I received an email today from Gloria Lemay, midwife extraordinaire from Canada. She wrote, “I saw this on a nurses list today and laughed out loud.”
Gloria was referring to a comment on the Perinatal Nursing Discussion List. The subject on the September 3rd list was “VBAC – refusal of monitoring.” The post went like this:
“Looking at your input on how your policies address fetal monitoring of VBAC: Are you using continuous or intermittent? For those patients who refuse monitoring, do you have them sign a form showing refusal of this intervention?” and was written by the Maternity Services Manager. There was one answer and it read, “Continuous monitoring. If they refused, there would be a great deal of education documented and a refusal signed.”
Continuous monitoring. Continuous. Monitoring.
Give me a VBAC woman, almost any VBAC woman, and the LAST thing I would want for her was continuous monitoring. In fact, the last thing I want for ANY laboring woman is continuous monitoring.
We all know that since the advent of continuous monitoring, the cesarean section rate has SKYROCKETED without ANY improvement in maternal or infant outcome. We all know that the monitors themselves do nothing to improve maternity care. They restrict the woman’s movement, making it difficult for her to assume positions which would help dilation of the cervix and the descent of the baby – and so that popular cascade of interventions begins with pitocin to speed up the labor and the resulting drugs and/or epidural to ward off the unnaturally violent contractions that result…. and so the baby goes into fetal distress partially as a result of maternal distress and partially due to all that “birthcrap”…. and off to the OR she goes. Many years ago the research (evidence based, of course… which is frequently done and largely ignored) determined that far too often, cesareans were done for babies who were supposedly distressed – according to the monitors… when in fact, there had been no legitimate reason to section that mother. The operating room is, indeed, a busy and popular place in this culture, isn’t it?
Of course, we ought to define our terms. “Continuous monitoring” does not have to mean only a machine-operated process. What if the continuous monitor was a person – a loving, knowledgeable, calm, skilled, experienced PERSON who was with the laboring woman, breathing with her, talking to her, being quiet with her, supporting… And what if the continuously monitoring person knew that on occasion, the best thing that she, as the monitor, could do was to un-monitor, that is, to let the mother be, to leave her – or her and her partner – in a quiet, undisturbed place for a bit…. And what if we need to monitor our OWN fears about labor and birth – and keep the machines and the technology at bay…?
The monitors themselves were not designed for routine use. They were designed for the high risk situations. But of course nowadays, EVERYONE is considered high risk. You’re too old, too young, too fat, too thin, too past-your-“due”-date to have a baby. If you are one of the blessed few, you can be intermittently monitored. Young couples begin to feel frightened when they DON’T hear the constant beep beep beep of the monitors – the sounds become some kind of a background security net – and when the beeps stop – intermittently – as they are prone to do naturally… you can see the look of panic on the faces of the laboring couple: Is my baby still alive??? As if the lack of sound from the monitor indicates that their baby no longer has a heartbeat.
I did some of my midwifery training in a very poor country where there were no fetal monitors. No monitors, I thought? How ever would we know HOW the baby was?
And then, over time, I learned that there are many ways to check on the baby during labor without machinery. And I learned that because these mothers did not have pitocin and epidurals and drugs, the babies were generally quite well, thank you. At the moment of birth, they breathed. They turned pink. They looked around. They occasionally wailed. They looked for their mommies and they nursed. They were born the way Nature intended, with all the inherent and necessary turns, squishes and squeezes – and they were ready to be here. And yes, without all the drugs and machines and technology and making-the-labors-go-faster – almost every time, they were inherently better off.
We are far too quick to rush women in for a cesarean section when the monitor indicates that the baby is in distress. Sometimes it is a defective monitor, not a problem with the baby. We know that what one hospital considers distress, another would not. We know that so many factors influence the heartbeat of the baby and yet we don’t seem t take any of those into account. We spend so much time monitoring, that we seem not to have any time at all for figuring out why so many AMERICAN babies go into distress – at an alarmingly higher rate than many other countries.
VBAC hopefuls need many things, for sure, to help them achieve the safe and peaceful birth of their dreams. They need education, time, information about how to help their babies get into position before labor begins and what to do if the baby is not lined up early on, and good food during labor among them. But continuous monitoring that will get them back into that operating room again? Not generally.
And just for the record, Glo, I know what you mean when you say that you read this and laughed. It warms my heart to hear your particular chuckle.