active birth with foetal monitoring

[mamatochompers]

Hi everyone,

I just found out that my hospital's telemetry foetal monitors are out of action for some reason so I may be confined to one with cords etc. Can someone tell me just how much it's possible to move around when hooked up to one of these? Are you stuck in bed? Does anyone know just how realistic the idea of having an active birth is whilst hooked up to one of these?

Thanks

[appletree]

The cables on mine were approx 2m so I was able to move around pretty freely, and I had periods where I just took them off when I went into the bathroom for around 20 mins for a change of scene, lol.

I definately wasn't stuck on the bed, I only hopped up there for pushing.

Could you ask to check them out at your next appointment? If no one is using them they shouldn't have a problem with it and it will help you prepare for your birth.

This was one of my biggest fears for my vbac, and in the end it didn't seem to be an issue for me whilst labouring if that gives you any comfort?

[Arimeh]

From what I've read, its hard because the belts slip off even when you're not moving around, so can be hard to get a good reading that is consistent.

Can you ask for intermittent monitoring with a doppler? Thats all I had.

[Traveller]

You won't be stuck to the bed, but you will be confined to an area near the bed for the time that you are on the monitor. You will be able to have an active birth but you will need to be clever with the use of space. So have a birth ball, lots of cushions, etc and use these to change positions either near or on the bed. It will be easier for your midwives and OB if you are on your back and fairly still but that would not be easier for you, so be prepared to face possible opposition to moving around.

Also remember that you can negotiate time off the CTG. So is bubs heartrate is fine then perhaps you could say 20 mins monitoring, 40 minutes off, which would give you time in the shower. You will also have to come off the CTG if you need to use the loo, some women use this as an excuse to move around and you should be passing urine regularly when you are in labour anyway so make the most of your time off the monitor for a loo break.

[LimeSlice]

The two notions are not compatible in my experience... unless of course you want your midwife following you around constantly occupied with ensuring the monitors are functioning.
And of course you don't mind not being able to breathe through the later stages of your labour because th elastics are so freaking tight around you to allow you to breathe deep enough into your belly...

Take a look at ways you can have an 'active' labour while being still - changing positions on the bed, bouncing on birth ball etc.

And negotiate as much as you can before labour - and get the results in writing on your file.

[LimeSlice]

You won't be stuck to the bed, but you will be confined to an area near the bed for the time that you are on the monitor. You will be able to have an active birth but you will need to be clever with the use of space. So have a birth ball, lots of cushions, etc and use these to change positions either near or on the bed. It will be easier for your midwives and OB if you are on your back and fairly still but that would not be easier for you, so be prepared to face possible opposition to moving around.

Also remember that you can negotiate time off the CTG. So is bubs heartrate is fine then perhaps you could say 20 mins monitoring, 40 minutes off, which would give you time in the shower. You will also have to come off the CTG if you need to use the loo, some women use this as an excuse to move around and you should be passing urine regularly when you are in labour anyway so make the most of your time off the monitor for a loo break.

they maybe wont take the belts off for the loo - they will unplug them. And during a vbac the ability to get off them at all is nearly impossible, even if they say they can at the beginning, when you are further in, they will oppose it everytime.

[mamatochompers]

Hi,

Thank you everyone for the replies.

Intermittent monitoring is actually my preference but I have asked my midwife about the opportunity to have a break from it so I can go under the shower, etc, and she already seems really inflexible. (I'm doing the Cosmos program at RWH in Melbourne so chances are she'll be the one who is with me when i'm in labour.)

Do you know what I might be able to try to get off the monitor assuming everything is going well? Would it be less complicated do you think if I just refused CFM altogether? If I was to refuse CFM, would they use a doppler instead? (I wouldn't want to opt for no monitoring whatsoever.)

I have a doula but I'm also expecting to be hassled a lot if I ask for intermittent monitoring and I'm not sure I'll be able to hold my ground if I have that kind of confrontation when I'm in labour.

Thanks again.

[Heaven]

I didn't have any continuous monitoring at all. Just intermittent monitoring with a doppler. The hospital's policy was CFM but I told them I didn't want that. I met with an OB before labour to discuss the risks and so they wrote down on my file that I'd already discussed this and was fully informed. Then I didn't have to argue about it in labour. During labour no one mentioned anything about having CFM because I'd already talked with everyone about it. Even though I pushed for 2 hrs, they still only used the doppler. So my advice would be to make sure you discuss it before labour, write a birth plan and get them to sign it.

[Traveller]

they maybe wont take the belts off for the loo - they will unplug them. And during a vbac the ability to get off them at all is nearly impossible, even if they say they can at the beginning, when you are further in, they will oppose it everytime.

I appreciate what you are saying, but a person in labour has the right to take the monitors off herself and insist on going to the loo without them. Equally a labouring mamma has the right to not consent to monitoring, or to agree to only intermittent monitoring. This is where the support people are so important, nothing can be done without consent but it is hard when health care professionals say no or insist on something contrary to what the mother wants. Equally with moving around the bed. The monitors will slip, the midwives may not like it. But this will be their problem, not the problem of the mother.

[HotI]

From what I've read, its hard because the belts slip off even when you're not moving around, so can be hard to get a good reading that is consistent.

This is what i found. It's not so much the cords attached to the machine and how long they are but just changing position (moving your hips etc) even standing in the one spot causes gaps in the trace. This leads to the hospital getting antsy.

And negotiate as much as you can before labour - and get the results in writing on your file.

they maybe wont take the belts off for the loo - they will unplug them. And during a vbac the ability to get off them at all is nearly impossible, even if they say they can at the beginning, when you are further in, they will oppose it everytime.

Intermittent monitoring is actually my preference but I have asked my midwife about the opportunity to have a break from it so I can go under the shower, etc, and she already seems really inflexible. (I'm doing the Cosmos program at RWH in Melbourne so chances are she'll be the one who is with me when i'm in labour.)

Do you know what I might be able to try to get off the monitor assuming everything is going well? Would it be less complicated do you think if I just refused CFM altogether? If I was to refuse CFM, would they use a doppler instead? (I wouldn't want to opt for no monitoring whatsoever.)

I have a doula but I'm also expecting to be hassled a lot if I ask for intermittent monitoring and I'm not sure I'll be able to hold my ground if I have that kind of confrontation when I'm in labour.

Has your doula supported women at RWH before? Do you think she will be strong when its needed?

Once you have consented to monitoring at RWH, they make it very difficult to have them taken off. They will also threaten you with the internal probe if the CFM is not working due to movement or other reasons.

If you are able to make your preferences known now, and have it written into your file the things you do not consent to, it may help later. In my experience you will still be pressured during labour, especially if your midwife has already stated that her preferences are opposite to yours.

[HotI]

I appreciate what you are saying, but a person in labour has the right to take the monitors off herself and insist on going to the loo without them. Equally a labouring mamma has the right to not consent to monitoring, or to agree to only intermittent monitoring. This is where the support people are so important, nothing can be done without consent but it is hard when health care professionals say no or insist on something contrary to what the mother wants. Equally with moving around the bed. The monitors will slip, the midwives may not like it. But this will be their problem, not the problem of the mother.

Bull nothing can done without consent. In an ideal world yes. In labour wards it is happening every day.

[LimeSlice]

I told, asked, begged, them to take them off the whole time.

DH and I both pulled them off, she put them back on eventually, and when they weren't on constantly, she would sit there holding the thing on by hand, regardless of what I said.

So yep, ideal world, but reality is, if you agree to them at all, getting them off again is nearly impossible.

[*Sparklez*]

With my 1st,3rd and 4th bub i had the monitors on and i wasnt able to get off the bed.. even when i wanted to turn the nurse would help me just in case one would slip.
Every case is different though, if they feel the need is there to continuely monitor you they wont take them off.. the doppler can be used but when in labour and due to the babies positioning they may not get an accurate reaading and then they will hook you up to the machine..
I know when mine used to slip the nursse would remind me that they are very fragile and loose the monitoring and i had to be sure i got assistance when i needed anything..
But like i said every case is different.

[Yeddi]

Honestly, just say no. This is one of the areas you will have to fight for, and it's worth fighting for. CFM is the very beginning of the cascade of intervention. The policy for CFM has nothing to do with your safety or the safety of your baby, it is all about litigation. The WHO have a study that shows that CFM doesn't decrease negative outcomes, but does dramatically increase false readings, carer laziness (who often get too busy looking at machines rather than you) and therefore unnecessary intervention.

[Heaven]

CFM is the very beginning of the cascade of intervention.

Yep, after my VBAC my midwife told me that if I had of consented to CFM I would have ended up with more intervention. She said right near the end when I was pushing and she was checking with a doppler the HR dropped but she could tell that this was only because it was close to the end and bub was getting squashed and the HR came back up again fine. But she said that if I had the CFM then that would have meant that after she saw a reading like that she would have been obligated to tell someone and do something even though she knew all was ok and bub would be out soon. But when they have that reading there I guess it's like permanent proof that baby was 'distressed' and they didn't do anything, you know?

[zap]

Wow lots of food for thought ladies!!! I had cfm with my first vbac but it was cordless so no restrictions as to where I could move but it was still very sensitive to my movement. I had not even thought about asking or demanding occasional monitoring. I am attempting my 2nd vbac this September so will be getting it written down in my records before hand. Especially if all they can offer is the corded monitor. I must day though come pushing time I don't even remember it being on me!

[helle]

I had a pretty active labour with them, at one point I was rolling around on a fit ball. The middies made it their job in making sure they stayed on and I learnt to forget about them eventually. However I wanted CFM, so that may have helped. I was at peace with it.