# Refusing Continuous Fetal Monitoring



## pageta (Nov 17, 2003)

So what would happen if you refused the continuous fetal monitoring that they insist upon doing for thirty minutes after you arrive at the hospital?

This is the issue I have with it. It is general knowledge that your blood pressure is different if you are lying down, sitting up, standing, or moving around. Likewise, contractions feel different based on what position you are in. In order to be monitored with their little machine that gives them their nifty printout, you have to lie down on a bed and not move for fear that the sensors will fall off and the nurses will come down to your room all in a huff to re-place them. But in reality, all that CFM is doing is telling them how the baby handles contractions you have while lying down and not moving. It doesn't tell them how the baby does when you're moving around, on your hands and knees, or in whatever position feels best at the time. And instinct would tell me that the baby would do best in the positions the mother tolerates best.

I have no problem with them running up and down the hall with me monitoring how the baby is doing (if what I want to do is run up and down the hall). Basically, it's fine with me for them to monitor the baby's heartbeat as long as they follow what position I want to be in rather than forcing me to be in a position that is convenient for them (like having to deliver on my back with my feet in stirrups).

So what would happen if I refused the monitoring? What are my options in regards to the issue of fetal monitoring?


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## Emilie (Dec 23, 2003)

I would discuss these concerns with your mw/ob/care provider and the hospital staff- sooner than later. You do have a right to refuse many procedures..... these are such the procedures that contributed to me wanting and having a hb. ( they also have the right to act crabby and bitchy and mess up the vibe imo)

i like common sense!duh.

btw my son is your sons age- 6-25-03.... and dd was born last november....

good luck!!!! that is one procedure of many i would be refusing....
hugs and congrats!!!!!!


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## arlecchina (Jul 25, 2006)

well...they forced me. I said no to all of it, ESP the internal monitoring, but they completely ignored me. was the only time in labour I kicked and screamed and threatened to sue...water breaking, detal monitoring. they honoured nothing.

then again I had a very horrible experience all around - so I dont know if what I say is anything typical although I have heard as bad and much worse.


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## JanetF (Oct 31, 2004)

Consent is a dodgy thing in the hospital system. For lots of women saying no doesn't mean NO it means "Ok so we'll send other people in to pressure you" or "We'll do it anyway and who cares if the woman screams?!" There is no scientific evidence to support CEFM but a lot of evidence that it causes unnecessary c-secs. Theoretically it's *your* body and it's assault if they put something on or in you without your express permission. In reality, this is hard to prove and pretty meaningless when you're in strong labour and unable to fend them off. If you can't give birth safely at home where none of these things are an issue, make your wishes VERY plain ahead of time and even then only use the hospital as a pushing venue. We know that the later you go in labour the fewer interventions are possible and being in the hospital no longer than the space between when they like to do VEs reduces your chances of stuff happening significantly. Take a doula with you who is experienced at running interference to distract the staff, give them a birth plan and have it attached to your record so it's pulled when they hear you're coming in, take more copies and attach them to the door of the room, the head of the bed and hand them out like party invitations. Your mental health, and the physical/emotional health of you AND your baby are too important to risk to the lottery of the hospital system so you need to take steps to protect yourself. You may fluke excellent staff but it's likely you won't. Be prepared! Or just give birth at home where no one has machines that go ping and there's no OR lying in wait to swallow you up...

http://www.gentlebirth.org/archives/vbacjjg.html

Quote:

Most hospitals require you to have an IV and an external or internal fetal monitor. These inhibit mobility, and make you feel like there's something wrong just by their being there. Obstetricians believe that these monitors provide a more accurate record of the baby's heart rate, thus guaranteeing safer outcomes by providing the opportunity for quicker intervention. The monitors do provide very detailed information, but machines can and do malfunction, showing distress where there is none. A. Prentice and T. Lind surveyed monitoring trials and reported their conclusions in the journal Lancet in 1987. They found that "many mothers will have operative deliveries for "distressed" babies who show no such distress at birth" (Korte and Scaer 111). These researchers also noted that Van den Berg et al. reported that 71-95% of babies diagnosed as distressed during labor show no distress at birth. *In other words, the monitor provides a "false positive" up to 95% of the time, and ! ! mothers undergo all the risks of surgery for nothing* (111).

In a groundbreaking study done by Dr. Albert Haverkamp to assess the worth of external fetal monitoring, the results of a study group of 483 mothers showed that among those who had an external fetal monitor, the cesarean section rate was 2 1/2 times as high as it was in the group which had auscultation. However, there was no corresponding increase in the rate of problems for the monitored babies (Jones 15-16). These results surprised Haverkamp. Several other studies have verified this outcome. *The EFM does not make your baby safer; it simply increases your risk of having surgery, which in turn, greatly increases your risk of injury or death, as described above. Another EFM study even found that the monitor did not improve neurological health outcomes for premature babies (Korte and Scaer 111), who certainly fit the definition of high risk, which is what the monitor was designed for originally!*


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## Emilie (Dec 23, 2003)

have you considered a homebirth mama?


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## hopefulfaith (Mar 28, 2005)

I didn't present to the hospital (intentionally) until I was at 8 cm and belly dancing around the room, so a "good" CFM strip was laughable. I allowed my (very wonderful) nurse to do her thing for the first few minutes, and let her get a print-out of some good contractions...and then I told her that I was taking it off and she could spot-check the baby's heart rate periodically.

She simply smiled and said "That's all I need to hear you say. I can't do anything against your will." We smiled at each other. I let her do what her job required, and she let me do what I needed to do.

Just my experience and thoughts. The belt was slipping off with my movement around the room, and no way was my labor going to focus around keeping that silly thing on.







I know the dearth of supportive research behind the CFM bit, but I was okay with a few token minutes of it when I knew my baby and I were just rocking it out together.


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## maxmama (May 5, 2006)

It's not true that you need to lie down for EFM. Anyone who tells you that you do isn't very good at keeping babies on the monitor. We continuously monitor moms on pit walking around on telemetry and get very good at it.


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## earthmama369 (Jul 29, 2005)

I had no problem with refusing the initial monitoring when I got to the hospital with ds. I told them I wanted to get right in the tub and they had about 5 minutes to do their thing, a nurse took one look at my face, saw that I was concentrating very hard on what I was doing -- having a baby! -- and she listened with a handheld doppler for a few minutes and off I went. They wrapped the end of the doppler in plastic and checked me in the tub a few times, but never bothered me about getting out of the tub for monitoring and were good about maneuvering around me to get a reading instead of asking me to change positions when I didn't want to.


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## MamaTaraX (Oct 5, 2004)

I haen't read replies but I wanted to say that if nothing else, external monitoring CAN be done while you are moving around, you just can't go to teribly far from the thing. You can ask if you can do it via telemetry too. (sorry for such a brief answer, kids climbing on me)

Namaste, Tara


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## ~member~ (May 23, 2002)

Quote:


Originally Posted by *arlecchina*
well...they forced me. I said no to all of it, ESP the internal monitoring, but they completely ignored me. was the only time in labour I kicked and screamed and threatened to sue...water breaking, detal monitoring. they honoured nothing.

then again I had a very horrible experience all around - so I dont know if what I say is anything typical although I have heard as bad and much worse.









: Me, too. Even refused the c-section, so they shot me in the arm and knocked me out.







:


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## alegna (Jan 14, 2003)

In theory you CAN refuse everything but you've heard from pps how well that goes. Honestly, short of a major emergency I will never birth in a hospital. It's just too risky for everyone.

-Angela


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## Patchfire (Dec 11, 2001)

I'm never going to test this theory, but here's my thoughts.

The monitoring is hospital policy, in all likelihood. Talking to your care provider ahead of time will not get the policy changed, in all likelihood. A nurse runs the risk of getting written up.

So, my theory is thus: don't sign the general hospital consent form. Have a durable healthcare power of attorney made for your dh or whomever you wish to have the power to sign a consent form should you be knocked out/passed out/whatever. Basically, then, in theory, you'd have to sign a separate consent form for everything.

However, my theory is also predicated on the idea that you don't talk about this ahead of time, and then you're in labor, and then they can't deny you care. Since you haven't signed any 'consent' forms, though, then they're open to suit or legal charges... this is my theory. I don't know how it would really play out and honestly I think homebirth would be a heck of a lot easier!







I realize that it may not be an option for some reason though, so. This is what I've pieced together in my head from reading various thoughts and suggestions in several places.


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## Pandora114 (Apr 21, 2005)

umm what's stopping you from taking the belt off and walking around. If you are in active labour they can't really kick you out now can they?


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## wannabe (Jul 4, 2005)

What reason do they give for not monitoring you in whatever position you adopt? I mean, what's the point of telemetry if you're in one spot?

Yes, the monitors might need more adjustment, but that's their job, not sitting in the nurses station having tea and biccies. They're supposed to be kneeling next to you in the shower holding the monitor on as you try and get the water on the sore spot. But you do need to stay within a certain distance from the base station - for me it was the whole floor of the hospital.


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## Codi's Mama (Jun 15, 2006)

Quote:


Originally Posted by *Pandora114*
umm what's stopping you from taking the belt off and walking around. If you are in active labour they can't really kick you out now can they?

I tried this. Just to go to the bathroom and I wasn't even in active labor, my water just had a "hole" in it (from the sOB doing a vag. exam at her office that morning). The nurses(2) scurried in, chastised (sp?) me for taking it off, put it back on and tucked me back into bed. They said I "needed" to keep it on to monitor the baby. I'm sure it was just "hospital policy" bs that they come and bully you into.
I would definately try for a hb if I were the op. It's what I'm doing next time for sure! Otherwise, get someone who'll fight for you. I've found it's very hard to fight them while you're in labor and they've had so much practice.


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## Pandora114 (Apr 21, 2005)

Quote:


Originally Posted by *Codi's Mama*
I tried this. Just to go to the bathroom and I wasn't even in active labor, my water just had a "hole" in it (from the sOB doing a vag. exam at her office that morning). The nurses(2) scurried in, chastised (sp?) me for taking it off, put it back on and tucked me back into bed. They said I "needed" to keep it on to monitor the baby. I'm sure it was just "hospital policy" bs that they come and bully you into.
I would definately try for a hb if I were the op. It's what I'm doing next time for sure! Otherwise, get someone who'll fight for you. I've found it's very hard to fight them while you're in labor and they've had so much practice.

So I'd look at them, take it off and say "Yeah whatever, get this thing off of MY body"

I'd keep taking the damn thing off. I'm not joking. It's my body, it's just velcro. Screw them.


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## AllyRae (Dec 10, 2003)

I echo the above posters that you can be monitored in any position (even underwater if they have the appropriate monitor). If you refuse monitoring, it will most likely be used against you if something God forbid were to happen to you or the baby during delivery (even if it were later found to be an error on the staff's fault and nothing to do with the heartrate during labor). That responsibility is something you have to know ahead of time that you're willing to take.

However, for the most part, hospital policy usually trumps your refusal. That's why I ended up with pitocin against my wishes, which ended up causing a lot of (most likely preventable) problems... As long as you're in their building, they will end up doing what they want unless you have it signed ahead of time by your OB that it's not necessary. Or unless you say "I do not consent to continuous monitoring while on my back and any attempt to do so against my wishes will be met with questioning from my lawyer"


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## hajenkatt (Jul 10, 2005)

Not to hijack--but has anyone had the internal fetal monitoring, and what positions were you able to achieve with it?


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## alegna (Jan 14, 2003)

Quote:


Originally Posted by *hajenkatt*
Not to hijack--but has anyone had the internal fetal monitoring, and what positions were you able to achieve with it?

I don't think there's any situation where I would allow internal monitoring. Not exactly what you asked, but my thoughts....

-Angela


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## arlecchina (Jul 25, 2006)

Quote:


Originally Posted by *Pandora114*
umm what's stopping you from taking the belt off and walking around. If you are in active labour they can't really kick you out now can they?

I did that when it was still external. I had to piss and had call light on for an hour, they'd told me I was not to get up. so I waited. finally yanked it off and went and the bitch came back in. she screamed at me and at my family for "allowing" me to do that. shortly after, they broke my waters and did an internal. against my will









they cna and will punish you for what they think you're doing wrong. you're not in much of a position to argue at the time


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## time4another (Mar 28, 2005)

This is why this time I'm having a homebirth.

I had it the CEFM with both girls pretty much and tried to get out of it with DD2 but it didn't work. I do have in my hospital birth plan (aka don't let backup MedWives know I *am* doing a HB) that I will not consent to being monitored laying down (which they will 'allow'







) and only one "strip" done upon admission and Doppler after that. But I also have in that birthplan that I plan on spending as much time laboring at home as possible too (yeah, laboring all the way at home







)

Heather


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## bhawkins (Jun 5, 2005)

Quote:


Originally Posted by *hajenkatt*
Not to hijack--but has anyone had the internal fetal monitoring, and what positions were you able to achieve with it?

From an L&D nurse perspective, internal monitoring is BAD! Do not allow it. Not only are you truly tied to the bed (unlike external monitoring), it is attatched to your baby's head, which can leave a mark, easily get infected, etc. We never use internal monitoring with a patient whose going natural. That would be an oxymoron


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## maxmama (May 5, 2006)

We only use scalp clips (nternal monitoring) if there's a problem, so walking around is not likely then anyway. But I guess it could be done.


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## AllyRae (Dec 10, 2003)

Quote:


Originally Posted by *bhawkins*
From an L&D nurse perspective, internal monitoring is BAD! Do not allow it. Not only are you truly tied to the bed (unlike external monitoring), it is attatched to your baby's head, which can leave a mark, easily get infected, etc. We never use internal monitoring with a patient whose going natural. That would be an oxymoron









Um...







: As an L&D nurse, you should realize that there are reasons to allow internal monitoring. It was the "do not allow it, it's very bad" mentality that echoed through my head as my son's heart rate was crashing and I finally had to stop refusing the internal monitor. As a general practice, no, that wouldn't be the choice, but there is a time and place for it (medical professionals really do have to learn what that time and place is though rather than using high tech devices as a universal precaution)


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## hopefulfaith (Mar 28, 2005)

Quote:


Originally Posted by *AllyRae*
As a general practice, no, that wouldn't be the choice, but there is a time and place for it (medical professionals really do have to learn what that time and place is though rather than using high tech devices as a universal precaution)

You hit it on the head, sister. I think there is a time and a place for high-tech intervention. Technology can save lives; I can name babies who I know have been (I am also a nurse). God willing, were I in the situation where I needed it, my baby would be saved by it, too.

...But high-tech devices as a universal precaution (and I love that phrase!!) -- nope. Can EFM/IFM be used inappropriately? Absolutely. But I decline to categorically write off its use in every situation. (Flames welcome.)

I knew I was having a normal birth. My care providers knew it, too, and there was no [email protected] way I was wearing that belt. But I don't think it's evil in every circumstance.


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## maxmama (May 5, 2006)

As an L&D nurse, I would never write off internal monitoring. There are times when it's the only way to identify a true decel from monitoring issues with EFM. I'd MUCH rather have a scalp clip that wasn't needed than a c-section that wasn't needed.


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## hajenkatt (Jul 10, 2005)

I was told that bc I am going VBAC that I have to have an internal monitor. I DO NOT WANT ONE, but the OB I saw gave me the whole spiel (sp?) about how external monitors are not accurate at all and that VBAC patients have internal monitors.

Oh, and I have to pee in a bed pan and laboring on my back is better than laboring sitting down in a rocker. Needless to say, all my good vibes about my VBAC crashed that day...god I hope she is not on call that day...


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## maxmama (May 5, 2006)

Quote:


Originally Posted by *hajenkatt*
I was told that bc I am going VBAC that I have to have an internal monitor. I DO NOT WANT ONE, but the OB I saw gave me the whole spiel (sp?) about how external monitors are not accurate at all and that VBAC patients have internal monitors.

Oh, and I have to pee in a bed pan and laboring on my back is better than laboring sitting down in a rocker. Needless to say, all my good vibes about my VBAC crashed that day...god I hope she is not on call that day...

Total crap. Ask for data showing that EFM isn't accurate for VBAC, and then ask why it's used for other laboring women if it's so inaccurate. A scalp clip can be put in in fifteen seconds if you need it. Also, there's NO reason to keep a VBAC on bed rest. It's just a good way to encourage another section. We don't treat our VBAC patients any differently from anyone else, except that they have EFM instead of auscultation and get a hep lock. Otherwise, they walk, they tub, they do whatever they want, and our success rate is the best in the city.


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## hajenkatt (Jul 10, 2005)

Quote:


Originally Posted by *maxmama*
Total crap. Ask for data showing that EFM isn't accurate for VBAC, and then ask why it's used for other laboring women if it's so inaccurate. A scalp clip can be put in in fifteen seconds if you need it. Also, there's NO reason to keep a VBAC on bed rest. It's just a good way to encourage another section. We don't treat our VBAC patients any differently from anyone else, except that they have EFM instead of auscultation and get a hep lock. Otherwise, they walk, they tub, they do whatever they want, and our success rate is the best in the city.

I agree and the more I have reflected on what she said the more irritated I have become. This is the ONLY practice in the entire city that takes VBAC patients, and my primary guy has been awesome. I have been trying to meet all the other "faces" but will go back to him next week to repeat some of my hard core questions bc I am not groovin' on what she said. I have no problem with the hep lock, but hell if I am going to be stuck on my back. I want to labor at home as long as possible, but we are SO far out in the wilderness that I am afraid I will either go in too early or have the baby on the side of a cliff.

Does anyone have a web resource on different positions for laboring that I could print out and take with me?


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## Emilie (Dec 23, 2003)

Oh mama.... I hope you find something.... I am not sure....
Someone will know tho. YOU are the mom. You can refuse anything. Please do. Switch providers if you can.


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## JanetF (Oct 31, 2004)

The question is why is EFM used on ANYONE because it doesn't work!

See above...

Quote:

In a groundbreaking study done by Dr. Albert Haverkamp to assess the worth of external fetal monitoring, *the results of a study group of 483 mothers showed that among those who had an external fetal monitor, the cesarean section rate was 2 1/2 times as high as it was in the group which had auscultation.* However, there was no corresponding increase in the rate of problems for the monitored babies (Jones 15-16). These results surprised Haverkamp. Several other studies have verified this outcome. *The EFM does not make your baby safer; it simply increases your risk of having surgery, which in turn, greatly increases your risk of injury or death, as described above. Another EFM study even found that the monitor did not improve neurological health outcomes for premature babies (Korte and Scaer 111), who certainly fit the definition of high risk, which is what the monitor was designed for originally!*


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## bhawkins (Jun 5, 2005)

Quote:


Originally Posted by *AllyRae*
Um...








: As an L&D nurse, you should realize that there are reasons to allow internal monitoring. It was the "do not allow it, it's very bad" mentality that echoed through my head as my son's heart rate was crashing and I finally had to stop refusing the internal monitor. As a general practice, no, that wouldn't be the choice, but there is a time and place for it (medical professionals really do have to learn what that time and place is though rather than using high tech devices as a universal precaution)

I do realized there are reasons to allow it. However, I do not understand why you received internal monitoring when your son's HR was crashing. If you could see it crashing with EFM, why did the scalp lead need to be used? The only times I've ever seen internal FM useful is with morbidly obese pts, where using EFM is extrememly challenging.


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## pageta (Nov 17, 2003)

I think monitoring is appropriate and necessary if you are having an augmented birth or if you have taken any pain medications because your hormones are no longer in control and they need to make sure THEY don't do something wrong.

It's the routine "you have to be on the EFM for 30 minutes when you arrive at the hospital" that I have a problem with. I just wrote on my birth plan why I think the information gained isn't useful or necessary (IFM is fine with me as long as they follow me and don't make me pick a position that suits them), and then I was quite honest and said that I will tolerate very little if any such monitoring. They can consider themselves warned.

Unfortunately, where I live, a midwife attended homebirth is illegal, or believe me, I would be having one. I am fully prepared for an unassisted birth, but if DH is home when I birth, he is terrified of birth and I do not think I will be able to relax sufficiently with him around. So I am also preparing for a hospital birth where DH, at least, will be more relaxed.

I had both external and internal monitors with ds. I had the external when I first got there and through the night because they gave me morphine for prodromal labor. Then in the morning I ended up with an epidural because I was still 3 cm and reached the end of my tolerance for pain. I remember that stupid EFM just kept falling off every time I moved, even if I thought it was an "innocent" move. The IFM didn't have that problem, though at that point, they were moving me.

I just dread CFM, but every doula tells me that it's hospital protocol and there's no way I'm going to get out of it unless I get there when I'm 8 cm (which is my plan anyway, but we all know how plans go with birthing).


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## AllyRae (Dec 10, 2003)

Quote:


Originally Posted by *bhawkins*
I do realized there are reasons to allow it. However, I do not understand why you received internal monitoring when your son's HR was crashing. If you could see it crashing with EFM, why did the scalp lead need to be used? The only times I've ever seen internal FM useful is with morbidly obese pts, where using EFM is extrememly challenging.

I asked those same questions too--they said they thought it was just the monitor not catching the baby because it kept slipping (I didn't think it was slipping, but that's what they said). So, they tried the internal (which they claimed was malfunctioning because his HR was in the 60's on it...







: So, they reinserted a new one and it went up to 90...they claimed "oh, look, it was just a bad monitor!" when even I know that sticking *2* leads into a baby's head stimulates them because it stresses them out).

But anyhow, yeah. And I'm not obese (I'm pretty petite and even 41 weeks pregnant was only 158 lbs). But then again, there's not a whole lot that happened during those 5 hours that I actually agree with, obviously... Then again, I wish you were my nurse that day because it sounds like you probably would have done a crash c-section instead of fiddling with the stupid IM leads...


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## rozzie'sma (Jul 6, 2005)

I had an IFM, you can't move AT ALL. Well I could tailor sit or lie down. It was done without even informing me and against my consent because I was taking off the EFM and PO the staff. And not every hospital has telemetry so it is not true that you can always walk.


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## bhawkins (Jun 5, 2005)

Quote:


Originally Posted by *AllyRae*
I asked those same questions too--they said they thought it was just the monitor not catching the baby because it kept slipping (I didn't think it was slipping, but that's what they said). So, they tried the internal (which they claimed was malfunctioning because his HR was in the 60's on it...







: So, they reinserted a new one and it went up to 90...they claimed "oh, look, it was just a bad monitor!" when even I know that sticking *2* leads into a baby's head stimulates them because it stresses them out).

But anyhow, yeah. And I'm not obese (I'm pretty petite and even 41 weeks pregnant was only 158 lbs). But then again, there's not a whole lot that happened during those 5 hours that I actually agree with, obviously... Then again, I wish you were my nurse that day because it sounds like you probably would have done a crash c-section instead of fiddling with the stupid IM leads...

Wow! That's so sad that they wasted precious time putting on scalp leads when they should have just been getting your baby out


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## orangebird (Jun 30, 2002)

Quote:


Originally Posted by *arlecchina*
well...they forced me. I said no to all of it, ESP the internal monitoring, but they completely ignored me. was the only time in labour I kicked and screamed and threatened to sue...water breaking, detal monitoring. they honoured nothing.

then again I had a very horrible experience all around - so I dont know if what I say is anything typical although I have heard as bad and much worse.

That was my experience too. I spent my first hour or so at the hospital fighting and crying and begging and they were total jackasses. If I had only known then what I know now I would have sued their asses (acually I wouldn't have been there in the first place but you know...)


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## mezzaluna (Jun 8, 2004)

i had a hospital birth with OB & doula, and consented to the initial test strip and intermittent after that (though i was only in the hospital less than 4 hours before delivering). i had talked to the OBs at length about it, and the compromise we came up with was that the monitor would be hand-held to me. the l&d nurse was actually an amazing woman - a very soothing presence and totally respectful of my birth plan... so i didn't mind in principle, but the pressure on my belly was sending me into constant contractions... but since she was staying with me she could take a little break if i just couldn't take it, and then get back to it when i was ready. still... next time i want to go without the EFM entirely... it sounded ok before i knew what labor would be like for me, but it was just a painful part of the experience even despite the very sympathetic nurse.

oh, and i was sitting up for it.

the one good thing i will say about it is that it became very motivating to feel the nurse have to check lower and lower on my belly for the baby's heartbeat! but there were plenty of other indications that labor was going great for me.


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## wannabe (Jul 4, 2005)

Quote:

However, for the most part, hospital policy usually trumps your refusal.
That's why interviewing your care provider and hospital very carefully is so important.


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## FrumDoula (Jun 10, 2003)

As a doula, I once RECOMMENDED internal fetal monitoring for a high risk patient. She had far more mobility than with an external monitor because she had to lay perfectly still in the position of their choice. It became ridiculous. CFM was completely appropriate for her, given her multiple medical conditions, so I suggested an internal monitor.

She had lots more options, and was able to sit, lie, rock, and stand next to the bed. All in all, it worked out well.

I suprised myself by recommending it, but felt it was a decent suggestion, and stand by it. You never know. Every intervention has a purpose in some way if used appropriately.

Alison


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## Swirly (May 20, 2006)

I switched mid-pregnancy from an OB to a mid-wife in the same hospital (insuarnce would nto pay for home or birth center birth). I had two doulas. I had discussed all my wishes ahead of time extensively. The mid-wife and senior doula told me to leave my birth plan at home, as it annoys staffers. (I should NEVER have listened to that).

Anyway, my water broke before labor started at home, and was heavily meconium stained. That threw all of my plans out the window, as I had no idea what to expect or who to believe, as I had not studied that scenario.

The evil b*tch of a nurse at the hospital insisted on doing an IV immediately and hooked me up to every monitor known to man. I got the IV taken down to a hep lock, and got up and kept taking off the monitors so I could move around. We *told* her we were going to do that and she kept coming back in and having a fit. The mid-wife came down after several hours (I was way pissed about her taking so long to come see me), and she basically told me if I didn't accept pitocin to get my labor going better and accept the monitors, that she would turn me over to an Ob for a c-section. I still don't know if that was justified or not. Was the baby in danger due to the meconium? My birth ended up beign attended by two mid-wives and 3 doulas! After 3 and 1/2 hours pushing, she came out and was not breathing, had to be intubated. So, I will never know if all the interventions in my birth were necessary or if they just made the birth experience miserable for me. I do know that using mid-wives prevented what would have been a c-section with a doctor. They also respected my desire to not have an epidural or episiotomy.

Also, since they "strongly suggested" I leave my birth plan at home (and my birth was horrible), my baby was also violated with stupid things like eye goop and Vit K. If I ever have another child, it will be AT HOME.


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## maxmama (May 5, 2006)

First of all, in the absence of orders, your nurse has to follow protocol. It sounds like your midwife dropped the ball here by not coming in promptly and/or amending standing orders.

Second, with thick mec most providers don't allow intermittent auscultation. There are a lot of reasons, but many of them boil down to liability. It's unrealistic in current American health care to think that providers will/can divorce themselves from awareness of liability issues.

Third, meconium is a sign either of stress or of maturity (post-dates babies will almost always have mec). Thick mec does tend to push the pink flag toward red, though.

Intubation can do two things for mec babies: they can be suctioned "deep" (below the cords), and, if apneic (not breathing), they can be ventilated. They're not really related to each other, except that babies who have been stressed (and thus have mec) are more often apneic than babies who are not. (The suctioning is of questionable value to prevent meconium aspiration syndrome, but if mec is visible below the cords then they are more likely to have MAS.)


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## Emilie (Dec 23, 2003)

my baby was 12 days past due date and no meconium.


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## Emilie (Dec 23, 2003)

Quote:


Originally Posted by *wannabe*
That's why interviewing your care provider and hospital very carefully is so important.

ummm.... really?


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## maxmama (May 5, 2006)

Quote:


Originally Posted by *Emilie*
my baby was 12 days past due date and no meconium.

Post-dates in our hospital is 42+ weeks. They almost always have mec, but in that case it doesn't mean much.


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## Emilie (Dec 23, 2003)

that is great 42 plus! wow- that is surprising! in a good way.


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## Kidzaplenty (Jun 17, 2006)

:


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## courtenay_e (Sep 1, 2005)

Quote:


Originally Posted by *wannabe*
What reason do they give for not monitoring you in whatever position you adopt? I mean, what's the point of telemetry if you're in one spot?

Yes, the monitors might need more adjustment, but that's their job, not sitting in the nurses station having tea and biccies. They're supposed to be kneeling next to you in the shower holding the monitor on as you try and get the water on the sore spot. But you do need to stay within a certain distance from the base station - for me it was the whole floor of the hospital.

Unfortunately, in the roughly ten hospitals I work in in my area, one...MAYBE two (but I believe the "maybe" is a no) has telemetry monitors, and they're reserved for the midwifery patients who're using the one room with a bathtub.

Many of the nurses I've worked with do their BEST to get a "strip" with the mama in her favorite position, but have a very difficult time doing so. In the end, with all of the distraction of people and belts and being still "just until they FIND the baby" six or seven times for different nurses, they mostly just acquiese to the 20 minute strip on their back or side, just to earn the other 40 minutes with nobody bothering them. The hospitals refuse to use the doppler, as it then disallows them from putting a paper record in the chart. THere is ONE birth center nearby which is attached to a hospital that DOES use doppler, and boy is a breath of fresh air. Frankly, as they can't refuse you, from the point of view of a woman who provides labor support and is SICK of watching mamas be bullied just because the LAWYERS need a paper record? Don't DON'T sign the general consent. Go in with a RESCINDMENT of general consent if you've already signed one. THen, procedure by procedure, be a pain in the a**. Say, "sure, you're more than welcome to get twenty minutes of the baby's reactions to my contractions...IF you can get them while I'm in a comfortable position. The minute I'm uncomfortable, I change position, period, whether it's good for your lawyers or not" Nope, you certainly won't be making friends. But, as long as they DO check the heart tones for a few contractions once an hour and the baby is fine, that's what matters. NOT that it's on paper. That's for THEIR convenience and legal safety, not for the baby's health and safety.


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## maxmama (May 5, 2006)

Quote:


Originally Posted by *courtenay_e*
Unfortunately, in the roughly ten hospitals I work in in my area, one...MAYBE two (but I believe the "maybe" is a no) has telemetry monitors, and they're reserved for the midwifery patients who're using the one room with a bathtub.

Many of the nurses I've worked with do their BEST to get a "strip" with the mama in her favorite position, but have a very difficult time doing so. In the end, with all of the distraction of people and belts and being still "just until they FIND the baby" six or seven times for different nurses, they mostly just acquiese to the 20 minute strip on their back or side, just to earn the other 40 minutes with nobody bothering them. The hospitals refuse to use the doppler, as it then disallows them from putting a paper record in the chart. THere is ONE birth center nearby which is attached to a hospital that DOES use doppler, and boy is a breath of fresh air. Frankly, as they can't refuse you, from the point of view of a woman who provides labor support and is SICK of watching mamas be bullied just because the LAWYERS need a paper record? Don't DON'T sign the general consent. Go in with a RESCINDMENT of general consent if you've already signed one. THen, procedure by procedure, be a pain in the a**. Say, "sure, you're more than welcome to get twenty minutes of the baby's reactions to my contractions...IF you can get them while I'm in a comfortable position. The minute I'm uncomfortable, I change position, period, whether it's good for your lawyers or not" Nope, you certainly won't be making friends. But, as long as they DO check the heart tones for a few contractions once an hour and the baby is fine, that's what matters. NOT that it's on paper. That's for THEIR convenience and legal safety, not for the baby's health and safety.

Actually, that doesn't meet standards for intermittent auscultation. In active labor, babies are to be auscultated every 15 minutes, with a baseline every 30-60 minutes and post-contraction auscultation every 15. In second stage, the new guidelines are to auscultate every five minutes, which essentially means continuously. 20 minutes every hour doesn't meet criteria for evidence-based practice. there used to be a distinction between high and low-risk moms, but not anymore. A hospital that's getting a strip every hour isn't meeting its monitoring/documentation burden anyway.

If it's truly, as you say, about baby's health and safety, then a once-an-hour strip doesn't cut it.


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## orangebird (Jun 30, 2002)

Quote:


Originally Posted by *wannabe*
That's why interviewing your care provider and hospital very carefully is so important.

Not really IME, Both my doctor and the hospital talked about how they were supportive of my natural birthing plans. It was a supposed "women's birthing center", with the new fancy LDRP rooms. My doctor said he had no problem with my natural birth plan and LeBoyer stuff and all that. But as soon as I showed up at the hospital the nurses did what they wanted, ignored what my doctor had told me he would do and acted nothing like the hospital had bragged about when I had gone on "the tour" months earlier. I don't believe that interviewing means crap. I guess I'm jaded.


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