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Thread: Internal exam

  1. #1

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    Default Internal exam

    Is it just me or does everyone find it incredibly painful when they do an internal to see how dialated you are. I may have tried to kick the obstrition - I was almost fully dialated at the time, but even if I wasn't there was no way I was going to be checked again. Apart from the actual birth of Lucas' head, that was the most painful part of the labour.

    I also find Pap smears painful so it could be just me.



    Mal.

  2. #2

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    I hated them both during labour & pap smears too. I found the internals in early labour to be horrendous & painful

  3. #3

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    Me too. Absolutely horrible. I have kicked my mw because she wouldnt stop. I'm ok with pap smears though.

  4. #4

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    WTG on kicking the care providers!!!! I've heard some midwives say that lots of internals aren't nessescary because an experienced midwife can tell if you're fully dilated or going into transition from your behaviour/vocalising etc. Personally I think that it's possible that they can interfere with labour to a certain extent because they introduce unessescary pain and tension and also make you feel like you're being timed and your 'progress' judged. Also every internal increases the risk of infection. That said there is a place for them - one of my midwives thought I was ready to push because I felt like it and I had become alot more gutteral but it was just Imran's head in an awkward position. If she hadn't checked I would have been pushing for ages for no reason.
    You can always refuse or delay an internal.

  5. #5

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    That is the problem though Dach - they rely on internals because they spend so little time with the woman that they cannot observe her and recognise signals of where she is at. Any woman can refuse an internal, it's optional and not required routinely. Thats why having a private midwife for your labour can be useful because they are able to assess where you are at without an internal, and they also have faith in the birthing body.
    Kelly xx

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    Author of Want To Be A Doula? Everything You Need To Know
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  6. #6

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    I found the internals related to my pg uncomfortable.
    pap smears on the other hand...my GP reckons I am the only patient he's had who laughs/giggles when he does it, and finds it ticklish.

  7. #7

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    Hi,

    I havent found them to be too bad.

    I think at the time there is so much else going on for me i havent concentrated on what they were doing. Plus its been mostly the midwives that have done them and they are pretty gentle.

  8. #8
    chelleg Guest

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    Quote Originally Posted by BellyBelly
    That is the problem though Dach - they rely on internals because they spend so little time with the woman that they cannot observe her and recognise signals of where she is at.
    Ok midwife getting offended here! LOL I'm sure there are midwives who "rely on internals" to do their job however i don't believe this is case for the majority. It's certainly not my aim at work to do VE's all day. We are taught to observe womens behaviour and take cues from that. However, as Dach said they do have their place. Not all women are the same and despite careful assessment and observation we just can't be sure whats happening with a womans cervix. I can think of a thousand examples: a woman having her first baby only contracting 2:10, very mild and irregular, lasting 25 seconds. The midwife discussed with her the option of going home to which she agreed, the midwife did a VE before sending her home just to be sure and she was 8 - 9 cm. On the flip side the other weekend there was a woman having her first baby - having 4 very strong contractions in 10 minutes, very regular and lasting for 50 - 55 seconds. Im unsure why they did the VE - i think it was for pain relief and she was found to have had no cervical changes at all - and this was after several hours of these strong, regular contractions. VE's are also important where a woman feels the urge to push - if not progress is seen after a few pushes it's worth doing a VE to see if the cervix is fully dilated because if it isn't and the woman continues to push we can end up with all sorts of problems. A VE is a great tool when needed. Definately should not be done just 'for the sake of it'. You'd be surprised how many women actually request them!!
    I know that heaps of women find them really uncomfortable, especially in early labour and it's for this reason that most midwives (experienced or not) wont do them other then when absolutley necessary. Believe it or not, most midwives actually do want to work for the woman and not against her!

    Sorry guys, i'm probably being over sensitive! Must be having a 'hyper-emotional' month! LOL

  9. #9

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    LOL chelleg fair enough, its the flip side of the coin, the ones who walk in & do internals without discussion or observations that are the ones we need to know how to handle not the midwives like you.

    I had a fantastic midwife & only had 4 internals during my 20 hours labour. One when my waters were released, one when I asked for the epidural 4 hours later, one when the position of Matilda changed & they were concerned that she had come away from the cervix & the one the OB did checking on what the midwife found....

    The most painful was the OB one, but initially when they inserted the gel the internal was HEAPS more painful.

    ETA: This time in my birth plan I have stated that discussion prior to VE is necessary to determine how valid it is to do one. And DH is confident he can handle that question

  10. #10

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    LOL on the midwife opinion. Good on you for speaking up
    I have found the only uncomfy internals to be from drs. I had 2 from drs pre labour to check on my cervix etc, and they were horrendous. The worst things ever.
    Throughout my induction and labour I only had 4VE (including gel application) before I was fully dialated and the epi was kicking in. They were all manageable - probably cause they were done by midwives!!

    So I would certainly say it depends on the person doing it, but certainly there would have to be a personal element of discomfort as well that would vary from person to person.

  11. #11

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    I havent debriefed about Zains birth, but I just thought I'd throw this in here. I had my son at Fairfield Hospital. The MW did an intenal to see how far I had dialated and my cervix was posterior. She tried to pull it forward without telling me what she was doing and it was very painful. I screamed at her to stop and pushed myself away from her up to the top of the bed. She then proceeded to tell me that my waters had meconium in them and that the baby was probably distressed, and that I was being unreasonable. I was terrified that something would happen to him and the rest of the labour was a nightmare.

    Another MW at the hospital told me that there was no meconium and she had probably been trying to "pay me back" for screaming at her and not letting her do a proper internal. My husband wants me to put in a formal complaint against her.

    Off topic I know, but just reading this brought it all back.

  12. #12
    chelleg Guest

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    Quote Originally Posted by rayla72
    Another MW at the hospital told me that there was no meconium and she had probably been trying to "pay me back" for screaming at her and not letting her do a proper internal. My husband wants me to put in a formal complaint against her.
    :eek: That is awful! Let aone totally unprofessional. I would be putting in a complaint also! I know what you guys mean about people who just walk in and do a VE with little or no discussion. Have you guys noticed that the midwves that do this tend to be a little older? Apparently when these 'older' midwives trained - back in the days when women had no voice (or at least it wasn't heard) they did routine 3rd hourly VE's as soon as they hit labour ward. I guess old habits die hard!

    Hmmm now look who's judging midwives LOL

  13. #13

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    chelle I don't mean all midwives but caregivers (as Dach said) in terms of Obs (particularly) and some midwives. *sigh*

    A midwife actually said what I said. I have actually observed many midwives spending very little time with the woman because now they can watch monitoring from the desk via satelitte systems or if they come into the room they look at the machines or whatever else instead of the woman. I am sure you are a very lovely midwife who spends lots of time with women, but let me tell you they are rare. And wasnt it you who acknowledged the other day that yes you were so busy and flat out as midwives that you don't get as much time for breastfeeding support? So I know there are factors other than wanting to be - it's the system that makes it this way too.
    Last edited by BellyBelly; September 6th, 2006 at 01:31 PM.
    Kelly xx

    Creator of BellyBelly.com.au, doula, writer and mother of three amazing children
    Author of Want To Be A Doula? Everything You Need To Know
    Follow me in 2015 as I go Around The World + Kids!
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  14. #14
    chelleg Guest

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    LOL i know Kelly! I'm just sticking up for all the 'good' midwives of the world I know there are many a midwife who do let us down

    I know the system isn't helpful in contributing to the ideal situation of one-on-one midwifery care and i guess i'm lucky in that as a 'student' i've rarely looked after more than one woman in labour - which is different to the postnatal ward and hence breastfeeding support where you can be expected to look after up to 9 women and their babies in a shift. All i'm saying is there are many variables in labour and consequently many reasons why a midwife may choose to do a VE. I would hope that there are very few caregivers that would do a VE 'just for the sake of it'.
    Last edited by chelleg; September 6th, 2006 at 02:07 PM.

  15. #15

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    My midwife did say to me a number of times after I'd agreed to the VE, but b4 the Ob came back to do it, that I didn't have to go through with it. I don't remember if she ever said how far along she thought I was, I know she said that the VE wouldn't tell us how long to go. If we have another (and my thoughts while in the pushing stage was he'll be an only child) I won't agree to a VE again.

  16. #16

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    I hate VEs - they are painful and uncomfortable. But by the same token I am a scientic type person - I like to know what is going on. So I was glad to be given a VE when I arrived in the labour suite (it wasn't a m/w though, the ob was actually there at the time and did it). I didn't think I was in labour but it turns out I was 2cm dilated so that's when I finally believed that it was really happening. I can understand when Chelleg says that often it's the women themselves who want them. I'm sure I will want one when I get to the labour suite again this time. Especially after a quick labour the first time, it would be reassuring to know I am already well on the way (hopefully!!!!!!!!!!).

    Melanie

  17. #17

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    I had managed to avoid all VE's (I was lucky with Olivia and Charlie.....I had my midwives with me the whole time, pretty much, so they must have been observing my behaviour/listening to my noises, rather than looking up my hooha!!)........

    I did have one VE with Olivia, after I vomitted on my OB's shoes, he said "I might just check how far dialted you are".......OMG, it nearly killed me, it was so painful, but he confirmed I was 9cm dilated, which was brilliant motivation despite the pain........

  18. #18

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    I have to say all the VE's i had in labour i couldn't feel a thing. I had 1 before i had the gels put in, 1 just before i had the drip in, 1 when i was 6cms and 1 when fully dialted. Didn't bother me at all.

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