Fetal monitoring

I was just told at my midwife appt this week that the hospital has changed policies in the past few months and now required constant fetal monitoring of all induction, VBAC and higher risk births.

Now, I am all for making sure our babies are healthy and doing well during labour, BUT our hospital seems to have variations of women's positions during monitoring which is frustrating. One midwife told me I would have to stay in bed, another said that some women are able to be on the fit ball & may not be able to roam heaps but are able to change positions and get more comfortable.

I have in my birth plan a clear indication that I don't want to be monitored constantly, that I want to be able to have breaks & shower etc etc... she said today the only option for that would be once my membranes were released & attaching a monitor to the baby's skull. And I don't know how I feel about that either.

So... for those who have been through it I just want to know:

1. what was involved in your fetal monitoring? i.e. doppler, trace, "antenna" etc?

2. Were you able to have intermittent monitoring?

3. Did you know ahead of time what was available to you? Had you made decisions prior to labour?

4. Did you find it useful? or just more scary?

With Paige, once my waters had broken and then they became mec-stained, I had to have the syncto induction as you know. But because they were able to reach her scalp, they placed the 'antenna' on her scalp, which does record a better trace than the one on your belly anyway. It was only ever on intermittently and I was able to move around, walk, change seats/positions etc. I didn't have a shower, but I didn't want one anyway so that wasn't an issue, but I could have if I wanted to so long as I didn't get the machine wet (for the drip).

I have always gone into my births with an open mind and have never worried about birth plans. I did make sure that once the talk turned to induction, that I was informed of my options should things go more pear shaped than they already were. But then I had fantastic midwives who made sure that I knew what was going on. So I was a bit scared because I had never had a birth like Paige's before, I had complete trust in the staff around me and my ability to get me through it.

It is possible to have an active birth despite them wanting to monitor you, and if you ultimately refuse to be constantly monitored to the point where you are inhibited, then there isn't much they can do about it - especially if you are not refusing anything that may make it difficult for you and for Jovie KWIM?

I didn't have a birth plan, so had no real decisions made on what I wanted. I was in labour four days. Our hospital has that same policy and I had to have a scalp monitor. Was a hassle to move around, but as I turned out I didn't really want to anyway. I had the synto and antibiotics as well, so it was all a pain. It wasn't scarier - think of it this way - if you have to have it at least you know how bub's going the whole time.
Don't know if I've helped, but I just took it as it came. All I wanted was a healthy baby, and if that was how it was going to come, then so be it.

Hi,

The times i was induced with 2 out of my 4 kids so far i had to spend the entire labour with the ctg monitor on. I wasnt able to get out of bed but i actually never wanted too.

The only time i got really annoyed with the ctg was in the last 10 mins of my labour when the contractions were basically non stop and the baby was moving down the birth canal so the m/w was pushing on the monitors to try and get her heartbeat still. My belly was rock hard and i just wanted to rip the thing off an throw it. I did at one point, right at the end lift them up off my belly cos i couldnt stand it. But her head was coming out then so the m/w let me go.

Apart from that though it didnt bother me. Its comforting to be able to hear your baby's heartbeat the whole time and know straight away if there is a problem.

Hi Christi,

I was induced with Kiara and had to be monitered regulary, before my epidural, I was able to move around, and we used the doppler most of the time, only had CTG after epi as I couldn't move anyway!

As long as you know what is going on with your contractions etc I am sure that the doppler will be enough. It also depends on the m/w... our first m/w who was just wonderful, allowed me to do what ever I wanted, and used the doppler now and then, but the second m/w was a bi*^h and had the CTG hooked up so i couldnt move... i did have the epi so couldn't move on my own, but wanted to roll over and she wouldn't let me (does this make sense... or have i just confused you?).

If you have it in your birth plan that you want to move around then they should let you... maybe discuss it with ob/mw before hand!

Good Luck

Christy, one of my teacher's clients was told to get on the bed and stay there. She said no, they said yes. So she stood on the bed.

You have the right to move around in labour, hospitals have policies but they are not LAW. I know for Cailin's birth they did 15mins of monitoring every hour or something, she could get into the bath without it, wherever she wanted to go. It's completely unfair, a scar is strong after birth and you have more chance of problems lying flat on your back in bed being unable to move. I would be ropable - I would even go somewhere else if they were not prepared to accept that I want to move in labour!!! Have you thought about hiring a private midwife?! Which hospital is this again?

Did you remind them that those monitors have a 50% false positive rate? You are only more likely to have a caesarean with one on continuously...

Kelly this is Redlands Public, but apparently its gone through all of QLD Health public systems that "higher" risk pregnancy's need constant monitoring during labour. I told the midwife today that under no circumstances would I agree to constant monitoring. I asked her what they could do about it & she said nothing really...

Easy Christy you can just say NO. Policy does not = LAW and unless there is a compelling reason for it... they cant strap you down and monitor you...

The thing that is best is that I feel so much more confident about this now, when I was in labour with Matilda I felt like I had no options, I didn't know that you could say "No" or compromise. Now I know and I have a "team" behind me. I know that I will either have you or a different birth attendant with me on my "team" as well as DH. So I feel so much better being able to say... Okay you can put the monitor on for now, or I need to move now etc etc... without feeling like I don't have the choice.

I can only imagine what it is like for other women who feel like they don't have that choice, that policy = must do...

Wow Christy - Thats all pretty full on.
I personally would probably take the easy stand on it now so as not to rock the boat, and when the time comes, then stand up for what you want. Who knows how it will all go - you might pop it out in 10mins!
Keep an open mind, and I definitly think its a great idea to say - OK I want to move around for 5mins, take this off me please and we will put it back on shortly.
I had an antennae with Jenna and it was so bizarre ;) Even though I had an epi, I could still feel everything (just not much pain) so I could feel this little thing wiggling around down there. Lucky I didn't want/couldn't move, so it wasn't an issue.
I would have thought that the CTG would be worse as it stops working everytime you move. Pain in the bum things!!!

Anyway - it sounds like you have the right attitude of compromise. After all, they may be policy "nazis" but they are just after you and the baby's best interests health wise (just maybe not mentally/emotionally wise).

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Easy Christy you can just say NO. Policy does not = LAW and unless there is a compelling reason for it... they cant strap you down and monitor you...

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Even if there is, what is perceived to be a compelling reason, you still have the right to say no. I can't speak for any other hospital other than my own - but where i work we do our best to negotiate with the Doctors about monitoring. Unless there are concerns with the trace i don't see why there would be any issues with intermittent monitoring. We usually like to get at least 15 minutes of reactive tracing per hour.
Moving off the bed is always possible with monitoring, however it can be difficult with external monitoring as the movement often causes the tranducer to move and consequently loses the heartbeat, so depending on how relaible the external monitoring is proving to be, they may recommend to put a scalp clip on, A tiny bit of wire is slipped in just under the skin on babes head and provides the most reliable form of CTG monitoring and allows women to move more freely without feeling so tied up to the machine. We remove the clip as babes head is born and they may be left with a small scratch on their head but often this is only just noticable or not at all noticable.
The most important thing is to do as you feel and what is going to make you satisfied with your birth experience. If you feel very strongly against monitoring then stand up for that belief. :D

Ahhh I didnt mean a compelling reason to be forced... shoud have worded that better...

I know you already are Christy but make sure you are well versed on the real risk of rupture so you can say no with confidence.

Some advice from Justine Caines (policy co-ordinator for Maternity Coalition):

Tell them that you are saying no and the risk of spontaneous abortion (at 1-2%) following amniocentesis is higher than rupture from VBAC - and rupture is not always fatal. Some doctors / midwives need to put the "risk" into perspective but instead some of them persist with it. Meet them head-on re the evidence and ask THEM why with the 1% risk of rupture they maintain these ridiculous protocols. Ask them where is their evidence? What are the relative risks of repeat C/S? Ask them to demonstrate that they know the comparison. You can get support, try the Maternity Coalition and they will help. Cas McCullough has just launched CANA. If you want an advocate I am sure Cas could assist in some way.

>> Hope that helps Christy - its good advice. Personally, I dont like fetal scalp monitors, I have seen them fall out and have to be reinserted etc. My mum had one when my sister was being born, it fell out but they didnt know and actually told her my sister was dead :O My poor mum...

Hi Christy

I have never done and will never do constant foetal monitoring. Research has shown that the only outcome from constant foetal monitoring is a very much higher rate of unnecessary medical intervention. We are talking about your body. You have the right to decide what they can do. Should the hospital try to put the monitor on you without your permission then that is assault and also a criminal offence. It really annoys me when policies are made by people who have probably never been present at a normal birth, and without ant apparent consideration for, or discussion with, the person that the policy will affect the most.
If you would like I can send you some research papers on this topic. ( If I still have them).

The following is an extract from an article I a few years ago. I hope it is of some use to you.

CARDIOTOCOGRAPH MONITORING
Cardiotocograph (CTG) presents as a good examination tool but can also have a negative impact on the labour due to the women being immobile during monitoring, prolonging labour, false positives and increasing caesarean rates. The CTG monitor can be over used and findings often insignificant. Although the CTG monitor has high sensitivity in predicting the normal foetus, the foetal monitor is not able to accurately and consistently predict a sick newborn (Cabaniss, 1993). Stroup and Peterson (1996) states that the benefits of foetal monitoring are modest and resulted in prolonged labours and gains are achieved at the cost of a higher rate of caesarean section and operative vaginal delivery. Odent (1996) also shares similar viewpoint stating the only significant effect of continuous electronic foetal monitoring was an increase in the caesarean rate. Odent (1996 ) also is concerned that the real threat is a powerful instrument of technology in the hands of those who have not understood birth physiology. Risk factors may be reduced if midwives and health professionals look at the big picture and not base there treatment solely on the result of a CTG. Return to using basic assessment skills and experience and not over using the CTG monitor. Stroup and Peterson (1996) states that a way to decrease unnecessary intervention when CTG's are used is to include better training of clinicians or develop better monitoring techniques such as pulse oximetry. The midwife has a duty of care to the labouring women and as part of that routine care a CTG is often performed this where the ethical dilemma can impact as the midwife knows it's limitations and the possibility of false positives leading the unnecessary intervention. On the other end of the spectrum the CTG monitor can be reassuring for the mother as it confirms normality.



Cabaniss, M.L. 1992. Fetal Monitoring Interpretation. J.13 Lippincott, Philadelphia.
Stroup, T.S. and Peterson, H.B. 1996. Routine intraparturn electronic fetal monitoring decreases neonatal seizures but increases operative deliveries. MIDIRS Midwifery Digest. 6(3).
Odent, M. 1996. Kitting needles, cameras and electronic fetal monitor. MIDIRS Midwifery Digest. 6(3).

OMG Christy

Heres what I experienced and it was only when I had the Epi that I had to have the internal Fetal monitor and be in the bed at all times.

1. what was involved in your fetal monitoring? i.e. doppler, trace, "antenna" etc?
When I was inducted and waters were broken and I was only monitored externally twice by a trace for 30mins each that they strap to your belly to make sure she was handling the contractions ok until I had the Epi. Ohh they used the doppler twice on me when I was in the bath.

2. Were you able to have intermittent monitoring? see above

3. Did you know ahead of time what was available to you? Had you made decisions prior to labour? No I didnt know but stated in my birthplan I only wanted fetal monitoring internally if it was necessary and told them to ask for my consent first.

4. Did you find it useful? or just more scary?

When I had the Epi I was scared at first about them putting it on her head, however it was a relief when I was going from 4cm - transition as I wanted to know how she was handling the contractions and based on my compilications during labour it was necessary at the late stage as her heartbeat dropped at one stage considerably and scared the crap out of us and I asked for an internal to check on her and Im glad I did as they figured out things were not progressing as they should be and I may have to consider a c/s. Then when I was in transition and pushing and she got stuck in my pelvis it was a good thing to monitor how she was going it was necessary and I had to have emergency c/s.

Hope this helps.
Bel
xxx

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Tell them that you are saying no and the risk of spontaneous abortion (at 1-2%) following amniocentesis is higher than rupture from VBAC - and rupture is not always fatal. Some doctors / midwives need to put the "risk" into perspective but instead some of them persist with it. Meet them head-on re the evidence and ask THEM why with the 1% risk of rupture they maintain these ridiculous protocols. Ask them where is their evidence? What are the relative risks of repeat C/S? Ask them to demonstrate that they know the comparison. You can get support, try the Maternity Coalition and they will help. Cas McCullough has just launched CANA. If you want an advocate I am sure Cas could assist in some way.

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I love that!!! That is awesome. I would love to see a doctors face as a woman sat there and told them that!!!!! Kind of puts it into perspective doesn't it - the risk kind of doesn't matter if it's a medical intervention but if it's a 'risk' to do with refusing a medical intervention then it's the worst thing in the world!!

Thank you all. DH & I had a big talk about this last night & we decided we would go in together to our 38 week appt and take a big stand. We will be together for strength & say that we will agree to certain amounts of monitoring on our terms. We will also be printing out some of the info given to us and handing it over to add to our birth plan with a written statement signed by both of us about monitoring.

I truely feel that it is my biggest fear to be forced into continuous monitoring, but now that we've identified it, we are able to make our decisions regarding it & what we are going to do about it.

Thanks again!

YAY Christy, I had a tear in my eye as I read that. Good on you for going in there together, I am so proud of you! You know I will be there for you for strength too, I am booked to come from the 26th-1st Nov but you know you can call me anytime and I will come right on back! Hang in there hon, you will feel such great accomplishment within yourself once you realise how much power you do have. No-one can take your pulse without your consent, the same goes for this monitoring... HANG IN THERE! Be strong - you are woman :)