Posted by My OB said WHAT?!?.
Feb
10
Posted by My OB said WHAT?!?.
“Well, You Came To The Hospital To Make Sure You’d Have This…Available…”
“Well, you came to the hospital to make sure you’d have this kind of thing available, so why don’t you just go ahead and make use of it? Why else would you be here?” – CNM trying to convince a mother to have an internal fetal monitor placed because the mom’s movements during labor were shifting the external monitor sensors. Baby was born less than 30 minutes after mom refused the internal monitor.
There are 34 comments to this post.
The Deranged Housewife had this to say,
Feb 10, 2010 @ 7:30 am (Quote)
So let’s go ahead and stick this thing in your baby’s head, just because. Good grief!
And the efficacy of EFM has been proven how ….?
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This is absolutely rediculous.
This is just like going to a store to buy a pair of socks and getting roped into buying a big expensive electronic item. “Well we’ve got it laying around and you came here to make a purchase. You may as well take this too. We do have to reach our sales goals”
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Brittany had this to say,
Feb 10, 2010 @ 8:32 am (Quote)
It saddens me to see so many CNMs with such an invasive manner! I guess all the birth management they learned in their years of nursing school are difficult to undo during their time in midwifery training.
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Sheva Reply:
February 10th, 2010 at 9:58 am (Quote)
I think it’s less about schooling and more about personal beliefs.
If a woman goes into nursing school with a loving heart and healthy and true beliefs about birth and mothers, she will still be a good midwife when she gets out.
I was told that a lot of the CNMs that are no good were probably just RNs before and decided to take one or two more years of school (midwifery) so they could make more money and be in charge for a change, and not because they love all things ‘birth’.
This is not to say that RNs who became CNMs later are all no good.
What I’m trying to say is that I think that the reasons that a woman becomes a midwife make more of a difference in how she’ll practice than the way she becomes a midwife.
And also, not all midwifery schools are created equal. So the nursing education might be furthered in her midwifery training.
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AMH Reply:
February 14th, 2010 at 7:14 pm (Quote)
I was seeing a great midwife for my first pregnancy. But when I went into labor, she was not on call (and there was a massive snowstorm), so I got another midwife in the practice. Who insisted that I push flat on my back in stirrups for 2 hours and ultimately cut an episiotomy (actually cut me in three places) for a 7 lb 2 oz baby, because she had a bad back and couldn’t deal with me squatting or standing while pushing.
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I have a question, as many of you ladies seem really well-read on birth and the hospital circus surrounding it. Why do I hear negative things about internal fetal monitoring? Both of my babies had the little monitor on their heads (I didn’t know there might be a drawback) and it didn’t seem to cause any harm… just wondering what the real story is. Thanks!
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Dawn Reply:
February 10th, 2010 at 10:46 am (Quote)
Lucy,
For the internal monitor, the water must be broken. This increases risk of infection and also, if baby is in an awkward position it’s harder for baby to move. This means that labor can stall at the end stages and can cause the incidence of “tools” being used to go up. Also, if you have meconium, they’ll know and it makes the staff more antsy. I’ve had babies with mec, they’re all fine, but the waters weren’t broken until crowning…and I had one in the full bag of waters. The more risk factors known the more intervention. Babies can also get infection on their scalp as well as can have a spot where hair won’t grow in. I believe the internal can be a good thing if there are issues, but if all is looking fine and it’s just an equipment problem I see no reason to screw something into my child’s scalp.
My last baby was in the OP position and the doctor refused to break the water. The nurse pushed for it, but the OB said that we’d end up possibly using equipment to turn the baby. Also, I would imagine the risk of c-section would go up with the water broken…but I’m not sure this is true.
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Lucy Reply:
February 10th, 2010 at 1:15 pm (Quote)
Okay, thanks for the info! My water broke on its own, at home, both times… so does that mean there really wasn’t any harm in having the monitor in my situations? Thanks again for your insights!
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Kat Reply:
February 10th, 2010 at 1:58 pm (Quote)
Lucy, after the water breaks, anything inserted into the vagina can increase the risk of infection. It may be that in your situation the benefit outweighed the risk? In general though there hasn’t been shown to be a clear benefit to constant fetal monitoring, which is why many of us would prefer to decline an internal monitor.
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Jane Reply:
February 10th, 2010 at 2:18 pm (Quote)
If you ask any doctor, Lucy, they’ll tell you that once the water breaks, you can’t insert anything into the vagina because of the risk of infection.
Then they want to insert the internal monitor with that nice cord which not only goes up the vagina but is outside and provides in effect a little highway for the bacteria, plus a break in the baby’s skin.
And there’s no documented benefit to offset this risk.
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Dawn Reply:
February 10th, 2010 at 2:51 pm (Quote)
I’m not sure about movement after the lead is put in….you women on here might be able to say. I know my water has been broken before and I’ve still been allowed to stand (first and 2nd births). I’m wondering if women are confined to bed with the lead in baby’s head or not? Maybe it makes you MORE mobile.
At any rate, Lucy, there is a place for the internal lead I’m sure, there is a time and place for every intervention. I do think though that this one is overused. I know my last nurse only wanted it because she said I wasn’t “getting credit for my contractions” though the doctor said not to break the water because my OP baby just might get stuck in a bad position. I had a feeling this nurse was more reliant on the monitor than she needed to be, and that I didn’t need that thing to restrict me as much as it was.
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Kat Reply:
February 10th, 2010 at 3:12 pm (Quote)
Dawn, unless the monitor was wireless-capable, the range of movement would be severely limited. Do they make wireless telemetry internal monitors?
I was confined to the bed when one was used on my baby, but I was already on pit, had an epidural, and the whole 9 yards… BP monitor on one arm, IV other arm, epidural in my back, contraction monitor on my belly, internal monitor in my vagina, and when I was pushing they put an oxygen mask on my face. No wonder I felt like I had some kind of wire or tubs in every possible orifice.
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Kathy Reply:
February 10th, 2010 at 5:44 pm (Quote)
Sometimes an internal monitor can give the mother more mobility, because external monitors can move off of the “right spots” on the mother’s belly if the mother moves too much, or the baby can move away from the sensors. I’ve heard numerous stories of women being scolded or reprimanded by L&D nurses for moving and causing the sensors to have to be re-situated. With an internal monitor screwed into the baby’s head, the mother’s movement is unlikely to dislodge it, even if she rolls over, sits up, or otherwise moves. And *if* there is telemetry (which some hospitals have), then she can move out of and away from the bed and walk around.
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Michelle Potter Reply:
February 10th, 2010 at 4:49 pm (Quote)
Lucy, first off, I would look at it this way. If a doctor wants to put a screw into my child’s skull, I’m not asking first what the risks are — I want to know what the *benefit* is. It seems to me that there needs to be a clear and definite benefit before *anyone* is screwing *anything* into my baby’s head. In this case, no one has managed to document an actual benefit to IFM.
However, if the doctor did manage to convince me that my child’s safety did require IFM, *then* I would ask about the risks. As mentioned, the risks are that the water must be broken, the wire creates a path for infection in the mother, the baby now has an open wound that could become infected, the mother’s movement is restricted, the baby’s movement may be restricted, and there is the potential that the staff will find something “wrong” to freak out over — and as we all know, they have a tendency to freak out and scare moms into major intervention when it’s not really warranted.
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Jespren Reply:
February 11th, 2010 at 5:12 pm (Quote)
Just a quick add in the risks category, baby’s feel pain, its not like there is some switch that gets turned on after they are outside the womb, think of how sensitive your scalp is, it would be really painful to have something screwed into it. The stress could cause baby to pass mec (depending upon how far baby is in canal could still be swallowed), or could cause increased heartrate. Baby is already going through a very stressful time right then, why add an additional pain input to the equation unless absolutely necessary?
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The real problem here is that the nurses and the CNMs and the OBs are being trained how to treat the monitor. Not how to treat the mother, but how to keep the monitor happy. Not how to advocate and assist for the mother and baby’s health, but how to keep the numbers on the monitors in the right ranges.
If you’ve ever been on a monitor, think of how often everyone who comes into the room looks at the monitor rather than you. Or how often you were looking at the monitor yourself rather than figuring out what your own body wanted and needed.
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Barb Smalley had this to say,
Feb 11, 2010 @ 4:29 pm (Quote)
I refused to have the fetal monitor placed on my belly when I was giving birth. The hospital didn’t like it, but I said “It’s not YOUR belly tha tthing would be strapped on!!!
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I dont think CNM’s should be able to call themselves midwives. Simply because they are trained first under the Techno-Medical model of care and Midwives are only trained under the Midwives model of care. Ive noticed that CNM’s are much more prone to suggest fetal monitoring, drugs, and interventions, which is exactly the opposite of what the Midwife model of care teaches.
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Tracy Reply:
February 12th, 2010 at 5:30 pm (Quote)
I would not be so quick to lump all CNMs in the same group. I have the most amazing midwife, homebirth midwife at that, who happens to be a CNM. She worked as an RN in L&D for I think 10 years before she decided she couldn’t support that any more and now she runs and independent birth center and done birth center and homebirths. She is low intervention and very hands off.
I think it has more to do with a CNM with a hospital practice.
(My own first birth was a traumatic, horrible even at the hands of a hospital CNM)
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Kat Reply:
February 12th, 2010 at 6:13 pm (Quote)
There are good and bad practitioners in every group. Statistically speaking, you are more likely to find a medical/interventionist mindset among OBs and CNMs, true, but there are good ones!
Just like there are ignorant and incompetent homebirth midwives, and overly “hands-on” homebirth midwives. You have to get to know *your* caregiver (or potential caregiver) as an individual.
My youngest was born under the care of a FABULOUS CNM. One of the few still practicing medical professionals who knows how to care for breech births. One of the few who not only tolerates waterbirth but encourages it. I did not have anyone in my face yelling at me to P-U-U-USHH! I had no restrictions on eating/drinking during labor. I got no flack about not wanting to chug glucose to check my blood sugar (I did the post-meal check instead), and once I declined ultrasound and quad-screening, that was that.
It would be much easier if everyone wore their birth-philosophy on their sleeve, but since they don’t, that’s why we research and interview, and ask other women about their births until we find a caregiver who feels “safe” to us.
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Kathy Reply:
February 12th, 2010 at 6:58 pm (Quote)
Kelsy,
I will add my voice to those who say that your statement was painting with too broad a brush. Sure, some CNMs are intervention-happy “medwives”; but there are many CNMs who are very naturally-minded. I have had both a CNM and a CPM, and I couldn’t tell the difference between the two, as far as practice style (except the CNM did cervical exams during pregnancy, while the CPM declined to do one until and unless I asked).
It’s true that you can’t just trust any midwife to hold to the “midwifery model of care”; but then, you can’t just expect every doctor or OB to come at you with scalpel in one hand and forceps in another. 
My CNM attended home births, encouraged water-birth, was very respectful of me and my wishes during labor, encouraged me, followed my lead, etc. Not having had an OB, I can’t speak personally to this, but I have heard of OBs that are “Dr. Wonderful,” when it comes to their style of management (or lack thereof — i.e., allowing labor to unfold naturally, unless intervention is actually warranted).
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Kelsy Reply:
February 13th, 2010 at 5:36 pm (Quote)
I should have narrowed my group a little bit. When i say home birth midwife, that includes the rare CNM who will birth at home, as well as CPM’s. So yes, i guess what i should have said was CNM’s in hospitals are more prone to intervene than a CNM or CPM who births at home. Thanks for your responses!
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Oh my goodness. See, this is what happens when you look away from the internet for a few days – your mOBsw?!? submission gets posted and the comments go ‘splody.
Anyway, this one’s from me, I was the doula at this birth.
The CNM’s concern stemmed from the fact that, when mom’s waters released, they were tea-colored from meconium.
Mom was pretty stressed out by the time labor started; she told me afterward that she’s certain she was so queasy and vomited several times during labor at least in part because her OB has been pushing induction since 38 weeks. I think that reaction was probably also in part because her labor was so FAST. Membranes released at 2:30 AM, baby born at 6:49 AM. !
During labor, at the moment of this quote, I asked mom and dad if they needed the CNM to give more information about IFMs so they could make an informed decision, and mom shook her head, face crumpled in pain as her body dragged her through a fierce contraction, saying, “No no no” over and over. I looked at dad, who looked scared, and said, “We can step out a moment, if you’d like some time to talk about it.” The nurse and CNM stepped out, and just before I left with them, after they cleared the door and were in the hall out of earshot, I turned to dad and said, “You always have the option of trying a position change first – getting her into a better position for the EFM might be an acceptable solution to the CNM.”
As I sat outside the door with the CNM and nurse, they shook their heads and kept saying variations of, “If only she’d see reason!” over and over.
Dad came out several minutes later, and asked if they could try a position change first. The nurse and CNM looked at each other, the CNM signed and said, “Well, okay. Let’s go try that.”
To get the best ‘signal’, mom had to change to a position almost on her back, which hurt more through the contractions. It had the desired effect and made the CNM happy; she and the nurse left – only to come, somewhat leisurely, back to the room when we called to tell them she’s pushing – 20 minutes later. I don’t think they believed us at first – then the CNM started rushing around to put on a paper gown and gloves when she saw baby’s head crowning. (Is it bad that I was covering a big grin with my hand at this point?)
Mom’s healthy, unmedicated baby girl was born a few pushes later – 8 lbs 1 oz, cried as soon as her head cleared mom, pinked up immediately once fully born, and looked all around the room, totally alert. (-:
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Lots of things are available in a hospital. The whole point is to use as few as possible and still have a good outcome. Maybe that CNM needs to ‘make use’ of the exit doors.
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