I’m watching this documentary on Netflix-on-demand on the birth industry (I just saw Ricki Lake naked and having a baby, which is weird) but all of the statistics and information they were giving was on normal, low-risk births. (Obviously, because that’s the focus of the movie.) A point brought up by a doctor and not really dealt with, however, is what happens when your crunchy granola home birth goes bad.
I know there are criteria for candidates for home birth, and that the people who do this are generally low-risk pregnancies. Also, I know there’s always a backup plan, and that some birthing centers are actually across the street or attached by a walkway or something to a major hospital. My question is, when something unexpected and very serious goes wrong at a home birth or at a birthing center without obstetricians and not super-close to a hospital (while I was Googling this I found one in town that they say is five minutes from Lexington Medical Center, but that’s not exactly “across a breezeway”) what, statistically, is the outcome?
In other words, I know home births are generally safe. I also know that a major hemorrhage can happen very fast and you can bleed out at light speed; how frequently does that happen, and how do the outcomes for that sort of crisis compare to similar emergencies that happen in hospitals? Is a standalone birth center statistically safer than a certified nurse midwife in your home?
Also, what about water birth? This stuff is so hard to get a handle on the real facts because people are so emotional about it and there’s a lot of hysterical websites on both sides. Is there any danger to water birthing?
It’s been years, but I asked the same questions of the midwife that delivered my two sons.*
In the over 500 deliveries which she had assisted as an apprentice and as the leading midwife:[ul][li]She had a three percent transport rate. This compares with a ten percent cesarean rate for obstetricians in my state.[]Two mothers had stillbirths. One was due to the umbilical cord getting wrapped around the fetus’s neck (The expecting mother called her and said that the baby hadn’t moved in two days.) This happened between weekly visits and was considered a risk regardless of care provider. The other stillbirth had multiple abnormalities. The family lived next door to a landfill. It was later found that contaminants were leaching into the soil, and the family’s house and property were condemned.[]There was one case where paramedics had been called to a homebirth where she was assisting. The expecting father got nervous at one point and dialed 911. The paramedics assessed the situation, said that the midwives were doing a better job than they could and offered to stick around in anyone wanted. Beyond that, the delivery was normal.[/ul]With all that said, Michelle made a few points clear. First, she was a registered nurse with experience in obstetrics. Second, she cherry picked her clients. Any potentially risky births were referred to an obstetrician. She also had an obstetrician that she could call when a hospital birth was needed.[/li]
Of course, you asked about statistics for each type of delivery, not just for our midwife. Unfortunately, there may not be any useable data with which to make statistics. It’s been fifteen years, but we were told at the time (by another midwife who may have had an axe to grind) that the AMA wasn’t interested in releasing statistics–HIPAA may also require that the data be kept private. Also, the apprentice midwives in my area were just beginning to organize, and I’m not sure how accurate their records were kept.
*For what it’s worth, here’s the story: my wife had written a letter to the editors of our local daily paper, and a paramedic had emailed us back with a missive about how home birth was dangerous, but he “would still be around to take us to the hospital when things go wrong.” I replied with the above points, making the point that if he had transported any home births, then they weren’t being done under the care of our midwife or anyone that she knew. He replied that he didn’t really know the facts and that he stood corrected.
I am a midwife but I practice in New Zealand. Unfortunately data on homebirths isn’t well collected. Most midwives keep their own statistics. A few do only home births, most practice in a range of locations (home, birthing centres, primary units, secondary and tertiary hospitals). In NZ all women have a midwife involved in their care, 80% of women have a midwife as their primary caregiver in pregnancy. 7-10% of women have homebirths, but the rates of transfer are not well recorded, and some of these may be unplanned homebirths. We have strict criteria for home birthing and what is key is the woman and her family’s attitude to birthing at home. The midwife can be as excited as she likes about home birth but if the woman and her family aren’t keen it won’t work. I give information to every pregnant woman on considering home birth and explore it further if they are keen. Waterbirth is (and probably always will be) very contentious. Midwives generally consider waterbirth to be very safe. There is research to back up the benefits of water - increased ability to cope with pain, fewer episiotomies and lower blood loss to name a few(http://www.online.karger.com/library/karger/renderer/dataset.exe?jcode=FDT&action=render&rendertype=abstract&uid=FDT.fdt15291)
Occasionally babies take longer to adjust to extrauterine life when born in water (it is less of a shock) and there is a suggestion that higher rates of neonatal infection occur in babies born in water, but again there is research to negate this. Personally I love waterbirth, however as with homebirth it is important to ensure low risk, well women are the ones who birth in water.
When I was pregnant and pondering a home birth, I saw quite a few websites for home births or birthing centers that claimed that it was ‘safer’ to give birth outside of the hospital and the lower risk of having a cesarean. But then would go on to say they only accepted low risk pregnancies. Well if you ONLY accept low risk pregnancies, then yes your statistics in regards to problems arising are going to seem ‘better’ than a hospital’s.
I myself would never take the risk, no matter how low risk I was. Just a few months ago in another forum, I read about a woman who chose to do a home birth and was low risk. Long story short, there was a complication and by they time they got to the hospital they baby was dead. If she had been in the hospital, it is almost certain it would have lived.
One trend I am seeing starting to grow though, that I find very disconcerting, is mothers having unassisted home birth. No doctors, nurses, midwife, nothing. Just the mother and whatever family member she wants around. I find that trusting WAY too much on mother nature to do the ‘right thing’. Especially given the mortality rate in the old days when this was the norm.
“One trend I am seeing starting to grow though, that I find very disconcerting, is mothers having unassisted home birth. No doctors, nurses, midwife, nothing. Just the mother and whatever family member she wants around. I find that trusting WAY too much on mother nature to do the ‘right thing’. Especially given the mortality rate in the old days when this was the norm.”
I agree this is a disconcerting trend. During research for my postgraduate degree I looked into unassisted birth and found the primary reason women give for unassisted birth is that they feel violated or interfered with when in hospital. It can be extremely disempowering, and feeling empowered during labour and birth is crucial. Even in the old days most women were attended to in labour by a midwife, or a respected elder who was experienced in matters of birth. Much of the mortality rate in the time you’re referring to was due to poor general health, malnutrition, communicable disease, high parity and inept medical practitioners not the actual practice of birthing at home. Actually it was generally considered safer to birth at home because birthing in a “laying in” centre (their version of a maternity hospital) was the fastest way to contract puepural fever, one of the biggest killers of childbearing women.
It’s been years, but I asked the same questions of the midwife that delivered my two sons.*
In the over 500 deliveries which she had assisted as an apprentice and as the leading midwife:[ul][li]She had a three percent transport rate. This compares with a ten percent cesarean rate for obstetricians in my state.[/li][/QUOTE]
It’s important to note that transfer != c-section. Transport often occurs not because of a problem but because the mother is exhausted/overwhelmed and wants pharmaceutical pain relief. For many of these women, once they have an epidural and perhaps a quick nap, they’re able to go on to have a vaginal birth in the hospital.
Also, many midwives count women or neonates who go to the hospital after birth, due to complications, as transfers, while others do not. This can often be for something like a perineal or vulval tear that cannot be managed in the home environment or a baby that doesn’t pink up as quickly as would be liked. (It should be noted that midwives who are not forced to operate outside of the law in order to practice can generally manage a post-partum hemorrhage because they have the same drug that would be given in the hospital in such a situation.)
Lastly, a 10% c-section rate in your state? Where is that? That’s got to be the lowest rate in the country. Most are about three times that.
Leading midwife Ina May Gaskin talks about this in terms of sphincter law. Hospitals and the people who work in them do not respect sphincter law which is, basically, you cannot control, cajole, demand, command or pry open a sphincter muscle that doesn’t want to open without violating the body that sphincter is a part of. And when you violate the body, you violate the mind and spirit. That’s modern obstetrics in a nutshell.
You really cannot blame any woman for feeling not just disempowered but endangered by hospital birth.[LIST][li]It must happen within a a set period of time which has gotten more and more narrow even though it’s based solely on estimates to begin with.[/li][li]A fetus must not be allowed to grow beyond a certain size, even though predicting the size of a fetus at term (usually attempted with sonography) is guesswork that is often off by as much as 2 pounds.[/li][li]It will be monitored, and preferably monitored continuously even though electronic fetal monitors were never designed or meant to be used in that way and continuous monitoring has never been shown to improve outcomes for mothers or babies (but has been shown to increase c-section rates eightfold. This will also serve to deprive women of freedom of movement which is important for pain relief, and to tie them to sitting on their butts in a bed, a position which is anatomically inhibiting to the descent of the fetus into the birthing position.[/li][li]The mother will be deprived of food (fuel) and even water to drink while her body is doing the hardest work it may have ever done or will do, based on the outdated notion that there is great risk to having something in the stomach if a c-section is necessary and must be done under general anesthesia. (There is also a growing body of evidence that lack of hydration increases the intensity of pain.)[/li][li]They will be put on a clock. Birth must occur within X hours once the water is broken. Birth must occur within X hours overall. Cervical dilation must progress at a steady rate of X cm per hour, and cannot regress.[/li][li]If labor hasn’t started within the narrow window of time, it will be induced, often with prostaglandin drugs being used, dangerously, off-label, as well as a bombardment of synthetic hormones which increase the duration and intensity of contractions beyond that which would occur naturally and can lead to fetal distress. If the time clock begins to run out, labor will be augmented with those same synthetic hormones.[/li][li]If all of this constriction, interference and meddling still doesn’t produce a baby when the doctors want it to, mom will be given serious abdominal surgery to get the baby out and will be told by family, friends, nurses, doctors and even strangers that all that really matters is that the baby is healthy[/ul][/li]
Couple that with the number of states where Certified Nurse Midwives cannot attend homebirths because insurance regulations or the rules of their “backup” OBs constrain them, and where Certified Professional Midwives cannot practice legally and are therefore scarce, hard to get into contact with and must be paid in cash, and it’s no wonder that the numbers of women who are going for the DIY birth is growing and growing.
You are completely right in that this is such an emotionally charged subject that it’s hard to find objective data.
The AMA has called for a ban on home births, and has used the cite “Danel, M.D., M.S., et al., Magnitude of Maternal
Morbidity During Labor and Delivery: United States, 1993-1997, 93 Amer. J. Pub.
Health 631 (Apr. 2003)” to back up the claim that, “Most maternal deaths and serious complications occur during labor and delivery.” However, I could not find any cite indicating the lack of safety of homebirths. I think if there were such a study (and I’m not saying there isn’t - only that I couldn’t find one) they would be citing it at every available opportunity. They have far better access to relevant data than I.
As to the safety of birth centers vs. homebirth, even the AMA recommends accredited birth centers as a safer alternative to homebirth. (but no cites) I found plenty of citesthat show that for low-risk pregnancies, ouctomes (mortality rates, birth weight) are better for certified nurse midwives than for physicians. But there are many CNMs that work exclusively in hospitals.
Waterbirth is another case with many critics and a lack of hard evidence for the suggested risks.
I do know that when the birth center I used was looking for a facility, one of their criteria was proximity to the hospital where the midwives also practice. The group I use does not perform homebirths, and while one can labor in a hot tub at the birth center (Heaven! I recall telling my husband that I was leaving him and running away to marry the hot tub.), when it comes time to push, you’re back on dry land.
I do not mean to malign the medical profession or anyone who chooses hospital birth, but everything I can see supports the availability of options in birthing. There will always be risks, there will always be complications, but the idea that there is only one true safe way to give birth seems narrow minded.
Results 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated.
Conclusions Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.
and their criticism of it: "and I would stress two things: 1) the authors have clear bias in that they’re measuring what they want to measure (maternal deaths and of course there weren’t any because our EMS system is quite good), 2)the study doesn’t measure what really counts - neurodevelopment of the infants at 18-24 months of age. In fact, they don’t actually measure infant morbidity in their study at all, instead they do a meta-analysis of previous studies comparing in hospital births (where some of the studies are 35 years old) to more recently performed group of at home studies. It was a stupid comparison and its one of the reasons why the study makes me angry. There was no significant difference but if you knock out the studies before 1990 (16 years ago) there would have been and it would have been in strong favor of hospital birth. This study should not be taken as anything other than propaganda for home births, but the data on the percent of women who end up at the hospital anyway should give mothers cause for pause, since these are the professionals who are advocating for home deliveries. "
The neonataldoc.blogspot has leads to other studies, like this one: http://womens-health.jwatch.org/cgi/content/full/2002/1022/1 "Infants Born at Home Are Twice as Likely to Die as Those Born in Hospitals In this retrospective study, home delivery was associated with increased risk to both mothers and infants. "
The anecdotal account in the blog was with an uncertified midwife, and the retrospective study listed that gives a 2x neonatal morbidity rate does not account for the presence or certification of a health care worker at the compared home births. The presence of a skilled, trained, and properly equipped health care practitioner is key. Direct entry midwives and women who choose to birth unasisted would account for many of the homebirths in that study.
In my state (Pennsylvania) there is nothing stopping me from hanging a shingle tomorrow claiming to be a direct entry midwife.
I don’t presume to know what **JennaJay **meant by her statement, but there’s a large population that believes that management of pain and complications such as failure to progress can be reduced significantly if the mother is in a familiar environment where she retains a degree of control over her body.
I’m glad, having read everyone’s statistics so far, that my wife’s planning on a home birth with a CPM, a Physician’s Assistant (actually my sister-in-law, which is vaguely unsettling) – and with an excellent hospital within two minutes drive.
Wow! I guess things have REALLY changed in the last 30 years, because the birth of both of my children (in a hospital, thank you) was nothing like what you describe. Either that, or there is some exaggeration going on.
IIRC correctly, the reason given to me, by a physician who was very cooperative with the idea of as “natural” a birth as possible, for not eating after labor had begun is that one’s digestive system pretty much shuts down for a while, since more energy is needed elsewhere. So the food will mostly just sit there in the stomach, and you’re likely to be at the least very uncomfortable for the duration of labor. Myself, having just gone through 8 consecutive months of heartburn, I was not inconvenienced at all.
There was certainly nothing about forcing open any sphincter, any more than might be done for any ob/gyn exam, and what there was, was very gentle.
I might add that in between those two pregnancies, I had a miscarriage at 18 weeks. I was in labor for at least 24 hours, maybe longer. I wished to all the powers that might be that something could be done to speed things up, since the pregnancy could not be saved, but there was nothing that could be done to that end. So I don’t know where all the stuff about the cervix not being allowed time to dilate, birth must occur within X hours, hormonal augmentation, etc. comes from.
I’ve never had a c-section, but from what I’ve heard from others, it is not unheard of to be awake for it, using a spinal anaesthesia.
The bottom line is that you don’t need to undergo the risks of a minimally attended home birth in order to achieve all of the things its advocates claim. What you do need to do is find a doctor who is in synch with your preferences, you need to make those preferences clear. NO ONE in a hospital these days is allowed to administer drugs or put you through any surgical procedure if you don’t consent. At least that was the case in every hospital admission in my experience, and there have been many.
You simply have to make it clear that you are refusing whichever procedure you object to, be in monitoring, pitocin drip, whatever. And have an advocate with you to be sure your instructions are carried out.
Yes and no. Many of the aspects of hospital birth are based on sound research, such as the requirement to birth within a given time frame after water is broken due to higher risk of infection. Some of them (continuous fetal monitoring) have no statistical backing that they improve outcomes.
Food continues to digest. I was required to snack while in labor (~6cm) because there were ketones in my urine, which was an indication that I needed more energy. I wasn’t the least bit uncomfortable (well, with regards to my stomach contents).
Hospitals do not like their patients to deviate significantly from the average rate of dillation. Failure to do so will be diagnosed as “failure to progress” and will lead to augmentation or c-section. That is where that comes from.
A patient that already has an epidural in place can easily be medicated for an awake section. For one who does not have one in place, or for whom the epidural is not providing pain relief (sometimes the epidurals don’t “take”), a fast section means a general.
A laboring woman (or her nervous partner) is frequently in no position to be advocating for herself against undesired procedures. Nor is that the time to have to be evaluating which procedures are life saving and which are for convenience/protocol/the avoidance of malpractice suits. This is an area where doulas can be of great assistance.
Not all doctors are amenable to the minimal use of routine procedures, nor is it always possible to find ones that are. Some of them have been known to claim to be of a like mind at prenatal appoitments, but less cooperative during labor. And to be fair, there are patients that are so hung up on not deviating from their dream birth that they would put themselves and their baby at risk rather than subject themselves to the “evil” medical establishment.
Determining what is unnecessary bureaucratic crap likely to lead to a cascade of undesired interventions (see defensive medicine) and what is sound, life-saving medical practice can be tricky. If only we could always trust our care givers to sort it out for us. The hope is that outside a hospital, the caregiver and patient are free to make sound decisions without “policy” dictating things quite so much.
No, there isn’t, but presumably a woman looking for a homebirth midwife is going to know to ask you where and how you apprenticed, with whom, and whether or not you’re NARM certified.
And if the state of Pennsylvania would recognize that NARM certification means that a midwife has followed a rigorous, years-long course of apprenticeship and sat for a very intense examination before she could be approved, and quit allowing/forcing midwives who aren’t nurses to operate in a penumbra of the law (and then turning around and charging them with crimes when something goes wrong in a birth, even when there is no evidence that the outcome would have been different with a nurse or a surgeon) then women would be protected from charlatans and would have increased safe options for birth and wouldn’t be going down the DIY path.
There is a long and strong history of DE midwives in PA because of our Plain population, who have fostered midwives amongst their own numbers and in the adjacent “English” populations. Sadly as midwives on both sides of the state have ended up on trial for manslaughter or under injunctions to stop practicing, not only are the Plain communities suffering, but the non-plain people who would have had these women attend their births are creating a strong underground of unassisted birthers. This is truly unacceptable in 2009.
Well I’ll tell you this much. I’m a birth doula. I’ve been in attendance for 68 births in the last ~4 years, some at home, some at a birth center, the vast majority at a hospital. I start my relationship with my moms as early in their pregnancies as possible. I’ve come and held their hands when they’ve been told at 36 weeks that their babies are getting “too big” based on an ultrasound, and that they may be forced to have a c-section because they may have a 9+ pound baby, even though women vaginally birth 9+ pound babies every day.
I’ve been there when the first time moms, who statistically will give birth closer to 41.5 weeks than 40, are badgered into inductions at 40.5 weeks because their babies are “late” and that’s “dangerous.”
I’ve been there when moms whose water hasn’t broken yet are still put on the time clock, told they’re not progressing fast enough, and augmented. I’ve walked out into the hallway, taken a look at the big (HIPAA violating) board and seen that 60, 70 or 80% of the women currently laboring are on Pitocin.
Slow down maybe. Stop entirely, probably not. If you’re hungry, your body is telling you to eat, it’s not going to take in that fuel and let it just sit. And if it does, you may throw up a little. It’s not the end of the world. Many women don’t want to eat but the ones who do and can are often quite better off for it. I’m not talking a cheeseburger, but things like yogurt, broth, Emergen-C or Gatorade.
Introducing prostaglandins and synthetic hormones to make the cervix dilate are forcing open a sphincter before it’s naturally ready (or faster than it’s naturally willing) to open.
I am sorry for your loss. I don’t know the circumstances, but I cannot fathom that if that happened today, your labor wouldn’t have been augmented so that it would be over as quickly as possible for you.
A doctor is still a doctor. And hospital protocols are still in place and doctors still have to follow them if they want to keep their privileges. And of course this presumes that your doctor is around through the majority of your labor and birth and they very very rarely are. And when it’s you and the nurses or the interns and residents and they’re pushing protocol and you’re resisting, you will then be seen and treated as a difficult, diva, demanding, bothersome patient. It will create animosity between you and the people who are supposed to give be your care providers. It’s not a positive or proper atmosphere in which to try to birth.
You’re entirely right. What they are allowed to do is badger, bully, coerce, lie and misstate the facts outright, and play the “bad mother” and “dead baby” cards until a woman in pain, vulnerable and worried about herself and her child gives in to things that she doesn’t want and may well not need at all. Welcome to cover-your-butt obstetrics, 21st century style.
Why does this happen? Because, as OBs are well taught, “you get sued for the c-section you don’t do.”
And the risk of infection is much higher in a hospital birth because a.) you’re in an environment teeming with alien bacteria and b.) protocols which demand a specific rate of dilation consequently require hourly cervical checks, and fingers introduced into the cervix are an excellent – and in fact the only – vector for bacteria to be introduced during labor. (Barring artificial membrane rupture procedures or internal fetal monitors.) It’s a solution to a self-created problem.
I agree, and perhaps I should have made it more clear. The point I was trying to make is that there are proportionally far less women who homebirth who see the admitting room doors than there are women who opt for a hospital birth who receive cesarians.
I’m in Texas, FYI. I could be wrong about the number. Even if I’m not, it’s a sixteen year old statistic.
I just want to add that the reason many hospitals don’t let birthing mothers eat or sometimes even drink is a precaution in case a general anesthetic is needed for a c-section. They want to prevent you from vomiting while completely under, which can happen and is very dangerous.
I had my daughter in the hospital and honestly, it was an absolutely HORRIBLE experience. At about 39 weeks they decided they needed to induce because an ultrasound revealed that the amniotic fluid levels were low. There were also concerns that the baby might be too big since I was measuring at 45 weeks. That was bull in my opinion at the time because I was overweight going into the pregnancy and gained over 30 pounds. I measured big because I had a fat stomach. But no one listened when I said anything so I just let it drop.
Long story kinda short, they admitted me at 6am on a Friday and was forced to stay in bed on monitoring and have hourly cervical exams. I was allowed a clear liquid diet which meant basically a lot of chicken broth and jello. I didn’t even progress past 2cm dilation until Sunday morning at which point my doctor was like “You’re having this baby today one way or another”. At one point a nurse even came in and told me that I was NOT to let the doctor break my water before 4cm because she had a habit of doing it much too soon and then having trouble with the cord wrapping around the baby’s neck. Great. So what happens? 3cm she decides to break the water to speed things along. Me, being completely non-confrontational, doesn’t say a thing. At this point I’m so mentally and physically exhausted from two days of no sleep and no real food I just want it over with. They even gave me an epidural BEFORE I was feeling any contractions at all, as a precaution for c-section. Basically she was convinced the baby was huge and I was going to need one. Finally once I start pushing I think things are going to get done quickly but after about an hour of pushing with no progress she tells me “If this baby doesn’t come out in the next half hour you’re getting a C-section.” Not wanting that at ALL, I give it everything and finally she comes out at nearly 6pm Sunday night. Cord wrapped around her neck but perfectly fine. And her weight? Just under 8lbs Yeah…
So basically while I had THE most horrid experience, I would still go to a hospital if I have another. Because just in my mind, I feel safer there. But…I would never use that same doctor and would be much more vocal about what I wanted.
There are good doctors and bad doctors. The OB for my wife (who was on call the night of the birth, so she delivered our son) was good, but a little too predisposed to non-intervention. My wife had a narrow birth canal and the baby got stuck twice (once at the cervix and again at the vaginal opening). My wife pushed hard for over two hours and the doctor waited until she was almost completely exhausted before doing an episiotomy (Firefox does not recognize this word for some reason). I am grateful for the nurse who called her in early to see how rough the labor was going. This doctor seemed to take the idea of a C-section as personal failure on her part. I am glad my wife did not need the surgery, and we were not really candidates for home birth, but I, for one, am glad we were somewhere immediate medical attention was available.
By the way, what is the argument against non-intrusive fetal monitoring? Is it that it used to keep the mother immobile? Where we were at they encourage us to walk around, use the bouncy ball and just find whatever made things go easier.
Did your hospital have telemetry (remote) monitors? Those ones enable the laboring woman to move around, but they’re not the most common.
Typical monitors are wired to a machine, which limits the amount of mobility. If they’re displaced (too much bouncy ball, switching positions, etc) the signal can get lost, making people monitoring the signal remotely (nurses’ station) nervous. Some hospitals will allow the laboring woman to have only periodic monitoring, but that’s more work for the staff. As you rightly said - being mobile can make things go easier for the mother, but it messes with your average monitor.
But wait! Isn’t it critical to know the baby’s heart rate and the strength/length of the contractions? Yes and no. While it is important to verify that the baby isn’t in distress, that can be determined by periodic monitoring either by doing an hourly monitor strip or by using hand-held doppler. No study has been done that shows better outcomes with continuous monitoring - in fact many people suggest that they make doctors more nervous from a med mal standpoint. (see above link to “defensive medicine”)
To sum: continuous monitoring tends to keep laboring women in bed on their backs, immobile, for no advantageous reason other than convenience for the hospital staff. (this is the argument against it - void where prohibited, exceptions do apply, etc)
I think they may have, but we didn’t use them. They just monitored periodically until the contractions got bad. But I think the monitor could be used in the bed or on the ball, just not wandering the halls.
Yeah…