VBAC – can I have intermittent monitoring?
So the short answer is YES! Legally health care professionals cannot force you to have continuous monitoring, it’s you right to decline this monitoring or any monitoring that you want to. But let’s dig deeper into why is continuous monitoring recommended and have a look at the evidence to support the recommendations.
Why is continuous monitoring recommended for a VBAC labour?
Planning a vaginal birth after caesarean you have an increased chance of uterine rupture (0.2-0.5%) depending on what study you read. One of the most common signs of uterine rupture is fetal heart rate abnormalities which are picked up by fetal heart monitoring.
The RCOG 45, NG121 and NG192 all recommend continuous monitoring. (UK Guidelines)
It is believed that continuous monitoring picks up fetal heart abnormalities quicker than intermittent monitoring. Does evidence support this? NO.
Andersen el at 20216 study states: “A pathological cardiotocogram should lead to particular attention on threatening uterine rupture but cannot be considered a strong predictor as it is common in all women with a trial of labour after caesarean delivery”
What is continuous monitoring?
CTG monitoring, 2 belts around your bump, one monitoring the baby’s heart rate and they other monitoring your contractions, it’s connected to a machine that prints out the results.
Fetal scalp electrode – a small metal hook that is screwed into your baby’s head, your waters need to be broken and baby needs to be head down.
Telemetry is wireless and waterproof continuous monitoring. Continuous monitoring is only available on the labour ward, CTG and Fetal scalp electrode can’t get wet, you are connected to a cable.
Evidence shows They increase the chance on instrumental birth and caesarean birth.
What is intermittent monitoring?
Intermittent monitoring involves periodically checking your baby’s heart rate and then your vital signs at specific intervals. These checks are typically performed using a handheld Doppler ultrasound device or a fetoscope (a special type of stethoscope).
Health care professionals listen in every 15 minutes in active labour and every 5 minutes when you are in the 2nd stage of labour (pushing/ bearing down)
Handheld dopplers can be used in water, you will have the freedom to move, you don’t need to change position, can use it in a pool, bath or shower, it is less intrusive on your labour.They can be used at home, in a birth centre or on a labour ward. Evidence shows they reduced the chance of a caesarean without increasing adverse outcomes for parent and baby.
What to do?
Deciding what type of monitoring you want is a personal decision, some people find it reassuring and others find it uncomfortable, restrictive and creates a seed of doubt. It’s important to think about the monitoring you want as it can impact place of birth and other birthing options. Guidelines are based on general care, one rule doesn’t fit all, we are all different and we all labour differently. There are some instances when continuous monitoring may be helpful, during an induction when there is an increased risk of a uterine rupture, or if you have an epidural as you can’t feel contractions or pain. If you want to have intermittent monitoring its good to have the discussion with your health care professional to agree a plan, you don’t want to be fighting and quoting your birth rights mid contraction..
It’s your body, your birth and it’s your choice.
Want to know more about VBAC why not book onto one of my VBAC & Hypnobirthing courses.
Jodie x
Evidence:
Effectiveness of intrapartum fetal surveillance to improve maternal and neonatal outcomes: a systematic review and network meta-analysis.
Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour.
Can Intrapartum Cardiotocography Predict Uterine Rupture among Women with Prior Caesarean Delivery?: A Population Based Case-Control Study.
