for you during labour, to negotiate these hospital protocols. You can refuse them if you wish but it can be hard to voice that when you're in the throes of it all.

Best of luck!

PS - I could never even think about eating during labour. Waay too much going on inside! I even struggled to drink water.

#11 kazlou

Posted 19 December 2012 - 09:36 PM

.

Edited by kazlou, 19 December 2012 - 09:37 PM.


#12 mummame

Posted 19 December 2012 - 10:03 PM

I found no way around this. My hospital was adament that I be monitored continuously. I was very shocked when I worked this one out but was told telemetry would be available. Well all good in theory until you turn up to hospital and the ONLY telemetry machine is being used by another woman. I was told to get up on the bed, cannula inserted and I was not allowed a bathroom break. I was in tears thinking about being stuck to that bed for my labour it was so painful sitting up having contractions. But my story had a happy ending because I had come to hospital 7cm dilated so I only had to sit up for about an hour before my DD had arrived. But ouchy!

#13 Lokum

Posted 19 December 2012 - 10:16 PM

I had continuous monitoring during my (failed) VBAC attempt, except for toilet trips.

I was reassured by the monitoring, because my first Ds went into distress, I had insulin-controlled GD etc.

Despite the monitoring, I spent 5 of my 7 hours in labour in hospital OFF the bed. I stood and rocked beside the bed, or bounced on a fit ball beside the bed. When I got on the bed to be examined, it was excruciating, but it was no trouble to be tethered to the monitor and still moving around, changing position etc. The midwives helped me. (The midwives said I was moving well, it wasn't the position or the monitoring that led to my failure to progress at all.)

I also wouldn't object to the canula - it has a purpose in case things go wrong.

I was hungry, because I hadn't really eaten before the labour got going, so was approaching 24 hours on a muesli bar and a glass of milk. I sneaked two bites of banana bread, which everyone got cross about because a c/s was always possible... but really it was enough to give me a tiny sugar lift and then I could feel it sitting, undigested.

#14 bambiigrrl

Posted 20 December 2012 - 11:19 AM

QUOTE (soontobegran @ 19/12/2012, 09:17 PM) <{POST_SNAPBACK}>
Just want to point out that this is not to try and be difficult but because if your VBAC doesn't work and you need a C/S it is better for your well being to not have a belly full of food so telling the staff where to go is a little silly. Ice chips are the most sensible thing to be consumed in active labour.
Women should not eat much when in labour anyway as digestion slows down terribly. It increases the chances of vomiting and as I just explained it can cause issues in the unfortunate event of an emergency c/s.



while i didnt eat during labour, as it started out hard and fast with contractions 3 minutes apart right from the start, I really did need to drink water and keep my fluids up. I hadnt eaten but just from a normal labour i had diareahh, vomiting and was sweating like nobodies business, i was dying of thirst the whole time and desperate to guzzel water which was refused. It is a fact that dehydration stops the uterus from contracting efficiently, as well as causing severe fatigue. I was progressing well and by planning so much for a possible c section in this way it becomes a self fullfilling prophecy.

http://www.midwifeupdates.com/prolongedlabor

#15 Soontobegran

Posted 20 December 2012 - 12:10 PM

QUOTE (bambiigrrl @ 20/12/2012, 12:19 PM) <{POST_SNAPBACK}>
while i didnt eat during labour, as it started out hard and fast with contractions 3 minutes apart right from the start, I really did need to drink water and keep my fluids up. I hadnt eaten but just from a normal labour i had diareahh, vomiting and was sweating like nobodies business, i was dying of thirst the whole time and desperate to guzzel water which was refused. It is a fact that dehydration stops the uterus from contracting efficiently, as well as causing severe fatigue. I was progressing well and by planning so much for a possible c section in this way it becomes a self fullfilling prophecy.

http://www.midwifeupdates.com/prolongedlabor



We are discussing a VBAC here where there is an increased chance of C/S, not a normally progressing labour or even prolonged labour?
This is why women who have prolonged labour will have IV fluids to rehydrate them without the need to guzzle water and eat. A constant intake of sips of water and chips of ice is all that is usually required. If your labour is looking prolonged and you are becoming dehydrated you will be treated accordingly.


#16 bambiigrrl

Posted 20 December 2012 - 02:30 PM

well i just dispute the theory that your chance of a repeat c section is greater in a vbac then in a normal birth. I was in labour for 14 hours with contractions 3 minutes apart the whole time, 20 months after my previous section and there was not a hint of a tear that entire time. The risk is only fractionally higher then in a low risk birth. You have a higher chance of bleeding out in a normal low risk birth then you do of having a uterine rupture during a vbac. The fact is that the risks are greatly over estimated and there is a lot of scare mongering going on. IMO if you treat a birth like an c section is going to be the likely outcome, then it will be.

If you treat it like any other birth then your chances of success are higher, which is why they tell you to stay at home as long as possible before coming into the hospital, because once your there your on the clock and subject to all the hospital protcol which is in the best intrest of the hospital not the labouring mother. If a vbac is so risky, then why are many women, myself included, told to stay at home as long as possible? Wouldnt they want you to come in asap if it was so incredibly dangerous?

And yes, sips of water would have been great during my vbac, but i was only aloud ice chips. Ever tried quenching your thirst with ice chips? Would you give someone running a marathon ice chips? I didnt think so.


An iv is great if you are already hooked up and strapped into bed, but if you want an active labour you dont need to be worrying about your iv. It is easier and more refreshing to drink water. If you are going to throw up anyway, whether you have water or not, then you may as well just drink water.

I also think all this preperation for a likely c sction is so mentally defeating for the mother in labour. She is basically aware that the hospital staff have zero confidance in her ability to give birth. Which in turn lowers her own confidance dramatically.

#17 Lokum

Posted 20 December 2012 - 03:03 PM

QUOTE (bambiigrrl @ 20/12/2012, 03:30 PM)
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I also think all this preperation for a likely c sction is so mentally defeating for the mother in labour. She is basically aware that the hospital staff have zero confidance in her ability to give birth. Which in turn lowers her own confidance dramatically.


I think it's good risk management. The midwives told my OB they thought my contractions seemed insufficiently deep, and ineffective, and were concerned they were 2 mins apart and I'd been working hard but making no progress. However, they didn't say do to me. When I was discouraged to be at 2cm after 7 hours, they kept being encouraging.
They all agreed to give me more time, then to try augmenting with ARM. They didn't fess up tO me until the next day that it didn't look favorable.
They gave me a great chance to do it myself... It would have been a hell of a lot more convenient for my OB to do the c/s at 4pm than 11pm... But she went to the gym and came back, went home for dinner and came back... All in the hope I could push him out. They boosted my confidence.
I just don't believe this institutional Push to c/s exists the way it's described. My experience was that my emotional welfare and the baby's and my physical safety were all of greater concern than anyone else's convenience.

#18 bambiigrrl

Posted 20 December 2012 - 05:18 PM

QUOTE (Lokum @ 20/12/2012, 03:03 PM) <{POST_SNAPBACK}>
I think it's good risk management. The midwives told my OB they thought my contractions seemed insufficiently deep, and ineffective, and were concerned they were 2 mins apart and I'd been working hard but making no progress. However, they didn't say do to me. When I was discouraged to be at 2cm after 7 hours, they kept being encouraging.
They all agreed to give me more time, then to try augmenting with ARM. They didn't fess up tO me until the next day that it didn't look favorable.
They gave me a great chance to do it myself... It would have been a hell of a lot more convenient for my OB to do the c/s at 4pm than 11pm... But she went to the gym and came back, went home for dinner and came back... All in the hope I could push him out. They boosted my confidence.
I just don't believe this institutional Push to c/s exists the way it's described. My experience was that my emotional welfare and the baby's and my physical safety were all of greater concern than anyone else's convenience.


thats great that your experiece was good, but unfortunatly every hospital is different and a lot of other women out there dont feel that level of support at all.

#19 Franni

Posted 20 December 2012 - 05:28 PM

I had scalp clip monitoring, this enabled me to be as active as I liked. I went private in qld at a hospital that has high ceaser rate but my OB was very supportive

#20 Lokum

Posted 20 December 2012 - 07:35 PM

QUOTE (bambiigrrl @ 20/12/2012, 06:18 PM) <{POST_SNAPBACK}>
thats great that your experiece was good, but unfortunatly every hospital is different and a lot of other women out there dont feel that level of support at all.


My hospital has up to 45% c/s rate, is private with lots of well paid OBs. It's not known for being all enya-birth-centre-natural blah blah. I think they have a good balance of patient choice and clinical best practice (though of course that would depend on the individual Dr.)

I just wonder if people 'feel' unsupported because of all this anti-monitoring, anti-IV bung, anti-establishment ideology... telling each other all the time that we're being set up and we're doomed to c/s, and we have to fight for a VBAC.

If people were encouraged to believe that generally their drs and nurses care about their patients (which is surely the truth?), maybe they would feel more comfortable and confident about things, and less affronted when they don't work out as hoped.




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