Neccessity of internal examinations in labour?

[HotI]

Just looking for info on the medical advantages/need for internal examinations in labour. I understand that they can check how dilated you are- but is this info needed, and what other info are they getting.

i have been reading Ina May's guide to childbirth, which is lovely and makes me want to move to the Farm, but i wonder if it is possible to have this sort of birth in a hospital here.

I have already refused an internal examination at one of my check ups (and felt quite proud for having been able to do so). I have also agreed to one with a caring dr, when there was a need for one- so i am not saying no totally- just i want to know why and when they need to be done.

I was reading an article on birth rape and traumatic births, and how women in this society are often 'groomed' to allow professionals (or feel they have no choice to object) to perform acts they feel uncomfortable with at the time. I am trying to empower myself so that i am comfortable in saying no- or asking for more info.

Even on this site, people post that you won't care what you are wearing- or what you are doing during labour, and in another post talked about 'the humiliation starting early in pregnancy'. This doesn't empower first timers in thinking they can have a safe birthing experience whilst feeling respected and non fearful.

Anyway, i have rambled but back to the original question of what is the purpose of internal exams, and how necessary are they?

ta,

Kate

[Inanna]

Sometimes they are helpful...
Mostly an intune care provider can tell with a fair amount of accuracy how far advanced a womans' labour is by: the sounds she is making - when a woman is making high pitched screaming yelling sounds - often that is fear based and often labour is not as far along as perhaps the Mama would expect. Deep low gutteral sounds show me a woman is progressing well and close to dilatation... Grunts show that a woman's urge to push has begun. Usually that is a sign that dilatation has been reached or is nearing...
A woman often gets really restless just prior to second stage. Ofte it's now that a woman says: "I want my undies back I'm going home"... (me! ), or says I can't do this. I want it to stop et etc...

Sometimes a woman has what is called an anterior lip - this happens sometimes with posterior babies a little more frequently than anterior babies.. It happens when woman gets pushy without her body wanting to... A VE can tell us if that is so.

Also if a woman is having a protracted labour it can perhaps help to know how far along she is..
Having said that - Women have perfectly designed bodies & a cervix can go from 2 cm to 9cm in a very short amount of time. I find that helping a woman with her head most often sorts out her body...

Mostly VE;s are not needed - when you have a primary care giver. A midwife that you know and trust & you have developed a relationship with. OR a Doula who you know & trust.
Those that are wise to birth matters listen with their ears & heart , feel with their hands & get a feel for what is happening. This is why the medicalisation of birth has made it so tough. It has taken the intuit out of birth & the primal call of birth for women.

Your job as a Mama preparing for her birth is to seek out good support - so you have a wise woman to listen for you and guide you.

You need to really tune into your body now. Learn to say NO! I am glad you felt you could do that when it didn't feel right for you.

I would care about being stark naked in a room full of people I didn't know. However, I haven't had that so I was fine to be. I think you go with thr flow. If in labour you are asked for a VE - ask why? Why do I need this? If the MW says I am thinking you have an AL - then you can decide if you are ok for her to coax your cervix back during a Cx.

Mostly though I think that your vagina is your sacred space - keep others fingers out during labour unless it is necessary!

[JellyBean]

Firstly - good on you for posting this - its something I believe women should think more about. It sounds like you are doing alot of preparation to make your birth an empowering one.

Incase it helps you to read about one persons experience:

There was no mention of a VE at any of my pre labour appointments at the birth centre I attended for my second labour. I didn't have a VE until I was halfway through my labour, and it was at my request. My midwife told me early on that the ball was in my court, and that anytime I wished to know how dialated I was, she would perform a VE for me. I only did so because I had been having consistent contractions for a matter of hours, and thought the outcome may provide further encouragement - plus, I was just curious by that point. She assured me however that if I was not comfortable having one, that would be fine - that my body would tell me when the time was right to start pushing, and she reminded me that many women the world over give birth without having a single hand laid on them!
Having a VE turned out to be a negative for me, as I was not as far dialated as I thought, and this disappointment completely knocked me out of my focused 'birth zone' - iykwim. I immediately started to have destructive thoughts like "Imagine how much further I have to go if its taken me this long to get to this point.." "I don't think I'll be able to make it to the end afterall.." (drug-free, that is). Luckily I was able to force myself to snap out of it and focus inward on coping with the pain again.

I agree that women are groomed for VE's by OB's - and what i essentially think they are grooming them for is intervention - or ultimately - induction.
I have heard and read some deeply disturbing things from women. One woman claimed after her 37 week appointment that "my OB thinks I may need to be induced as dialation wasn't progressing very well" Firstly - why the heck would her cervix be expected to start dialating 3 weeks before her estimated due date? And secondly, how is it that women can be so unempowered and uneducated that they allow this? Birth rape is not such a radical term - when you think about it logically - in the least it is an abuse of power.

Besides, what is the point of knowing how ripe the cervix is anyway? Its not going to change anything. Ultimately, the body will go into labour and the cervix will start dialating when it is ready to do so. 'Checking' to see how ripe or dialated a woman is only serves to push her toward artificial intervention (gels, drips, stretch and sweeps etc) if her body is found to not be performing as it 'should' according to some arbitrary timetable set by a scanning machine. Its complete nonsense - and dangerous, I believe. Touching a woman unecessarily in the delicate area that holds her baby in her womb is just unwise and invasive - to say the least. Obviously once labour has begun spontaneously a VE cannot disrupt the natural order of things - although some birth activists would beg to differ.

Of course not all OB's are this way inclined, but in my experience midwife-led care is much more women-centred in this respect. The woman's body is viewed as her 'sacred space' as Innana put it, and intervention is only performed when deemed absolutely necessary, or if desired.

He he - Obviously you can see I'm quite passionate about this issue and about empowering women to take control of their bodies and their birthing experience!! I have had 2 very different birthing experiences - the invasive and the empowering, so I'd like to think I can help prevent others from having a negative birth experience.

Thanks for starting this dialogue... I wish you an empowering labour. Trust in your body, your baby and mother nature. Combined they are infinitely wiser than any machine or person standing by in a white coat. Request a VE during labour if you wish - but don't forget that you are in control, and it won't change anything physically - but perhaps mentally, for better or worse!!

XX

[BellyBelly]

Vaginal Exams - When Are They Really Necessary?

[Arimeh]

Ahhh Inanna I so wish you could have flown to Tassie to be with me a week ago - I needed you to make my fear go away!!!!!!

My midwife told me that they don't do VE's because of everything that Inanna said in her post.

However, I was running on fear and I requested one. She agreed to do it because I was fairly insistent, and luckily I was 7-8 cm. I am glad that I DID get it, because before then I was pretty sure that I was still in prelabour - and having a hard time dealing with the pain because of the "prelabour" and freaking out about what was to come - so it helped me get my head straight, and realise that my body WAS working, it WAS doing what it was supposed to.

So I think depending on your personal circumstances (I had never laboured before, so didn't have a clue if my body could dilate nicely) they can be a good thing.

[nellnell]

In my personal experience in both labour 1 and 2, VE's were performed to determine how ripe my cervix was as both bubs 'needed' to be induced due to IUGR. I was okay with that (well, not really okay about being induced but it was certainly a better option than a c/s). I wasn't given a VE after being induced and had a relatively quick 4.5hr labour. The MW was wonderful and watched me, asked a few questions and could see what stage I was at.

2nd labour (also induced) I had many VE's (and I WISH I had said 'NO'), very frustrating.....no progress. Synto turned on and off and 1 midwife who lived in the dark ages and couldnt even read the CTG machine (DH found a ruler and 'taught' her how to read it....I mean 'COME ON!)

Anyway, as JB said, it was disappointing and really does your head in. 33 hours after initial synto induction I convinced myself that I was heading towards a c/s. I had refused all drugs (as I had laboured without it with my first) and I thought my time was up. Luckily Dr was FABULOUS and so was MW who had just come on duty and talked me into believing in my ability again.

VE's are really uncomfortable normally, but during labour they are horrendous. Personally I think they hurt more than labour itself.

BUT sometimes they are necesary. It's up to you to decide what you want and how you are treated before and during labour.

[fourthontheway]

There are some valid reasons for VE's, however most experienced midwives don't NEED to do one to check progress. They can tell from the behaviour of the woman in labour. The thing with a VE is that it's only as accurate as the person who gives in. Say you're looking at a piece of string, and I ask you to estimate how long it is, and I ask 5 other people to estimate as well. Chances are that everyone will have a different estimation.

VE's might show you to be 5cm at one exam, but that doesn't mean that you won't dilate to 10 in the next half hour ... they are shown time and time again to be a very poorly evidence based method of assessing labour progression.

You can hire a midwife and have a homebirth, that's about the closest you'll get to the farm in Australia .... I reckon it's good!

[Inanna]

Kate I want the farm too my love... In my early twenties I dreamed of going there...

[HotI]

Kate I want the farm too my love... In my early twenties I dreamed of going there...

Your job as a Mama preparing for her birth is to seek out good support - so you have a wise woman to listen for you and guide you.

You need to really tune into your body now. Learn to say NO! I am glad you felt you could do that when it didn't feel right for you.

Thank you for all your replies, makes me feel less freaky. Getting info on VE from a few different experiences assists in helping me to work out where my comfort level, and preferences are.

I am searching and seeking out people that will guide me in the time leading up to, and the time of the birth, and after. Testing the waters with people who are close to me to see if and how they will support me and my choices.

I am also talking to a student midwife, and another midwife to see if they are the right people to join us (me, DH and bub).

unfortunately there are financial considerations, distance to hospital if required, and pre-existing conditions that i have to also add in, but a homebirth is still on my possibility list.

Ahhh Inanna I so wish you could have flown to Tassie to be with me a week ago - I needed you to make my fear go away!!!!!!

If i do decide on hospital, i have some sayings that i want to have written out to remind me if things go alittle array. I think some of Inanna's posts may be printed out and added to my hospital bag, cos you never know when her words will come in handy!

Mostly though I think that your vagina is your sacred space - keep others fingers out during labour unless it is necessary!

[Inanna]

Well that's a lovely thing to say Kate - but you know what you have that wisdom inside of you - it grew at the same time as your ovaries did.. It is intrinsically printed on your DNA... It just needs to be awakened.

Maybe we should get Kelly together & we can open a farm... Now there is a thought. I can see me there working with the psychadelic rushes! I love the way Spiritual Midwifery is written...

[JellyBean]

Kate - if you don't go for the homebirth perhaps you would like to consider a midwife-led birthing centre attached to a public hospital? I had my very empowering second birth at one and took my doula with me. It was a fantastic experience to be surrounded by wise and gentle women and the great home-like facilities they had there.
Just thought I'd mention it. That way if all goes well (as it should!) you may feel more comfortable about a homebirth 2nd time around.
Best wishes whatever you decide!

[HotI]

Thanks Jellybean

As i am considered 'high risk' due to a rare neurological condition (so there is not alot of info available on women with the condition having babies), i am not eligible for a birthing centre birth. The info that i have acquired says that the condition doesn't greatly affect the birthing process (and i am pretty good at reading my body, and working with it) but the medicos are being 'conservative'.

So, i think my options are birth at home, or at a primary hospital. My partner has doubts about a homebirth for a first birth (even though his siblings were born at home), and i am scared that i won't be able to relax enough in a hospital. So, we still working through the options.

[Oorki Galoorki]

Kate if i were you , and being open to a HB i would go with that for your first. it is much better to have tried everything 1st time and had an empowering birth then go in to the hospital setting not totally sure about it then getting steamrolled into an experience that you didnt want.

i wish i had done it 1st time round.. i have a close friend who was the same and she ended up being forced in to a c/s due to fail to wait. we both went on to have glorious HBs with our 2nd babies and she is pg with #3.. you can guess where that is being born..

[Janie]

Kate, although I am quite comfortable with VEs, having had plenty over the years for a gynae issue, I wasn't wanting to have more than necessary during pg and labour. My Ob never did one while I was pg, and only one when I was in early labour (3cms) as it was preterm labour. My midwife then did two more, one at 7 cms, at my request, and another to check I was fully dilated, because I was feeling pushy for some time, but not excessively so (my posterior, malpositioned baby made the transition to second stage tricky). All my VEs were performed inbetween contractions, which I was most pleased about, and were done in a very calm, gentle, and unobtrusive manner. And they all left me feeling quite pleased with the progress my body was making. In fact, after the one at 7cms that I requested, I felt fantastic, like I could really do this drug free!

So yeah, I would agree with all of Inanna's words, but if necessary, and done nicely, VEs can be useful

[Inanna]

I actually requested a VE during DD5's labour.... My M/W knew I wasn't into the idea & when she said: "are you sure?" I growled YES! It was hideous - mainly as I had to recline and that was just awful after being on all fours in the tub... She estimated I was 7cms which deflated me no end...
I then said outloud: "I just have to do this don't I"... ( what the hell else choice did I have!") My SIL (who has never birthed but has been at my births - nodded dutifully "well.. yes?) With the next contraction I felt an overwhelming urge to push and out she came into the birthing tub... Because the room was only candle lit (my request) & I had meconium in my amniotic fluid the water was murky... I said "it's out"... Very unceremonious I know... With that my M/w began fishing around in the water - as I bought her out to breath her first breath...

So, I too had the experience with that birth that the VE actually promted me to get on with the job of birhting. (I was having such a good time labouring - savouring my children, breastfeeding, meditating that I put the whole birth on the back burner!).

With my first child I had a VE after 24 hours of labour & I was only 2-3 vcms. You can imagine the devastation... My cx were 2minutes lasting 40-50secs... However, that was due to a very mal positioned baby & a high fear factor. (my M/W was a very evangelistic Christian - when I was shouting: "Oh God"... She kept saying Praise the Lord - which would be fine if that was my leaning - but I was bought up by a very very evangelistic mother & it took me places I didn't want to go in labour!) So labour was stopped for me... When I got to hospital I was actually 8cms with an anterior lip - she wasn't born until 7.16am the next morning after a 33 hour labour.

So, it's important to choose your midwife very very well. If you are a Christian and your midwife is a Buddhist & starts chanting - you will likely lose the plot... (not that a professional would do that anyway) If your midwife doesn't understand your triggers the same will happen.

I moved to Brisbane heavily pregnant & took the only midwife that I could get to attend myhome birth so I am responsible for not really looking into that well. I trusted my body & the birthing process implicitly. I didn't factor in the need to be in sync.

That's all a bit off topic - but kinda related...

[jackrose]

I too thank you Kate for bringing this topic up, it is such a reasonable question to ask and one that all too often gets lost among the other important questions surrounding childbirth. It is so fantastic that you are thinking all of these realities through as I think it will really help you feel empowered when you give birth.

I am also so with you on the Ina May Bandwagon and I am moving with you girls to the farm!! I loooved Spiritual Midwifery and Ina May's guide to childbirth when I was pg the first time and I was so thankful to have found the books. I used so much of her philosophy when in Labour and it really helped me get as far as I did without drugs. I really enjoyed my "rushes" and had wonderful visualisations of opening up. It was so feminine and so empowering.

Forgive me if this has already been mentioned to you before as I know how as a pg woman you can receive so much well meaning advice (so feel free to disregard ) But I would recommend another book to read which I have found really helpful this time around and I wish I had it first time around. Henci Goer's Thinking woman's guide to a better birth. It is full of information about what the research says about all sorts of things like fetal monitoring, episiotomy, C/S and VEs. Henci is very pro natural labour and is not shy about letting you know that is her viewpoint but it is really refreshing to have all of the research at your fingertips should you need it (and need to convince a husband who is not so sure... ) (Like mine ) - I found Henci's book in the Belly Belly shop and it was at my door within a few days.

Another great book is Men at Birth by David Vernon. It is a collection of stories about labour from the man's perspective, written by the husband. It is very readable - especially for men who shy away from all of the 'technical' chick books! Once again, it does come across as very pro natural labour and even very pro homebirth so it may be helpful for your DH to read. Personally, I really loved reading it!

I was also struck by a comment you made in the OP

Even on this site, people post that you won't care what you are wearing- or what you are doing during labour, and in another post talked about 'the humiliation starting early in pregnancy'. This doesn't empower first timers in thinking they can have a safe birthing experience whilst feeling respected and non fearful.

Once again you are so right. Childbirth should be about being empowered and if you are someone who does not feel comfortable in the nude around others, it can me disempowering to read that it is not a worry for women. FWIW, I was absolutely one of those women who whipped all of my clothes off as soon as I entered the birth room, I never would have guessed I would be though! I did have something to wear that was easy to labour in but, nope, it was starkers for me. Everyone is different though and it is important to do what you need to do to feel comfy and be ok about that. I think you are well on your way to having an empowered birth given the sorts of things you are talking about, you are miles ahead of me when I was at your stage. Go the Ina May philosophy and channel that farm! x

[Shanti]

I only had one VE and it was during labour when I was quite advanced.... I would have refused any other VE's if they'd been offered to me but luckily they weren't.
They aren't very comfortable anyway, mine hurt!

I had a wonderful labour and birth in a public hospital and I feel it's because I prepared myself and empowered myself with knowledge so that I could birth my baby in the way that I wanted to birth her and knew my rights. (also it is a good, small public hospital with baby friendly MW's) You are doing the right thing by doing your research and knowing your rights and that you can say no if you don't want something done to you or your baby.

All the best

[BellyBelly]

Kate, have you considered setting up a no-obligation meeting with a midwife or two so your partner can hear/ask any questions about how they work? Often it's all so unknown to them and they are unsure so default to the status quo. There are some gorgeous midwives around I am sure they could help him feel at ease