When you are creating your VBAC Birth Plan do you ever sit there and just think, "this is so overwhelming, There is so much information. I feel like I'm just making any old birth plan... But what is different about a VBAC birth plan? Do I have to make any special changes? Are there any special considerations?"
Maybe you have a lot of fears about certain interventions and whether or not they are options if you are planning a VBAC. If this resonates with you, you're in the right place.
Check out today's episode of theVBACpodcast below! We will be discussing the decision of whether or not you should choose continuous fetal monitoring or intermittent monitoring during your TOLAC. You have many fetal monitoring options available to you.
But first, I wanted to let you know...
Inside of VBAC with Confidence, I can help you find clarity on each of those questions. We go through each step of creating your birth plan, each option that you have, we go through the benefits risks alternatives. We figure out what your intuitive reaction is to that intervention and we discussed how it applies to VBAC. Specifically, inside of this program I give you all the information you need to make decisions you feel good about to make decisions you feel confident in so that you are communicating with your doctor clearly and so that your birth team is all on the same page. This will ensure you're walking into this birth excited and happy and not filled with fear.
The VBAC with Confidence Complete birth program gives you all of the tools that you need for a positive and peaceful birth experience.
Reminder: This post is is for informational purposes only and is not intended to serve as individual medical advice. Please discuss your healthcare decisions with your private healthcare provider.
VBAC BIRTH PLAN: Fetal Monitoring
We are continuing the VBAC BIRTH PLAN series and today I wanted to talk to you about fetal monitoring.
Fetal monitoring is one of the very few parts of the VBAC birth plan that might be a little unique, but at the end of the day it still isn't that unique, which is why today I wanted to go ahead and chat with you about fetal monitoring and your VBAC plan.
Fetal monitoring and VBAC
Why is it so important to talk about fetal monitoring when we're talking about VBAC birth plans?
Well here's the thing: when you are afraid of uterine rupture and you learn more and more and more about rupture, you learn that one of the earliest signs of uterine rupture is variations in fetal heart tones.
Now, not just any variations, but usually sustained decels are one of the big red flags that say you might be experiencing rupture and we probably should go ahead and go back for a C-Section to make sure everybody stays safe.
It's really great that we have a way to monitor for that now. Of course not every Uterine rupture experiences fetal decals, now, I'm not gonna go to into that right now. But I want to talk to you about the decision to have continuous fetal monitoring or not.
Continuous Fetal Monitoring
It sounds obvious that everybody would want continuous fetal monitoring if they're concerned about a uterine rupture. And for you, that might be true.
It is reasonable to believe based off the evidence we have that continuous fetal monitoring would be the prudent decision to make sure you are catching ruptures early and before they're a problem.
So why are there women who don't get continuous monitoring?
Why do some women decide not to get continuous monitoring? That's what I want to talk to you about today.
I want to remind you that I am not telling you not to have continuous monitoring.
I am not telling you to have continuous monitoring. I am explaining the thought process that some women have that you might also be having and trying to figure out and understand.
And I'm just going to facilitate that thinking,
When I had my firs VBAC, I had my VBAC in the hospital. You know the protocol is, "You're a VBAC you have to have continuous monitoring." There's no argument about it.
We know in reality at the end of the day, we can decline anything, we really can.
For me, I felt like that was not a fight worth having. I was aware of the fact that in general when we're speaking about birth in general, continuous fetal monitoring is not actually associated with better birth outcomes.
A lot of people think it is and that's why so many hospitals actually do have continuous monitoring as their standard for everybody. But the truth is that's not actually saving lives and all. The truth also is that for some VBACs it might be saving lives.
Fetal Monitoring Options in Labor
When we're talking about continuous fetal monitoring, we have different options.
We have monitors that have wires and you have to be all hooked up and then you have wireless monitors and you have waterproof monitors.
And this is where we need to start having conversations about monitoring options and figuring out what's available, understanding our options and understanding how to work with those options.
So the problem that I personally have with continuous fetal monitoring um for my own births wasn't actually the monitoring, it was the monitor.
I could not stand having something around my waist because typically the monitor really is that belly band with the little toco, you've got the the two little circles.
You might remember kind of like for an N.S.T. (non stress test) or whenever you go into triage and they check your contractions they've got the belt, they've got these little things that stick on and are, to me, quite uncomfortable.
I don't like to have anything restricting me so I personally was like, I don't want that. I was so blessed that my hospital when I had my VBAC had a wireless monitor. It was one of the ones that just sticks on your belly.
So some wireless monitors are still that belt, right? Not all of them though. Some of them are just that little sticky on your belly thing and it's great.
It just wasn't even on my radar with the belt at that point because I had this awesome wireless monitor. It was waterproof and it worked. Come to find out a lot of hospitals experience this specific monitor only working about 50% of the time and then they end up having to use their wired monitors.
And that sucks.
Why does being on a wired monitor suck?
Well, first of all, you're tangled up in wires and lines and it's very frustrating and annoying.
But also it can kind of restrict you to the area right around your bed. Usually the leads are long enough that you can still get up and be on a birth ball and change positions in your bed.
But you have to disconnect yourself to go to the bathroom, walking the hallways,
you have to disconnect yourself. So if they want you to be on continuous monitoring,
they might get really salty about you, disconnecting yourself to walk the hallways or get in the shower and use the shower. A lot of labor rooms have a shower but they just use it as storage and they don't want anybody in there and that's a whole different conversation...
Anyway, having wired, continuous monitoring makes that all a lot harder.
So having wireless monitoring opens up the opportunity for you to still be monitored but move around freely and we know how important it is to be able to move freely so that you can respond to your body help your baby come earth side.
So if we don't have the option for wireless monitor?
This is when intermittent monitoring would start to become a conversation.
So I with my second VBAC I was originally planning a hospital birth and the monitoring was actually one of the sticking points for why I ended up choosing a home birth because I didn't want the continuous monitoring because they had the bands and they had wireless,
I was able to be wireless, I was able to be moving around, I could take them and get in a tub,
They were waterproof, but it was still a band that went around my belly and I it makes me want to vomit just thinking about it. It's like a sensory thing for me, it it makes me very anxious.
But for that particular practice to attend me in the hospital, it was the hospital's protocol that I would have to be on continuous monitoring again.
Yes, I could have declined that, but it wasn't a fight I wanted to have because I didn't want to be in a fight mode. So that's why when I ended up with home births, obviously I ended up with intermittent monitoring and for me it ended up being safe.
But in the hospital you do have this option too.
If you only have wired monitoring and you really really, really need to be moving around, you don't want something attached to you, You can ask for intermittent monitoring.
Yes, it might be a slightly higher risk of not catching a rupture quite as early. However,
there are other signs of rupture, that's not the only sign that you would probably be experiencing.
I think intermittent monitoring can be a great compromise.
I have heard some really weird protocols for intermittent monitoring lately.
In my experience, intermittent has always been 15 minutes on the monitor. 45 minutes off the monitor. 15 minutes on the monitor. 45 minutes off. So 15 minutes each hour would be intermittent monitoring.
I recently heard of a hospital where they have their internet monitoring is an hour on and an hour off that I would not be so keen on that. That's then I would be like having some conversations for sure because I don't want that thing on me for an hour that kind of defeats the whole purpose and at intermittent an hour on/hour off, that doesn't make sense to me.
Again, I'm not a doctor, I'm not a midwife: but I have seen intermittent monitoring done differently. So that just was weird to me.
When you're discussing wireless monitoring or intermittent monitoring and continuous monitoring with your provider, I really want you to think about like all the different scenarios and I want you to remember that BRAIN acronym: benefits risks, alternatives intuition and now or never.
At the end of the day if you really don't want the monitor on, you can just take it off and they can come in and ask you to put it back on and you can either comply or you can say no.
But that could put you into a more of a fear cycle because you have to start fighting more of a stress cycle.
But if the band is putting you into that fear cycle and you need it off to be in a safety cycle.
I think that's fair as well.
The good news in that situation would be like you are in a hospital, So if an emergency does arise, hopefully, other symptoms will notated right away and hopefully they'll check on you frequently and you are communicating well. they're communicating well.
When you are creating your birth plan and the question of monitoring comes up, there are a lot of things to take into consideration.
There is data to say that you know, to back up their reason for this policy and that's understandable. You can always say no because policies are not laws.
There are valid reasons for why you may not want continuous monitoring and I want you to have those conversations with your provider because you might be able to find a compromise like the wireless monitor that sticks on your belly or waterproof wireless monitoring so that you can still have continuous but still have freedom to move.
This is just your weekly reminder that this is your birth.
You need to be making your decisions from a place of intuition and information, not from a place of fear and that it's okay to change your mind.
I look forward to talking with you more about your VBAC birth plan. If you have any questions about your VBAC birth plan, I want you to go ahead and reach out to me.
I would love to make sure that you are feeling confident as you walk into this birth.
Jaimie Zaki is a mother of four, cesarean mom, VBAC mom, homebirth mom, Birth Doula, International board certified lactation consultant (IBCLC), Author, and hostess of theVBACpodcast. Jaimie is dedicated to supporting women like you as you plan a vaginal birth after cesarean, whether that's in the hospital or out of hospital. Jaimie is here to help you overcome your fears, trust your body, and walk into your VBAC with unwavering confidence, to facilitate a positive and peaceful vaginal birth after cesarean.
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