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.