Question re birth plan - constant fetal monitoring

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Little Miss Hopeful Posts: 1193
Hi just reading recent post re birth plans and I think someone mentioned not having constant fetal monitoring - could someone please explain what that is and why you wouldn't want it. Thanks
GentleBirth Posts: 750
Hi there, Continuous fetal monitoring means you have two straps around your bump during labour which are attached to the CTG machine. Each strap has a transducer that lies against your bump - One measures the strength of your contractions and the other is [i:3h6xfy2c]supposed[/i:3h6xfy2c] to monitor your baby's heart rate. It is only recommended in high risk pregnancies and not in normal labour OR during admission (these recommendations came out in 2001 in the UK) but unless you're going to a midwife led unit or are with the community midwives you're likely to be offered this on admission. Here's a bit of background. In the 1960s the US military developed new technology to listen in to a baby’s heart rate during labour. It was thought that if a mum wore this monitor and her baby was in distress the staff would be alerted and a potential complication could be prevented. Electronic Fetal monitoring was originally designed to be used in high risk pregnancies. The company’s experts claimed that EFM would save the lives of babies..... By 1976 questions about it’s accuracy began to come to light and study after study showed significant problems – mothers who were being continuously monitored had a significantly increased rate of cesarean section (30%) and it was not saving any more babies compared to regular listening in by a midwife (every 15 - 20 mins with a sonicaid/pinard). EFM was causing more problems than it was solving but by this time nearly every labour ward in the US had invested heavily in this new technology - just like Irish hospitals so there was no going back. Current evidence recommends that the most appropriate way to monitor your baby (assuming all is well) during labour is intermittent monitoring with a small hand held device called a Sonicaid or with a Pinard (an instrument that looks like a little trumpet). Your Midwife generally listens in every 15 – 20 minutes and you can be mobile, using the bath, pool or out walking the halls. You might be thinking - what about a baby that really is in distress ? Surely continuous monitoring would be able to prevent cases of brain damage – wouldn’t we be able to tell if a baby was having trouble and save it? Not so. One large study that was carried out in Dublin concluded that babies that were monitored continuously had less seizures – obviously that sounds like it’s worth using then. But further analysis showed that these seizures occurred mostly in women that had had their labour speeded up with synthetic oxytocin (Pitocin) and once those figures were adjusted there was no difference in the rates of seizures. (Interestingly in the United States 43% of all cases taken against Obstetricians involving brain damaged babies, Pitocin was involved) One of the problems with using electronic fetal monitoring is not just the machine itself but how skilled the person is who is interpreting the information it produces. There are no standard guidelines. It’s recommended that if CTG machines are routinely used and there are suspicions of a problem then a sample of blood is taken from your baby’s scalp and analysed immediately to determine if your baby is really in trouble or if it’s a false alarm….but this is not offered routinely in all Irish maternity units. It depends on whether the Doctor assigned to your care will do it or not – if you are being continuously monitored for any reason and there seems to be a concern for your baby you can request an FBS and if the Doctor assigned to you or your consultant can’t do it – they’ll find one who can. Phew...sorry this has ended up being a history lesson but it's if you're a low risk mum with no problems being tethered to the bed can really change your experience as it's more difficult to change positions and remain mobile (depending on your midwife). All of the most recent UK guidelines (NICE 2007) mantain that an admission CTG in low-risk pregnancy has no place in modern maternity care. Tracy
Little Miss Hopeful Posts: 1193
Tracy thank you for taking time to reply in such detail - you have explained everything so well for me.
lollyfp Posts: 2441
Hi Tracy, Very interesting to read. Can you tell me in Irish hospitals when is synthetic oxytocin (Pitocin) used or recommended by the hospitals and what are the other alternatives to it? As for the constant fetal monitoring I have to admit that is what I had always planned to use because I am quite nervous that something could go wrong with my baby and I would never forgive myself if I missed that. I would prefer to be able to walk around and use a birthing ball, etc so that would be impossible with the constant monitoring so I am torn. I have had 3 friends lose babies after 39 weeks so that is why I am so nervous and afraid to not be monitored - what do you think based on what I have said? Also what is your opinion on getting a sweep and what exactly does it entail? Hope you don't mind me asking but you seem to know so much! Thanks :wv :wv
alton Posts: 3077
I'm curious to know if anyone who has given birth in Holles Street avoided fetal monitoring? I specifically asked not to be monitored, because I found that the contractions were more intense when I couldn't respond to them by moving but the staff were absolutely insistent that I be monitored on admission for 20 minutes, and then throughout the second stage.
GentleBirth Posts: 750
[quote="Lollyflashpants":39isrwj1] Can you tell me in Irish hospitals when is synthetic oxytocin (Pitocin) used or recommended by the hospitals and what are the other alternatives to it? [color=red:39isrwj1]Hi Lolly - most units use a partogram (a graph) which charts your progress during labour. If you dilate at 1cm per hour then Pitocin won't be on the cards...but if you aren't dilating at this rate then it's a different story. In H.Street close to 35% of first time mums are given Pitocin because of what H.Street considers 'deficient myometrial action' - in other words 35% of first time mums in H.Street somehow have a dodgy uterus....... Vaginal exams tend to be every 2 hours (especially if arrive in to the hospital in very early labour) - UK guidelines recommend VE's only every 4 hours. A study by the WHO in '94 and another study in 2006 confirmed that leaving labour to progress for a 4 hourly check rather than a 2 hourly check. The two hourly check increases other interventions - without improving outcomes.[/color:39isrwj1] [color=red:39isrwj1]If you felt that you were under pressure to do something you could try nipple stimulation.....having something to eat/drink.....clary sage essential oil.......get out of the delivery room for a bit....use the bath/shower - but just like every woman has different menstural cycles it's unrealistic to expect every woman to progress at exactly the same pace. The Community Midwives/Midwife Led Unit would generally consider a dilation rate of 1/2cm per hour to be a better guide.[/color:39isrwj1] As for the constant fetal monitoring I have to admit that is what I had always planned to use because I am quite nervous that something could go wrong with my baby and I would never forgive myself if I missed that. I would prefer to be able to walk around and use a birthing ball, etc so that would be impossible with the constant monitoring so I am torn. I have had 3 friends lose babies after 39 weeks so that is why I am so nervous and afraid to not be monitored - what do you think based on what I have said? [color=red:39isrwj1]Lolly I would say if you'll be able to relax more if you have the monitor on then this would make sense for you. There's no right or wrong way to give birth - it's about understanding the pros and cons of each offering and then making the decision that's best for you. It's been my experience that the majority of Irish women aren't getting the information so they can make informed decisions. Tell the midwife that you want to sit on the ball so at least you'll be upright. Another problem with the monitor is that when the baby moves or sometimes if you've moved the transducer loses the signal and the alarms go off.....and this can be very distressing for the mum especially if she's already nervous....even through everything is perfect with the baby it's just how the machine works.[/color:39isrwj1] Also what is your opinion on getting a sweep and what exactly does it entail? Hope you don't mind me asking but you seem to know so much! Thanks :wv :wv[/quote:39isrwj1] [color=red:39isrwj1]The sweep is like a very thorough smear test and the goal is to separate the amniotic sac from the cervix in the hope that it will kickstart labour. It works in about 1 in 8 women....IF they are just about ready to go. The cervix has to be opened slightly so your doc/midwife can insert their finger to do the sweep. You should expect that you'll have some show after it and some women have cramps. A sweep can 'excite/irritate' the uterus for a few hours and then everything stops (especially if your cervix isn't ready) and for some mums it does the trick.[/color:39isrwj1] Tracy
silíní Posts: 4219
I had cyntocin last time as i had pre eclampsia and was induced early. They had to get baby out in a hurry so used drip to hurry labour along. I was happy for baby to be monitored to be honest, i didnt mind at all as i was just so overwhelmed.
GentleBirth Posts: 750
Hi Silini, Induction or any complications are times when continuous monitoring [i:2jbfomtf]is[/i:2jbfomtf] recommended. I'd have no problem being monitored continuously myself if it wasn't a normal labour. Continuous monitoring isn't the end of the world if you need it - try to get yourself into a comfortable position on the ball so you don't feel so 'trapped' being on the bed and not being able to move (especially if you don't have an epidural). It's often at this point where some mums feel they can't cope when they lose that mobility. Tracy
lollyfp Posts: 2441
[quote="GentleBirth":3qmqqncw][quote="Lollyflashpants":3qmqqncw] Can you tell me in Irish hospitals when is synthetic oxytocin (Pitocin) used or recommended by the hospitals and what are the other alternatives to it? [color=red:3qmqqncw]Hi Lolly - most units use a partogram (a graph) which charts your progress during labour. If you dilate at 1cm per hour then Pitocin won't be on the cards...but if you aren't dilating at this rate then it's a different story. In H.Street close to 35% of first time mums are given Pitocin because of what H.Street considers 'deficient myometrial action' - in other words 35% of first time mums in H.Street somehow have a dodgy uterus....... Vaginal exams tend to be every 2 hours (especially if arrive in to the hospital in very early labour) - UK guidelines recommend VE's only every 4 hours. A study by the WHO in '94 and another study in 2006 confirmed that leaving labour to progress for a 4 hourly check rather than a 2 hourly check. The two hourly check increases other interventions - without improving outcomes.[/color:3qmqqncw] [color=red:3qmqqncw]If you felt that you were under pressure to do something you could try nipple stimulation.....having something to eat/drink.....clary sage essential oil.......get out of the delivery room for a bit....use the bath/shower - but just like every woman has different menstural cycles it's unrealistic to expect every woman to progress at exactly the same pace. The Community Midwives/Midwife Led Unit would generally consider a dilation rate of 1/2cm per hour to be a better guide.[/color:3qmqqncw] As for the constant fetal monitoring I have to admit that is what I had always planned to use because I am quite nervous that something could go wrong with my baby and I would never forgive myself if I missed that. I would prefer to be able to walk around and use a birthing ball, etc so that would be impossible with the constant monitoring so I am torn. I have had 3 friends lose babies after 39 weeks so that is why I am so nervous and afraid to not be monitored - what do you think based on what I have said? [color=red:3qmqqncw]Lolly I would say if you'll be able to relax more if you have the monitor on then this would make sense for you. There's no right or wrong way to give birth - it's about understanding the pros and cons of each offering and then making the decision that's best for you. It's been my experience that the majority of Irish women aren't getting the information so they can make informed decisions. Tell the midwife that you want to sit on the ball so at least you'll be upright. Another problem with the monitor is that when the baby moves or sometimes if you've moved the transducer loses the signal and the alarms go off.....and this can be very distressing for the mum especially if she's already nervous....even through everything is perfect with the baby it's just how the machine works.[/color:3qmqqncw] Also what is your opinion on getting a sweep and what exactly does it entail? Hope you don't mind me asking but you seem to know so much! Thanks :wv :wv[/quote:3qmqqncw] [color=red:3qmqqncw]The sweep is like a very thorough smear test and the goal is to separate the amniotic sac from the cervix in the hope that it will kickstart labour. It works in about 1 in 8 women....IF they are just about ready to go. The cervix has to be opened slightly so your doc/midwife can insert their finger to do the sweep. You should expect that you'll have some show after it and some women have cramps. A sweep can 'excite/irritate' the uterus for a few hours and then everything stops (especially if your cervix isn't ready) and for some mums it does the trick.[/color:3qmqqncw] Tracy[/quote:3qmqqncw] Thanks so much for your reply!! Do you think Pitocin causes fetal distress in a number of cases or is that rare?
GentleBirth Posts: 750
Hi Lolly, It's impossible to predict which babies will react badly to Pitocin and which ones will do fine. Pitocin drives the uterus chemically so you and your baby have less breaks between the surges/contractions. There's less time to rest in between and less time to oxygenate this wonderful muscle that's doing so much hard work and unfortunately less oxygen is getting to your baby. It definitely changes the intensity of labour for both of you which is why continuous monitoring in this case is recommended - it's not a definite that a baby will have problems but it is more likely. There is a time and a place for Pitocin - just not the routine overuse that we see in Ireland. Tracy