internals - are they really nessescary?

I seem to be obsessed with labour at the moment so here's another silly question.......
What purpose do internals serve?
We've all heard about people who have gone into labour a day after being told that thier cervix is still not dilating.
In labour a cervix can take hours to go from 4cm to 5cm and then suddenly jump to 9 cms really quickly.
Internals aren't very pleasant.

So..... why do they do them?
What sistuations are they nessescary in and when are they just a waste of time. I'm sure that care providers aren't trying to cop a feel unessescarily so why do they do them so often ie if they can't indicate when labour will begin why do so many check the cervix at 40 weeks?

any thoughts.... insights.....

Not Sure Chloe, all I no is it hurts like hell, I had over 6 when in labor with William and each one hurt like hell. Sorry not much help there mate.

I didn't have a single internal (other than the strep b swab) until I was 6days over & being booked in for an induction. During labour is a whole different story - the midwife that checked me a few hours after my c/s said I had had so many internals it looked like I had had twins, one vaginally & one c/s :shock:

I didn't have too many internals... 1st when they put the induction gel in, 2nd for ARM, & 3rd when I yelled at my midwife that I was pushing LOL. I wish she'd done an internal before I started on the gas though. If I'd known I was that close to pushing (ie only a couple of contractions away!) I wouldn't have bothered with it! I guess sometimes they are beneficial, a lot of times they aren't.

I've had a few, I think they were all beneficial, especially the one that ended my second looong labour (19 hours at that point); labour had stalled because after my coccyx got in the way then my cervix formed a "lip" that my DS couldn't get through... it was excruciating when my Ob maniplulated the lip of my cervix but things happened fast after than (not too fast to tear luckily) and the pain was lessened and I actually started to feel postive about being able to push (I could feel it was achieving something). I've also had to have my membranes ruptured (foetal distress) which showed meconium... I'd be annoyed if I'd have to have too many internals but so far things have improved because of them. I'd definately dislike and possibly refuse to have an internal early ultrasound though.... never had one but they sound shocking.

I didn't keep count of the ones I had during my labours (but there were many!). I also had internals at 37 weeks with each of my pgs. My Doc does this just so he knows and I know where things are up to in there. I have an hour drive to hospital and I suppose I wanted to know if I was dilated beforehand too so I didn't waste anytime in getting there IYKWIM? With Paige I had an extra one at 39wks because at my drs appointment, I was having contractions and he wanted to see what was going on cause he didn't want to sent me home if I was dilated.

I think if you don't like having them too often, you can refuse them. It would be your choice to have them or not.

I only had internals during labour - my OB hadn't checked my cervix or anything like that, even at my last appt which was at 40w1d.

IMO they're an unnecessary intervention that doesn't really tell us anything useful and should only be performed with a very good reason. They don't tell how long labour will last, they cause infections (hence all those hospy rules about how long they'll "let" :rolleyes: you labour because of the infection risk from multiple VEs), they can be painful and humiliating, you risk membrane rupture, the list goes on. Many home birthing women never have one because there is no clock ticking on them, their CP knows that their baby will come when it's ready and there are other, better, ways to tell where a woman is in her labour. And if you can see a head you know the baby is about to arrive ;)

These are used by many MWs in the UK:
Practice Recommendations
• Many women find vaginal examinations painful and sometimes traumatic (Menage 1996); sensitivity to this issue, privacy and continuity of midwife will make them less so.
• Vaginal examinations measure of the progress of labour imprecisely when performed by different examiners (Clement 1994). Where possible therefore, they should be carried out by the same midwife.
• Examinations should not be routine or prescriptive but carried out only where there is clinical necessity and after discussion with the woman.
• Midwives should give weight to their other skills in determining the progress of labour (McKay and Roberts 1990).
• "Repeated vaginal examinations are an invasive intervention of as yet unproven value" (Enkin 1992).

If a woman wants to know what her cervix is doing she can either check it herself (I have a great article clearly describing how to do this written by a MW) or ask for a VE. They're used way too often in hospitals because of the pointless and meaningless time limits put on labour. You can use them, more usefully, to ascertain a baby's position by feeling the lines on the baby's skull and then using optimal foetal positioning or Pink Kit techniques if the baby is not in an optimal position.

I think VEs in pregnancy are the worst of all. We know you have a vagina, we know you have a cervix, they don't need "checking" because of the risk of infection or "accidental" (sometimes on purpose) membrane rupture.

Just in response to the internal u/s bits - I often *have* to have them as I have a very retroverted uterus and visualisation and date measurements in early pregnancy is difficult to achieve for me. They aren't too uncomfortable - and yes, just like a dildo (only no fun at all :shock: ). Due to my history of m/c etc and the concerns I may have had an ectopic pregnancy they were a necessary evil.

I had one internal at the hospital and I was 9 cm and they told me to start pushing. They didnt know i'd been in labour for 28 hours at home and up until then had refused to go to the hospital except for earlier that day when i went up, they checked me, said yes its labour and i said see ya and left. So when i got there they thought i was young and stupid and being a drama queen and nothing was really happeneing until they did the interal and were shocked!

I very rarely perform internals. I think that most of the time a midwife can get all the information need by just watching and listening to the woman. I can think of only 2 reasons why I would do an internal.
1 If I am asked for by the woman
2 Sometimes before I give pethidine/morphine.


Jannet

I would love a copy of that article if possible
alan.irene@bigpond.com

I have a retroverted uterus but I also have a CP who doesn't see dating scans as very useful, and neither do I :) Babies come on their birthdays ;)

Jannet

Thanks I got the article

And now that you mention it, I have also notice that babies alway seem to arrive on their birthday!!! :lol:

Extraordinary! :shock: :cryinglaugh:

I have two children and I didn't have any internals with either of them. First time I said "aren't you going to check how many centimetres dilated I am" and the midwife said I was making progress so she wouldn't check unless I insisted. Second time I was a tad late with phoning my midwife - when she arrived, she walked in the door, heard the noises I was making, took one look at me and said to my husband "baby's nearly here"! She was right too. I think internal examinations are exactly like all other labour interventions: very useful if they are necessary / medically indicated, but not appropriate as standard procedures.

Did not have internals until I went into labour and then only really when they thought she was stuck. The midwives were great at it, but the ob was just awful. I basically felt violated and assulted. After it I actually sat up in the stirrups and said "there is no need to be THAT rough" and then fainted.

I'm so sorry, Astrid. There is NO excuse for that. I hope you made a complaint to the hospital. No woman should go through that.

I had one internal when I was in labour with Olivia, by my OB. It hurt like nothing on earth, but it confirmed that I was nearly 10cm dilated (up until that point everyone was convinced I was in pre-labour, LOL!) and Olivia was born about 20 mins later.

So whilst it hurt, I am glad he did it, becasue hearing that I was so far dilated gave me a huge renewal of energy to push.

Once women are fully dilated they almost always ( largely provided they're undrugged and free to move) get a HUGE burst of energy without knowing this information. It's another way to tell without touching a woman where she is in her labour :)

I HATED the idea of internals when I found out I was pg, but my ob hasn't even been interested! Even for the strep b swab at 37 wks he gave me a DIY kit to take home and bring back in.

Unfortunately, since I had a low placenta I had to have two internal u/s, but they weren't so bad and I didn't feel like I was on 'display'. Now that I have to have a c/s due to placenta previa all I can think about is the indignity of the catheter... :rolleyes: Oh well, at least I got to organise my wax beforehand and at the very least I'm looking my 'best'!

You'd think since we all have pap smears we'd get used to this kind of thing!