Nervous about refusing EFM, vaginal exams, IV in hospital

Hi all - I hope this is a good place for this discussion.  I'm having trouble finding a forum to express my concerns anywhere else.

 

I'm due with baby #3 in a couple of weeks (July 20 is my EDD) and I've recently begun to get informed about all the unnecessary things that go on with hospital births. I've begun to want to assert myself with this (probably last) delivery and have a birth experience that's as intervention-free as possible. BUT - I'm only two weeks away, I could go into labor at any time. I don't think looking for a birthing center or finding a home-delivery assistant is viable at this point. Realistically, I'm having this baby in the hospital.

 

I've had 2 perfectly fine birth experiences at this hospital. I had an epidural with my 1st, found I didn't like how I felt while it was wearing off, and had my second without any pain meds or epidural. Both times my labor was pretty brief and uncomplicated so I never felt like I HAD to assert myself. This time, I really want to keep off the monitor, avoid vaginal exams, etc. What are my rights? How likely are they to put up a fuss?

 

I don't want to cave over issues I believe in but I feel like time is working against me. Any advice?

Tags: efm, exam, vaginal

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Hello,

I just joined this group today. I'm a mom of 5. I had my last baby at home 10 years ago. My husband and I had to go into the hospital during my 33rd week of pregnancy because I had gone into pre term labor and my midwife wasn't comfortable with me having him at home that early. Upon arrival, we knew what to expect and had prepared ourselves for it. We were upset (angry, even) when we were heavily condemned for our refusal of an IV. My husband informed the nurse that I was hydrated, I had been drinking water all day and had probably had 2 gallons by that point in the day. The nurse told us that we were endangering the life of our baby (by not having an IV? Really?) and called the on-call Doctor in the room. He did the same thing, condescended to us, tried to guilt trip us, etc. We held firm and asked for them to do what they could to stop my labor without an IV. They were able to give me a shot (which they could have done in the first place without the lectures) which stopped my labor. I ended up going to 41 weeks 2 days with that pregnancy. My healthy baby boy was born at home after a 2 hour 40 minute labor, weighing 11 pounds 4 ounces.

 

That experience was the first I had ever had like that. My previous 4 births were all planned hospital births, where I was uninformed and did whatever they told me to do. Because of that experience, I would feel as you do in your situation. It will probably not be easy, and you will probably run into opposition at every turn. I have a few of suggestions for you:

 

1) Be educated and informed. Read as much as you can about natural child birth. Know why they insist on these interventions and why you don't need them. Have your husband do the same. Cram as much knowledge into your head as you possibly can in these next tw0 (+/-) weeks.

 

2) Hire a doula. Tell her what you want and how important it is to you. It will then be her job to advocate for you when you can't do it for yourself. A lot of doulas will even work for a lower rate or free of charge if you have a financial issue. Women who become doulas do so because they love birth and they believe that women are capable of doing it.

 

3) Write a birth plan. You can find samples online and insert your own wishes. Give a copy to your doctor and go over it with him/her at your next visit. Request that it be put in your file. Take a copy with you to the hospital and give your doula a copy. Have someone remind the nurse when you check in that it's already on file and you want to have it followed as closely as possible. Have extra copies in your bag just in case.

 

4) Be open-minded. Occasionally there is a reason for an intervention. In your birth plan, outline what you consider legitimate reasons for interventions, and what interventions you are willing to accept should something happen. Do all you can to make everyone aware of your choices before you go into labor so that you don't have to try an articulate them during your birth.

 

Good luck!!! ~Erin

Im a Bradley instructor and these are some tips I give my students. With these three things specifically, its really knowing the basic policy of your doctor before you get to the hospital. With the EFM, I will be honest in that most doctors and hospitals insist on an intermittent strip at least, you can do things to put this off like get up and use the bath room when the nurse comes into your room, heck, stay on the toilet to labor if its comfortable. If you are willing to be flexible you can just allow a short strip run, but it depends on how alarmist your doctor is if you are comfortable with that. Remember prioritizing is important, so pick which battles are most important. For me the vaginal exam would be more important then the intermittent EFM, meaning if you dont want a vag exam then be firm, let them know that you are concerned about infection especially if the bag of waters is broken or that it is extremely uncomfortable to you especially because you are not on any meds. This is a totally unnecessary intervention as far as I am concerned. Possibly you could be flexible when you are feeling the urge to push and let them check just to be sure you dont have a lip of the cervix blocking the head or anything, it will make them feel better, sigh. The IV is an easy one as long as you dont have Group B strep. If you dont and you are willing to be flexible then just insist on a heparin-lock. They will open the vein but leave a lock in place, that way you know they are not hooking up secret fluids or injecting Pitocin in your bag, but you will give them the peace of mind that if an emergency arrises that you already have a vein open and they dont have to worry about it. It depends on your comfort level, it didnt bother me that much compared with the labor pains. If you have Group B strep you can ask to have the antibiotics (if you agreed to them) intermittently and the IV removed after the administration. 

 

Basically you are in the hospital and things are not going to be perfect, thats why folks have homebirth. I have to have hospital birth too, because of finances, but you can do little things to make the best of it. Personally I think prioritizing is key, what is REALLY important to you, stick to your guns on those things and weigh your options on the rest, that way you are not arguing about everything. The best advice, depending on how far you are from the hospital, wait as long as possible before even showing up there! Discuss everything with your doctor beforehand and get an idea about which policies are most important to them. Let them know that you are an informed consumer and that these are things that are of concern to you. As far as your rights are concerned, you can refuse anything but if you talk to your doctor beforehand and have a birthplan then they are less likely to put up a fuss. I second the doula comment, if you can afford one that has experience at the hospital you are delivering at dealing with interventions they can be helpful but the doctors and nurses always have to hear it from your mouth, the doula cannot speak on your behalf. 

 

Hope that helps a little!


Candace

 

 

Thank you, Candace and Erin! I appreciate the feedback.

I will keep working on sorting my priorities - I don't have any problem with a heparin lock and intermittent monitoring, though I'd prefer to monitored with Doppler or a stethoscope as these methods seem to carry less risk of C-section. 

I'm hearing more and more that my best chance of going intervention free is to stay away as long as possible, and that's very doable - with my first two I only labored at the hospital for an hour or two before giving birth.

I am planning to talk to my doctor today, not sure I can have a whole birth plan ready by my appointment, but I have a pre-registration appointment at the hospital next week and can be ready with one by then. Hopefully that will be a good time to firm up what THEIR priorities are and see how we can mesh them with my own. Still sort of angry/amused at how much I think I'll need to concede to to keep THEM happy but I know they have their reasons and there's no point getting adversarial at this late date!

I wish I'd been better informed earlier and am thankful that my lack of education didn't prevent (nearly) natural births with my first two. And I'm REALLY thankful that I found Business of Being Born and some other great information before it was too late to try for the birth experience I really want for this baby!

I know what you mean about how much you have to concede.  I prefer to look at it as how much you have to manipulate them, to trick them into thinking they have control, not that its alot better. Its sad but its the reality of the state of maternity care in the US today and thanks to people like Rikki and Abby perhaps it will change. I dream of the days of insurance covered homebirth and birth centers dotting every corner but I dont know if we will ever get there and seeing as I'm on my last pregnancy I wont be able to enjoy it. Perhaps our grandchildren will have options!!! 

Im in the exact same boat as you, due in September. Best of luck!!!

Of course it depends on the hospital and their protocol somewhat, but it may not be incredibly different at anywhere you go.  You must understand that once you are there, they're thinking of their own liability and it may be very difficult to avoid the monitor wholesale.  I would also offer that you only want to be checked when you ask for it, and ask how your doctor feels about that (don't go in saying you don't want any vaginal checks whatsoever).  Are you willing to compromise--say--15 minutes every hour on the monitor?  A cervical check every 3 hours?  Be ready to offer such an olive branch, because you will need to compromise somehow at most hospitals. 

 

Indeed it may be a "perfectly fine" experience if you're not generally asserting yourself in any way.  It is your right not to submit to medical treatment of any kind, but there are limits to what your rights are once you've given yourself over to the care of your doctors and the hospital staff, and there are certainly limits to how much your birth team will want to put up with you asserting yourself.  There have been scary cases of hospitals getting injunctions to perform a c-section, for example. 

Sorry, I digress.  The crux of this: Talk to your doctor NOW, not while you're in labor. 

I had to have a hospital birth for my first child because he arrived three days before the legal cut off to deliever at the birth center.  I kept this important piece of information in my head throughout my whole labor, the hospital, doctors, and nurses CANNOT do anything to you without your consent.  It is called consent for a reason, and thus you must consent to everything.  I allowed the EFM for 20 minutes when I first arrived and never allowed it back on.  If the nurses wanted reassurance that the baby is okay, they were more then welcome to come my room to use a doppler.  EFM really just saves the nurses the trouble of having patient contact.  I also had 100% support from my husband who is a paramedic.   Having a support system around you that will advocate for you is extremely important.  Good luck!

I so know how you are feeling.  I am due with my second any time now and I am freaking out.  My first birth didnt go so well so I am doing all I can to make this one different. 

I will be delivering at a military facility, and I have only been told bad stories about them, but I have no other options because of insurance issues.

Today I talked to one of the OBs and she assured me that they would do everything they could to make me comfertable, but to remember they cant do anything without my ok first. 

I do agree that staying away as long as possible is probably your best plan of action.  That is what I plan also.

How did everything go?

My third beautiful daughter, Cordelia Josephine Wilson, was born at 9:18 Monday morning.  I started having serious nonstop contractions while dropping my kids off at their summer school, went home and picked up my husband and went straight to the hospital. We got there about 8:45. With only a half hour to prep everything and actually deliver, there was no question of any intervention! I know the EFM was hooked up but I never saw it or heard it. No IVs, no pain meds offered, etc. They didn't even give me the Pit injection after since the placenta came fast and was whole.

 It was chaotic and pretty scary, going so fast, and the pain was very intense - my contractions never let up for more than a couple of seconds. So it wasn't the natural childbirth experience of my dreams, exactly - more of a wild rumpus than I had imagined! - but Cordelia and I were both safe and are very happily at home now!

Thank you for asking, and thanks to everyone who replied. I hope all of you have your best births!

Congratulations! I know it wasn't your dream birth, but at least there was no worry of pressure to accept unneeded interventions. Out of curiosity, does that hospital or the doctor give pitocin routinely after birth?

Congratulations to again. Enjoy the beautiful girl. I am planning on having one more and I would really like a girl. I have a 15 year old girl, an 18extra year old son, and a 14 month son. Time for another girl!

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