Toco Monitoring in Labour (CTG) - Motherhood Diaries Parenting Magazine - Preconception Planning | Pregnancy Journal

If you’re pregnant, grab your free pregnancy pack now – details inside!

I have been thinking about VBACs, i.e. Vaginal Births After Caesarean. There is a very strong argument for allowing women wanting a VBAC to give birth at home or in a midwifery-led birth centre. Within the medical constraints of hospital care offered in the UK a home/birth centre birth would be strongly contraindicated and not encouraged.

If you think about it for a moment, a home/birth centre birth seems the perfect place for a VBAC. In my experience, most caesarean sections are performed when a woman fails at bringing on labour and during fetal monitoring, the baby is seen to be distressed by the long labour on the toco monitoring machine when measuring contractions. There are physiological reasons for this.

Going into hospital can be a stressful event, adrenalin will be secreted when a person is under physical or mental stress. Adrenalin (the hormone secreted by stressed people) attaches itself to the uterine cervix and prevents it from opening normally. So, when stress is a factor within active labour, expected progress will not be made due to the actions of adrenalin. The contractions will have to become stronger in order to pull up on a resisting cervix. How will this help someone having a VBAC? It will make a uterine rupture much more likely.

At home/birth centers however, a woman is much more likely to remain calm and in control. If she follows the advice on relaxation techniques then she will not secrete adrenalin and the cervix will be free to dilate. The contractions will not have to become stronger, as the cervix will not resist, and so they will remain at normal contraction levels. The first stage of labour, if conducted under the methods taught in my blog, will be pain-free.

When in hospital, a woman having a VBAC has to be continuously monitored (CTG reading) to detect any early signs of uterine rupture. She will most likely be confined to a bed with only brief breaks to visit the loo. Staying upright during labour helps the uterus work with gravity so that the contractions do not have to become strong. Lying down during toco monitoring will make the contractions become stronger and so will cause pain. The fact that she is not mobile will also impact on the descent of the rotating baby into the complicated anatomy of the birth canal.

At home/birth centre, a woman is free to move around and relax as her body dictates. She can eat and drink anything she chooses according to her body’s needs. She can remain upright and have the power of gravity which will encourage bringing labour on, rather than hindering it. The contractions will remain normal as her environment and mental state will be in harmony with her labour, instead of placing obstacles in the path of normal progress.

With the element of a pain-free first stage of labour, a home/birth centre birth can become a real option with all the benefits working toward encouraging normal progress. The only element that will prevent women from seeking out pain-free labour is FEAR. The fear of litigation. The fear that women are irresponsible little tykes that are all too willing to put their babies at risk. Hospitals will not support home/birth centre births for VBAC. But. They may support birthing on a labour ward that usually has at least one pool to birth in. Water births are so nice and gentle that no extra stress will be put on the scared uterus causing it to rupture, the contractions can remain normal. The midwife is still listening in every 15 minutes to the baby’s heartbeat on the fetal heart monitor, which will detect any adverse changes. Mobile CTG monitors are the latest thing at the moment – you can walk about or sit on a birth ball or even get in the pool as they are waterproof. The only trouble is they tend not to work very well and you will be constantly bothered by a midwife trying desperately to regain a lost signal!

Why using toco monitoring in labour for a VBAC is a bad idea:

Lying down on a CTG machine will cause the contractions to become painful as they work against gravity.
The pain will cause stress that will hold the cervix closed, which will make the contractions become stronger.
Not moving about in labour will slow the normal rotation of the baby.
Not eating in labour will prevent enough carbs from being available to fuel a contracting uterus, causing labour to slow down or stop.
If it slows down or stops, a drip may be started that will put extra stress on the scared uterus.

Everything we do in the hospital seems to be against helping women to achieve a VBAC. I know of a young lady who recently turned up at her local birth centre and was asked to leave as she was high risk. She calmly told them that she was going to labour in their pool and refused to leave. She had a normal delivery in their pool. Another I met was planning a home birth after a previous CS.

Let’s start a campaign today to allow women VBACs within a home/birthing centre setting. Let me know what you think?