Foetal Monitoring During Labour.

Hi there,

What are your experiences of foetal monitoring during labour? I'm working on my birth preferences at the moment, and am definitely do not want to have any kind of continuous monitoring of my baby during birth. If faced with the situation where a midwife is demanding a heartbeat check, what are my options? Could I suggest a doppler instead, so that I could keep moving? Could I refuse intermittent monitoring, as I could with an internal examination? Apologies for my naivete - I'm just trying to think of ways to compromise if faced with a bully in the birthing ward (which I really hope will not be the case at Frances Perry)!

I had both of my girls in the birth centre and had intermittent monitoring with a doppler. I had water births and one of the MW's accidentaly drowned the doppler coz she forgot that it wasn't one of the waterproof one but that is the only thing that can make it difficult for them to monitor bubs with a doppler. You have the choice as to how you are monitored so you can tell them you want to be monitored with the doppler rather than CTG.

I had monitoring and was still active ... they put the monitor on me and every now and then they'd plug it in...

I think it gets down to if you're having an OB then they aren't comfortable without the high-tech gadgets, whereas midwives are a bit more relaxed?

My best advice for you with the birth plan is to start with best case scenario, and then put in trigger points at which point you want stuff to happen and not before. Cause I think that saying stuff like "I will have no painkillers" is setting yourself up for failure if you need them cause your body's been working really hard and you just need a rest?

Good luck!!!

Just like anything else done during labour you can refuse continuous monitoring. It isn't usually a big issue because many women now request intermittent monitoring with a doppler so you won't really be pushing them out of their comfort zone too much.

One thing to think about though is even for mums having doppler monitoring they will usually want to do a 20 minute trace on CTG when you are first admitted. Again you can refuse this if you like, or tell them you wish to have it while you're sitting on a birth ball so that you can remain upright. Many women find lying on a bed for 20 minutes excrutiating because we're not built to labour on our backs.

Hi there!

No such thing as silly questions on here! i think it is awesome that you are preparing in this way.

I was monitored for 20 minutes when i first came in and again when i went into active labour (i went in with broken waters but no active labour). i was on the machine that straps you in. this wasnt an issue when i wasnt yet in labour, but when my contractions were 2 mins apart those 20 minutes were pretty yuk. and next time i will ask for mobile monitoring ITMS...

good luck with the birth plan (and the birth!!) :)

I was never put on a CTG machine and I had a 17 hour labour. Different hospital though. I only had gas & peth, it might make a difference if you have an epidural (don't know).

I didn't have CTG either. But they did occasionally listen to her with the doppler, particularly in the second stage as for me that took around 1.5 hours. They'd listen to her after every contraction.
I think you're well within your rights to ask to not have the CTG.

Thank you so much for all your responses! I'm preparing for a natural and active birth, so I am happy to hear that there are less restrictive methods of checking up on baby during labour. I think that if the option exists to refuse even intermittent monitoring (if all is going well), then that is something I would prefer to do. I think, for me personally, monitoring or internal examinations would just put the pressure on. It's so nice to be reminded that when you do enter a hospital to give birth you aren't just at the mercy of protocol and procedure, and you are able to exercise your right of choice. Thank you!

It's a good idea to stay at home for as long as you can in that case ;)

Intermittent fetal monitoring with a doppler is standard at hospital or home, so if you are talking about continuous CTG, then the studies all say that all that results in is higher c/s rates without improving outcomes. So why is it used? Well, if they get sued, they have proof on record that there was something on the read out that concerned them, so they did something about it.

Here here Kelly!!! Beautifully said!!!!

I was induced as my waters broke and I couldn't go into labour so I had to be monitored continously on a CTG. It was hospital policy and I couldn't get out of it (and I work there, GGGRRRRR!!!!!!). I still had an active upright labour and spent hours in the shower.

Fingers crossed you get a much much better response than I did and you get your intermittent monitoring.

continuous fetal montinoring or CTG's has been introduced into 'standard' care in labor for a variety of reasons (inductions, epidurals. percieved risk)...but there is not any evidence based practise for this...CTG's increase medical intervention but do not increase health outcomes for mother and baby

intermittent monitoring remains the best way to check your baby during labor, most mw's will want to check this every 15 mins or so once you are in established labor

x

I had an induction and ended up with continuous monitoring. When I tried to get up bubs heart rate kept dropping. It was also a reaction to the induction drug causing tonic contractions (the drip had to be stopped completely but I went into natural labour). So I stayed on the bed and the monitor the whole time. I ended up in a few different positions but probably wouldnt have argued anyway. It was pretty scary having the heart rate alarm go off and lots of people pour into the room. But it wasn't a usual labour.

You have the legal right to refuse ANY intervention that you don't want!

I hear where you're coming from, however, I'm so very grateful that they did want to check bubs heartrate cos it turns out it was dropping to 40 bpm after every contraction. The only internal I had was after they saw this happening continuously to check where he might be. He was still sitting up high. So we had some intervention, still had VBAC though but like I said, very grateful for the fact they did like to do a check. Just another view :)

With delivery #5 (my fourth induction) I was told I would have to have continuous monitoring. I was a bit cross because this wasn't the case with my other inductions. My sister was with me and she suggested that we make sure we place the belts so that I could still move, and indeed this was possible, even though at times my sister had to lie across the bed and hold the transducers inthe right spot!

I'm glad in the end I had it on, because one very comfortable position (on the birth ball) led to some kind of issue for the baby and I had to move to get the heartbeat back to a favourable trace.

I'm generally not in favour of continuous monitoring, however.

This may be a silly question, but may I ask the reasons for not having continual monitoring if it's suggested? I too am starting to look into birth plans and whatnot, but am very much a "if the doc/midwife suggests it I'll do it" type gal.

Tutmae, Often continuous monitoring requires laying flat on your back for the whole labour. Intermittent monitoring allows for more movement thus making things faster and more natural. Many continuous monitoring systems aren't waterproof which also restricts natural pain relief options. Unfortunately some middies and drs like to do things by the clock and like to over-medicallise births. Pregnancy is not an illness to be treated, it is a medical condition to be supported and allowed to progess naturally, unless there is something that is actually wrong. Intermittent monitoring does provide an accurate picture of what is happening because it is doen both during contractions and between them. HTH

Cheers Alioops. I didn't realise it was so restictive!! I don't know what I would do if I couldn't spend at least a bit of the birth in the shower!!
Thanks for the help :)

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This may be a silly question, but may I ask the reasons for not having continual monitoring if it's suggested? I too am starting to look into birth plans and whatnot, but am very much a "if the doc/midwife suggests it I'll do it" type gal.

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Aside from the extremely restrictive nature of constant monitoring, there is a good deal of evidence that use of it during a normal labour increases your risk of ending up with a caesarean. And the kicker is that it does not lead to more healthy babies.

Intermittent monitoring by hand held doppler has been shown over and over again to produce as good outcomes as continuous monitoring - without restricting the mother and without making her more likely to end up in theatre.

So why do they want us to use it? Because as kelly pointed out in another thread, it spits out a black and white record of everything that happened to the baby during that labour. A record that protects their backsides.

It's scary, but there are alot of practices used in obstetrics that aren't based on best evidence. And that aren't motivated by what's best for mum and baby. While we'd like to think that all hospital policy on this stuff is driven by good evidence, and by the needs of mum's and babies...hospitals are big institutions trying to deliver a service. So they're not just driven by you and your needs - they're driven by limiting liability, staffing issues, budgetary constraints - lots of other stuff that can end up impacting on you at a time when you're least likely to be able to negotiate around it or fend it off.

After I had a a lot of bleeding in pre-labour,I had continous monitoring for most of my labour (which, thankfully, was only 3 hours). I wasn't allowed to get off the bed (I remember begging the midwife at one point to just let me walk, just for a few minutes, but it was a no go). It made it a really excruiating experience.

Having said that, I'm glad I had it. My baby's heart rate had dropped to 40 bpm and wasn't coming back up. I had no idea anything was wrong, and I was given an option of getting him out in two pushes or going for a c-section (I managed to push him out myself and he was bright blue). I can see the argument against my point- that I might have been one of those women that ended up with an unneccasery caesarian, but better to be safe than sorry.

It's one of those things that in some cases is not only neccesary, but highly advisable. In a normal labour, no, but if anything starts to go wrong, don't hesitate to use the technology that we are so lucky to have available to us.
Best of luck with your birth experience :)