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    Questions? Ask Henci!


    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Archived User
    Hello. My name is Julie. I am currently on bed rest in a hospital in Utah after a pPROM at 31 weeks. I am currently 33w5d. No signs of labor, no infection, no problems, I feel great with all this tlc and food and rest. This was to be my third homebirth. I am ONLY in the hospital so that if my baby decides to come before 36 weeks, she will be in a "safer" environment than my home, which is currently 1 hour away from the closest hospital with an NICU, we have very iffy weather right now, and I am home alone all day. I am expecting a fast birth. I am very non-intervention, and have managed to fend off MANY of the things they have wanted to do to me here. However, as you can imagine, I am "subjected" to a daily NST test. Which, in the beginning, I didn't mind so much. Now, 2.5 weeks later, they are really starting to stress me out and I am losing what little peace I have left. I want that back. You can read my entire story here: http://www.mothering.com/discussions/showthread.php?t=821201 I start out with a great attitude, and over the last 2 days, it has kind of fallen apart. Basically, I am writing to ask for a little advice or thoughts on a couple of things, as I do not trust doctors to give me a truthful and natural birthing viewpoint. I find them busy at the task of finding something "wrong" with me, and there just ISN'T. 1. How early do you believe is TOO early to check out of this hospital and go home to birth? I guesstimate my baby pushing about 5 lbs. right now. I had steroid shots when I came to the hospital just over two weeks ago. Both my other babies were healthy and large 42 weeker at 8lb.10oz & 37 weeker at 6lb.8oz. 2. If I refuse further NST's do you believe the hosptial can "kick me out"? 3. What am I not thinking of? Ultimately, my dream plan from this point is to lay here with no further testing until 35.5-36 weeks and then return home to deliver as planned. Until now, I have NEVER been in the hospital and I am 40 years old. I most certainly have not had anything LIKE a medical pregnancy or birth. I am terrified of being sectioned. I am even terrified of induction and get absolutely nauseous when I think of an epidural. I want nothing to do with any of those things, yet here I am, facing the possibility of being threatened, bullied, or co-erced into things I just don't believe I need. I do not enjoy scare tactics. I even find the doppler to be somewhat unnerving, as it's always a "let's see if your baby is still alive" moment with the nurses, even when I can feel her happy and healthy as ever in there squiggling around... there is a period of time I find myself holding my breath... JUST because of a machine. I am a firm believer in natural birthing. I do not believe that doctors or hospitals or even mother nature can assure me a happy ending NO MATTER what I do. I know that tragedies happen, and of course they could happen to me. I don't believe that being in the hospital is going to "save" my baby... unless of course, she is born too early to breathe on her own. I do not believe I can be assured a perfect baby JUST because I submit to tests, inductions and sections. I don't believe monitoring me for 1 hour out of 24 does ANYTHING towards the health of my baby or myself. In fact, it's making me doubt myself, fear the hospital even more, and I am becoming angry. Hopefully you have some helpful words for me right now. I'm starting to weaken and feel just awful. Certainly not in peace as I was the first two weeks of this PROM adventure. Thanks in advance
    Henci Goer

    Here's the thing: you have the right to complete, objective information about your options so that you can make informed decisions, and the right to make an informed decision includes the right to informed refusal. As I read your post, you have two questions: One is "What is the best estimate of the risks to my baby in my specific case if I leave the hospital altogether and how likely are they to occur?" I say "your specific case" because your baby's estimated weight and condition should be factored in as well as such things as your distance from the hospital. This equation changes, of course, as time passes. Factor in as well that most home birth midwives confine their practices to women who do not have medical or obstetrical problems at onset of labor, which would preclude preterm labors. The other question is "What care do I agree to while in the hospital?" It isn't, as it appears to be, an all-or-nothing issue. You could refuse any monitoring and interventions for which, after hearing the pros and the cons, you think the harms outweigh the benefits--and your mental distress is definitely a harm that should be counted as a "con."

    Here are some useful sources from the Childbirth Connection website: The Rights of Childbearing Women, and Informed Consent, Informed Refusal. And if you need a bit more muscle, here are your rights according to HIPAA, which is a set of government regulations:

    Consumer Bill of Rights and Responsibilities: Participation in Treatment Decisions

    -- Henci

    Archived User
    Ok, one more... I've already had to fend off today's resident on call about the daily NST's. She is on her way to "tell on me" and send over the head ob to argue the case again. Are there any studies I can arm myself with in relation to NST use and actual outcomes? I'm not convinced they are going to "make or break" my baby's life or death, however I know what they are doing to ME. I guess I'd like some studies on how useless I am starting to see they are, at least, in my case.
    Henci Goer

    This is an easy one. It isn't up to you to find research that supports not doing NSTs; it is up to them to show you research that supports doing them. If they can't show you research that NSTs improve outcomes of babies born preterm--and I will bet the mortgage they can't--then you are home free. Keep in mind as well that the argument that they don't do any harm isn't good enough because NSTs aren't harmless. As with all fetal suveillance tests, they have a high false-positive rate, that is, the test says the baby has a problem when the baby is really fine. This means you could end up with an induction and a premature baby or cesarean surgery that you didn't actually need. And, of course, there is your ongoing stress, which isn't good for you or the baby.

    If I am wrong, and research exists, you may wish to rethink your position--or not. Your right to informed refusal doesn't depend on anything but your own judgment of your situation.

    If you want to stand pat, I think your best bet is not to let yourself get drawn into arguments. Just keep politely insisting on your right to informed refusal of NSTs. You may also need to make clear that you are not refusing any and all care and monitoring if that is not the case. You could, for example, refuse NSTs while agreeing to monitoring for signs of infection. Also, make sure that anyone close to you to whom medical staff have access are on board with you. It isn't uncommon for staff to attempt to co-opt them.

    -- Henci

    Archived User
    Ermm, are you still leaking any fluid? Bags can reseal if it is a minor leak and water constantly replenishes.
    Also, in your evaluation, you may want to include the risk of infection by simply being there for so long.
    As far as fetal monitoring, can you just do a movement count at the same time each day? This should give you a good picture as to what is normal and what not and if baby is fine. No need to stress him/her out either.
    What foods are you eating in the hospital? You should be eating lots of probiotics, zinc and vit. C rich foods, for you immune system and the amniosac!
    maria.

    All Times America/New_York

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