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FAQ--Home Uterine Monitoring
As a bit of background, there are no studies that definitely
show that home monitoring is effective in preventing preterm
delivery. This is likely due to the fact that no studies have
been done which show statistics from Higher Order Multiple
Pregnancies (triplets or more). There is a large difference in a
woman's ability to detect preterm labour with a singleton
pregnancy, and preterm labour with three or more babies.
Here are some excerpts from Home Uterine Activity
Monitoring for Preterm Labour- a study published in the July
21, 1993 issue of JAMA (Journal of the American Medical
Association). Notice that NONE of the participants were
triplets or higher. Only one study differentiates singleton
from twin pregnancies, and that study finds that monitoring is
more successful in detecting early labour in twins than in
singletons.
"In twin gestations, the incidence of preterm birth was
significantly lower in the monitored and control groups than in
the standard care group. There were also significantly lower
rates of neonatal death, intensive care nursery admission, and
respiratory distress syndrome in the control group than in the
standard care group. All neonatal outcomes were significantly
better in the monitored group than in the standard-care group.
The monitored group had significantly lower rates than
controls in the incidence of birth weight less than 1500g,
intensive care nursery admission, and length of hospital stay.
The authors conjectured that benefits were observed in twin
gestations and not it singleton cases because women with twin
gestations had decreased perception of contractions or
because the number of singleton cases was too small to
demonstrate a benefit." ( Page 374, JAMA, July 21, 1993-vol
270, No. 3)
For further information, contact MOST
([email protected]), or the Triplet Connection
([email protected])- either organization has more
up-to-date studies and research than we can possibly present
here.
From the members of the Triplet List-
--1) What exactly is involved in home monitoring?
- Home monitoring is a big funny looking belt that your wife
straps on twice a day for an hour each time. As she is wearing
the belt, she will push a button on it every time she thinks she
feels a contraction. At the end of the half hour she will plug
the belt into the phone and download the signals to the nursing
staff taking care of her. The belt registers when "it" feels a
contraction and compares it to when the patient thinks they
feel a contraction. This clues the nurse into how well the
patient can feel the contractions. If your wife has more than
the stipulated amount of contractions (like 4 an hour) then the
nurse might recommend a bolus of brethene (if your wife is
hooked up on a pump). If I had too many bad readings (lots of
contractions) the nursing staff would call my peri and I would
go in for an appointment the next day.
- Many times, if I had 4 or 5 contractions in an hour, I would
just have to drink a big glass of water and monitor again - and
I think they would call my perinatologist.I only had to do it
more than twice one time. I was never put on any tocolytics.
If it was a great amount of contractions and they were regular,
they would actually send you in immediately or at least contact
your doctor. (I never had to do this, either). Also, the monitor
picks up uterine irritability. This is basically contractions that
are technically too short to be called contractions. A
contraction has to be a minute or more.
- If I had too many contractions the nursing staff would have
me drink a ton of water, lie on my side and monitor again for 1
hour. If there were still too many contractions (more than 6) I
was sent directly to the hospital. This happened to me 3 times
-- the last time they kept me. I never felt any contractions.
- Contractions can feel differently to each person. Some
people can "see" or feel their whole tummy contract. I
couldn't. To me, contractions were concentrated strictly
around my cervix and felt like menstrual cramps.
- When I was doing home monitoring, I occasionally had 6 to 10
contractions an hour. Many of them I couldn't feel (despite
having been through labor with my first son). As soon as they
(the nurse on call who would read (interpret) the monitoring
strip) would call to let me know how many contractions I was
having and how often they were occurring, I would (if there
were a large number of contractions) go take a nice hot shower,
get in bed on my side, and drink a huge tumbler of ice water.
Sure enough, after 30-60 minutes, the contractions would go
down to no more than 2-3 per hour if that.
- I'm speaking out with you in full support of Home uterine
monitoring.I have done alot of research on the subject and you
are completely right- most of the research was done on
singleton and twin pregnancies and much of the studies are
conflicting, some show a benefit from monitoring and some show
that it has no benefit at all. There has been much discussion as
to whether it is the monitor or the daily nursing contact which
is the greatest benefit, but most of us know that even if we
went to the best perinatologists around they didn't call us
every day to see how we were feeling. I went for an office
visit at 29 weeks and I was 3 cm dilated and having about 10
contractions an hour. I did not have a monitor and will regret
this decision always. I was not able to detect most of the
contractions that I had which is the case for many triplet
pregnancies. One study in 1996 showed that women missed an
average of 85.7% of their contractions. Women pregnant with
singletons were better able to palpate contractions than women
pregnant with twins or more. I have had two other pregnancies
complicated with preterm labor and was able to detect my
contractions from the moment they started. I can't say that
for my triplet pregnancy. Our local triplet support group has
had 6-7 women deliver prior to 28 weeks in the past several
months, none of whom were home monitored. Two women lost
their babies at 21 and 22-23 weeks. After speaking with Dr.
Elliott in Phoenix(TTC advisory board) we decided to start
speaking with the perinatologists in this area to try to figure
out why most of them do not use home monitoring. He starts it
as early as 18 weeks. He told me that he doesn't know of any
insurance companies except maybe one or two that will not pay
for home monitoring if the doctor says that it is necessary. It
is also important to know that 22-23 weeks is a prime period
for increased contractions which explains why he starts
monitoring so early. Compared to a NICU stay for three
babies home monitoring is inexpensive. It astounds me that the
insurance companies can't see this and push for home
monitoring.I know that this is long and possibly repetitious, but
I highly recommend home monitoring for women carrying
triplets or more. It might have helped us buy a few more
weeks. There are also many women who had monitors and still
delivered at 28-29 weeks, but most of the women I know who
this happened to feel that if they had not had the monitor they
would have delivered at 20-23 weeks. Most people I know who
had monitors were glad that they did. It's a small inconvenience
twice a day that could save your babies' lives.
- My doctor was one of those who didn't support home
monitoring - they believed more in patient education: "a
braxton hicks feels like horizontal cramping and contractions
are more vertical" Not the best idea for a clueless, first-time
pregnant mom with triplets! The cramps all felt the same to me.
I am convinced that if I had monitored my contractions, I
wouldn't have delivered at 27.5 weeks. Since my checkups
were always so good, I believed that I was doing fine, and that
my level of activity was OK - wrong! If I could do it all over
again (hah!) I think I'd start monitoring around 20 weeks.
- After reading all the info from the Triplet Connection, I
asked my dr about home monitoring...he said that he did not
believe that monitoring was effective and that if I needed to
be watched that closely that I would be put in the hospital. I
can't remember if it was at that visit or the very next visit
but when he did an internal exam, he said he detected a change
in my cervix....nothing major but that it did seem "different".
He asked if I was having any contractions and I confidently
said no. Anyway, to be on the safe side, he decided to monitor
me for 1/2 hour before he sent me home. I knew I was in
trouble when at least four people had been in the room to
check my monitor strip within the first 10 minutes (including
the dr)....all of them asking if I was feeling any
contractions....my answer was still no (I did not feel any
tightening or anything). After my 1/2 hour was up (by the way,
this was all around 24 weeks), they called over to the hospital
and then told my husband and me that they wanted to observe
me for a while longer. When I got to the hospital, I was sent
through a battery of tests (checking for infections, etc.). I was
not allowed to get out of my bed for nearly two days and was
not allowed to eat anything for at least the first 24 hours
(they thought that delivery might be imminent). Needless to
say, I was scared to death.
Well, ten days later (and still feeling no contractions), I was
still there....I was now allowed up to the bathroom and to
shower and was allowed to eat but still having regular
contractions just the same. At that point, I just wanted to go
home (once again, knowing what I know now, I would gladly have
stayed in the hospital until the day I delivered)...in fact, I
begged to just be at home....I was both lonely and afraid. I had
the pleasure during this time interval of listening to my dr and
his colleague argue over what to do with me....my dr wanted to
keep me there basically to be "safe" (same dr as Julie)...his
colleague felt that my delivery was too far off and that I
needed to be sent home for my emotional well-being....I was
still contracting on a regular basis (4-6 per hour) yet my
cervix was not showing any notable changes. Well, I ended up
going home on a monitor with the understanding that I would be
living at my parents' house (ranch vs 2 story AND my parents
were more available than my husband due to their respective
jobs).
That monitor was both the best and the worst thing that
happened to me....my threshold was set at 4 contractions per
hour (which I often exceeded at least on the "first try").
Often times, I "barely passed" on the second monitoring....this
meant that I frequently monitored for 4 hours per day. I can
only speculate that perhaps the monitor caused me to make sure
to stay well-hydrated, etc. but there was never any real
significant change noted in my contractions. Some of the nurses
I spoke to were great...others seemed to be insensitive and
actually brought me to tears (often times they would tell me to
re-monitor immediately and I would beg to have a small break
and hope that my mom would be home to bring supper, etc. in
the meantime....most of the time I was alone). I do know that
the number of contractions per hour seemed to shift ever so
slightly the week before I delivered but never enough to cause
a trip to the hospital. At 31 weeks, I went in for a routine
exam and they found my cervix had dilated to 2 cm....I was
immediately hospitalized and given steroids....I delivered the
next day (before the steroids took effect)....my children were
all on vents (from 12 hours to the longest at 5 days....he would
have been on longer but he extubated himself and did fine
without the vent so they left it off). Anyway, I guess my point
is that I'm not sure if the monitor made a difference...maybe
they would have picked up on changes in the hospital that were
responsible for the change in my cervix....in retrospect, I think
I did feel different that last week (just kind of cruddy) but
the monitor gave my somewhat of a false sense of security. I
think that is the potential danger with the monitor but that a
monitor, if used properly in conjunction with any other signals
from one's body, can't hurt).
- I TOTALLY agree, if not for home monitoring my children
would have been born at 20 weeks, obviously way before
viability, and they wouldn't be here with me today. My monitor
picked up contractions that I wasn't feeling and I too had had
2 pregnancies before this one so I knew what a contraction
felt like. Wouldn't you rather look back on your pregnancy and
KNOW that you did everything you could to go as long as
possible. Just my 2 cents worth.
- I know I got blasted before about this but I really feel
strongly FOR home monitoring. Unfortunately, the HR practice
I went to did not. As a result, my water broke at 27 weeks and
my children were born 7 hours later. Studies done on women in
low-risk, singleton pregnancies show there is no valid reason
for home monitoring. Who in their right mind would agree to
experiment with a high risk multiple pregnancy? As far as the
argument that they produce too many false alarms and cause
undue ER visits, I would have rather visited the ER a dozen
times than have my children live in the NICU for 3.5-4.5
months. I will forever feel guilty for not insisting that I be
put on a monitor every time I look at my precious son sitting in
a wheelchair or the numerous scars on all my children's bodies.
When I questioned my dr about the monitor I was told not to
worry because I had already had a son and would know what
contractions felt like. Believe me, I felt NOTHING!
Ironically, my insurance WANTED me on home monitoring and
would have paid for it 100% Please don't make the same
mistake I made. INSIST on being monitored or ask for
another dr.
- While some will paint a rosy picture of how unnecessary
monitoring is, I have had a very different experience of what
can happen if contractions are not detected. If the technology
is available to help insure our children are born healthy, why
would anyone not use (believe in) it?
- Although the my OB/GYN group of three didn't believe in
home monitoring, it was entirely different when the group
consulted and turned my care over to a perinatologist group
much more qualified in the care of high risk or extreme high
risk pregnancies.
- My perinatal group of TEN, ALL believe in home monitoring.
I happened to get the most liberal of them all, and he held me
off until 20-22 weeks for monitoring and bed rest, somewhere
in there..... I figure they must have a clue what they are doing
since doctors from around the world seek their advice and
opinions on cases.
- Personally, home monitoring gave me a sense of peace and an
active part in my care. I was also able to speak to the nurses a
minimum of twice a day which helped alleviate the boredom of
bed rest and allowed me to get my many questions and concerns
answered without bothering my OB with the "small stuff".......
It also SAVED me trips to the hospital when I was able to
monitor my own contractions. Yes, I did take a couple "false
alarm" trips but I DIDN'T take other trips I normally would
have. My monitoring showed an increase of contractions, but
my local OB's didn't think it was cause for alarm. ( This was a
greater increase then usual)... I had even been to the doctor on
Friday and he told me everything was fine, and that if I kept
doing what I was doing, I would be delivering at my local
hospital in a few weeks. I had PROM at 4:20 AM the following
morning. I transferred down to the specialist group. The
doctors ( Perinatologists) were trying to hold off delivery for
48 hours in order to give the Betamethazone (sp?) a chance to
work. I couldn't hold out that long, and my babies came via
C-sec at 6:37 PM, 6:38 PM, and 6:38 and 40 secs PM. I
wholeheartedly believe in home monitoring because I have first
hand experience with it. The signs were there, my doctors just
didn't pay attention to it. IF home monitoring saves the lives of
just ONE set of mother and baby, isn't it worth it?
- My advice? Do your research yourself and decide what is
best for you. I went to my OB armed with information from TC
and other areas, but was STILL told that they wouldn't put me
on it. THEN! Someone far more educated and qualified to make
that decision put me on it......... If you CAN'T get your doctor
to put you on, then don't worry about it as many woman have
had their babies without it and have been just fine....
- My doctor prescribed home monitoring when I was 20 weeks
pregnant. At the time, I think he was being cautious because he
had another triplet mom (3 months older than mine) who had
gone into premature labor and spent from 19 to 34 weeks in
the hospital. Anyway, I could never accurately detect my
contractions. When I would compare with the monitoring
company, most times I was off. It was a blessing in disguise for
me. Although, I begrudged the time I spent on the machine, I
think it ultimately saved me from premature labor. I had a
major episode at 27 weeks and would probably not have known
I was in labor without the forewarning of the monitor. With it
and tocolytics, I held off until 31 weeks when I delivered due
to premature abruption of the membrane. My primary
insurance covered this, although only 80%, and the monitoring
company wrote off the difference. My doctor had told me that
most times, if insurance denies you, they'll provide it anyway.
This may have changed a lot in 5 yrs, I'm just relaying what
happened to me. Anyway, it was expensive, about $100 a day.
I'm not saying that it is the end-all solution of preventing
premature labor, I'm just saying that for me, it was a
precaution that I feel helped insure my babies healthy birth.
- My wife had a relatively problem-free pregnancy for the
first 25 weeks. Based on information from the Triplet
Connection, we did lobby our perinatologist to get a home
monitor. He was somewhat dubious about the benefits of this,
he was quite experienced with triplet pregnancies. I suppose
what convinced him was that this was the first pregnancy of my
wife and she didn't really know how to distinguish between
contractions (at the time, she hadn't had any yet). So, after it
cleared with the insurance company, we got one by the 26th
week. Good timing. By the 27th week, my wife was having
contractions (as many as 6-8/hour) that SHE COULD NOT
FEEL. Without the home monitor, she would not have known and
we would not have gone to the hospital. A shot of terbutyline
(brethene) and it was controlled. Over the next 4 days, her
contractions came back stronger, this time she was able to feel
1-2/hour when the uterine monitor reported that she had
6-8/hour. We went back to the hospital. We were then
confronted with the possibility of either being discharged the
next day or at the insistence of my wife stay in the hospital
until delivery. Again, my wife must have had a sense of the
situation that the doctors were not aware of because during
her stay at the hospital, her contractions continued,
occasionally getting more frequent/stronger that was
immediately controlled by a change in the terbutyline dose. At
the hospital, they set her up with a terbutyline pump. At the
hospital, she was monitored nearly continuously. The next 3
weeks were a rollercoaster ride. At least 2 times, the doctors
were convinced that she would deliver. Throughout this time,
she still could only feel perhaps 20-30% of the contractions
that she was having. During her stay at the hospital, they did
give her the regular injections of steroids. Eventually, she
graduated to Mag sulfate (not a pleasant experience). Finally,
her water broke at 30.5 weeks and we became parents of
three boys.
1. Home monitoring was important for us and probably alerted
us to preterm labor early. One note is that prior to getting the
home monitor, my wife did learn to do the self-palpation of her
uterus to determine contractions. For us, it was really the
combo of the two that was important and not just a reliance of
the home monitor. Still, we cannot deny the importance that
this piece of equipment was for us.
- My Ob did not recommend home monitoring and I could feel
contractions as early as 18 weeks preg. My Ob said that when
the idea of home monitoring came out he invested in the
equipment so he could rent to his clients at a low cost. After
about two years and some research he said that it was not
showing a useful device on mostly singleton pregnancies. (Of
course I am only is 6th triplet mom) He said since it really did
not catch labor much earlier than the people did the
intervention and out come was the same. He ended up getting
rid of his monitoring equipment. I also asked my perinatologist.
He did not use home monitoring for most of his cases either.
(That surprised me !!) My perinatologist recognized that I had
contractions from 18 weeks on any never recommended
monitoring for me. He would check my cervix every once and a
while and that is it. I decided to do my own research and got
the TC packet. I ended up deciding against the home monitoring
all together. I continued to have contraction, sometimes as
many as 4-5 and hour but usually not more that 12-18 per day.
Of course this is how many I recognized and not necessarily
how many I had. I felt I knew my body very well and I would
catch any labor clues. - For me I GUESSED right. I never
went into labor and ended up scheduling a C-section when we
were 36 weeks. I would still say that it is a very personal
choice and I can see why so many people advocate it.
--3) How can you convince your insurance company to pay
for it?
-I didn't have that problem (I just started monitoring last
week) but the nurse I'm dealing with told me she and others in
her company have become involved in appeals that have
succeeded by sending the insurer information about the service
and the ways it can reduce the insurer's costs later (i.e. if you
end up in the hospital). Can you contact the monitoring company
directly for help?
-Have you been hospitalized with pre-term labor? Are you on
doctors orders for bed rest? Home monitoring is a lot cheaper
than stays in antepartum.
-Get in touch with the home monitor people and see if they can
work it out with your insurance company. My insurance
company did not want to approve the type of monitor that my
doctor prescribed, but the monitoring company worked it out
with an insurance company contact. If you can, try to get one
person assigned to your case from the insurance company who
is not a laims processor, but someone who can make decisions
for you. Good luck.
-I "enjoyed" being at home for 5 wks after a 10 day hospital
stay with home monitoring (wks 21-26) Mine were born at 29+
weeks ; 2#15 to 3#10 and are all doing great now - 22# -
25+# at one year.
- contact Kate here at MOST (http://www.mostonline.org)and
she will help you in getting your insurance company to cover
the monitor and in the meantime if you want to give me a call I
will teach you how to monitor yourself until you get the monitor
into your house. Let me know how many weeks you are as well.
Doing this over the phone is easier than by email so we can get
instant feedback on how you are doing. Take care. Maureen A.
Doolan Boyle (516-434-MOST)
-Tell them to read "The Rainmaker" by John Grisham. It deals
with an insurance company's failure to provide coverage, which
leads to the insured's death. They get hit for $50 million in
damages. Seriously, call the state board of insurance; they will
help you if your company continues to refuse. - appeal with
them, with as much medical data as possible, ie: savings
prevention etc. Your high-risk doctor should be able to assist
you in this. If it still fails, then write a letter to the board of
directors, maybe even suggesting a possible malpractice suit if
you still get nowhere. Your best bet is to be better informed
than the other side is. Facts usually work.
-Our insurance initially denied a monitor and we appealed and
won. My perinatologist wrote a letter explaining why I needed
monitoring and I also wrote a letter. My letter contained
information that I got when I called the hospital where my
babies would be born and spoke to the billing dept to find out
the daily room rate for NICU...not including vents or MD fees
or meds or anything else. I multiplied that rate by 3 and then
said this is the total PER DAY that the babies would cost the
insurance company if they were born early! I also included my
feelings regarding having lost several children in the past by
miscarriage and said that I wanted to do everything possible to
end up with HEALTHY and more mature babies! I also sent a
letter from The Triplet Connection that came with my
expecting parents package that had information about
monitoring. Overall, It is cheaper for them to pay for the
monitoring while the babies are INSIDE rather than paying
for all the expenses after the babies are premature. I stressed
that the goal was to PREVENT labor rather than to STOP
labor once it starts preterm! |