Have been reliving my last labour.. and i very strongly remember having a internal during a contraction. It hurt like ell, and, i wonder why the midwife gave an internal then, as opposed to waiting to do it between contractions..
Any ideas?
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Have been reliving my last labour.. and i very strongly remember having a internal during a contraction. It hurt like ell, and, i wonder why the midwife gave an internal then, as opposed to waiting to do it between contractions..
Any ideas?
thats quite unusual not sure why she did that buit all of them are different and do weird things. You poor thing must have been in so much pain...
I remember I had an internal during a contraction (well one hit whilst I was having one) and the midwife said it was good because whe could see where I was at when the contration hit. Ie. when no contraction was ther I was 4cm when the contraction hit the cervix would widen to 5-6cm but close back up a bit after the contraction was gone. Hope that made sense.
I don't have any answers, my first thought was maybe so it didn't hurt so much (like, combine to pain in one...)...? But then, its late, I'm tired, and that doesn't realy make all that much sense in my head... so ...? I but just wanted to say she's lucky you didn't kick her across the room! I'd be interested to know the reasoning...
Yes every midwife is different. Mostly an internal is done inbetween contractions although sometimes if you want to break the waters its better to do it during a contraction as it brings the baby's presenting part down so its well applied to the cervix and reduces the risk of a cord prolapse. There can be a big difference between an examination during a contraction and one when there is not a contraction. Sometimes it might be necessary if you are needing to push and the midwife/dr wants to speed the delivery up by trying to push the cervix over the baby's head to facilitate birth when you are not already fully dilated. Obviously this would only be done if the baby needs to be born quickly (fetal distress) or in some case for the benifit of the mother with her consent of course. By the sounds of things these things I have just mentioned were not the case with you but thats some reasons I know why an internal might be done during a contraction. Other wise the midwife is nasty or thinking to save you two pains seperately you might have one larger pain so you can have the inbetween to rest.
My midwife did an internal at 8cm when I said I felt like pushing. She stayed there during the contraction and then told me I was fully dilated so I could push any time I liked. She may have given the cervical lip a little nudge at the same time but it confirmed I was ready to go - just as my body told me I was ;)
Unfortunately many internals are done either because the hospital policy says that they should be done, the doctor wants one done or the midwife wants to see what is going on. Personally I don’t do internals unless the woman asks me to check or prior to giving morphine/pethidine. I prefer to watch a woman in labour, if you watch closely then you can usually tell within reason how well that woman is progressing and give a reasonably accurate estimation of how far she is dilated.
Alan - that's why we need to clone you ;)
When I was in labour the doctor did an internal during a contraction without warning me. First time in labour and some guy sticks his hand up my ....... It hurt and was uncomfortable and until now I thought it was normal. Geez I'm never going back to that hospital!!
There is no need for that whatsoever. I'm so sorry you had to experience that :(:
Thats It! I's moving to QLD. You arent busy around tax time are you, Alan? LMAO.:
I know they say you need to leave your dignity at the door, but that to me does not mean that they don't need to reserve at least a modicum of common courtesy.
I had 2 internals done by ob ealier in the day. once first thing as i was admitted the night before(no internal) and to confirm that waters were completely broken.
Second was about 8 hours later to check progress.
I only had one internal done by the midwife when I said i was ready to push. I think she did strecth out cervix before giving the okay to pushing.
I had a contraction during an internal and it hurrrrrrrrts :(
I hardly laid on the bed for labour so just being there at all hurt, let alone when a contraction hit during an internal, owwwwch.
Going back to see my ob for a check up on the 28th anyway, so, will ask him why. I remember telling my DH to "get her out of me".. maybe it was to save the pain by getting it over and done with in one hit, but, it was just horrid. Much more painful then the contraction on its own.
It is, I agree. I have had 4 AROMs, which is done during a contxn so that the membranes are bulging and the babies head is pressed down to avoid cord prolapse. It is basically an internal during a contraction and it really stings!
But I have had regular internals where she just "waited it out" which was even worse IMO! Could you get your hand out of my personal space while I scream in pain - please! Its entirely possible it was just bad timing on her behalf. I just hate internals all together. They are innacurate and not actually medically necessary 99% of the time, so I am not permitting any this time. Thats going to be fun...
Definitely bring it up with your ob and let him know you would at the very least prefer that VEs are not done during contractions. Thats the least they can do for you!
Mags you are so right - my midwife in labour kept telling me to turn over while i was pushing so she could see if babies head was crowning (mind you my 2nd stage was about 10-15 mins). I was on all fours at the time saying im having this baby but she made me get on my back so she could see, she should have known! DF said my anus was pushing out and even she said there was pressure there was no way she needed an internal then...
Debbie I really think it all depends on their policy and it can be so hard to find someone that listens and respects you. The best way to avoud VE is to stay at home as long as possible that way you have one on arrival and hopefully that's it. Good luck with impending labour and birth, Aiden must be so excited!
I totally agree with Alan. I've seen him in action at homebirths, and I know he's right about how you can quite accurately tell how a woman is progressing without VEs.
I'm really sorry about some of the experiences described in this thread. To my mind, it is tantamount to assault. It's not right. No VE should be done for routine reasons, without the woman's explicit consent, without her being ready, and if at any point, the woman says, that's enough you need to stop the exam now, the careprovider should cease and not continue the exam. It is a violation of your basic rights when you are at your most vulnerable, in a position where you should be able to trust your careproviders. To my mind, this is actually birth rape.
Please know that you can request your birth plan that you do not give your consent to VEs, and will only have one if YOU specifically request one. All good careproviders know how to assess the progress of labour without VEs. I have seen midwives perform a VE gently, with the woman's consent or at her request, and gently stay there during a contraction to see what's happening. The understanding is that the midwife would end the VE immediately if it was too much for the woman. But some of the incidents described here don't have that gentleness and patience. I'm really sorry, I don't think that's right.
You could think about a different model of care the next time - choosing a careprovider who does not do routine VEs, but only at a mother's request, and after careful discussion with the mother.
Another thing that might help, is learning about the signs of progress yourself, and learning how to examine yourself and observe for changes. You're allowed to do that, and you're allowed to say no to other people's fingers! Here's one article called 'External signs of progress' by Gloria Lemay.
This is why my OB did it, and yes.. it hurt! Well.. the initial internal during contractions didn't hurt that much.. it was pushing the cervix over the head that hurt!! For quite a while I was pushing & dilating at the same time. I told the midwife this.. I could tell it was both. The internal showed me moving back & forth from 6cm to 8cm & back again. Both mine & DD's heartrates were up quite high, and DD was prem, so I would think that's why we moved things along a bit. Once she was out of the cervix she crowned and was out within a couple of contractions.:
ETA: Interesting link Julie. I was bearing down like I was trying to get her out with each contraction. I wonder how a trained eye would have seen me. I think the midwife knew what was going on.. and I told her what was happening anyway LOL. I've never felt forced into VE's or violated by them. Maybe my midwives & OB had good bedside manner LOL.
I was having one when a contraction hit.....middy went to move her hand and i screamed at her to leave it as it helped with the pain! LOL
As an RN, I sometimes had to do some pretty mean things to patients in the course of their care - like, injections, wound dressings, manual evacuations ....
We were taught that if we take hold of a peron's wrist to take their pulse, without explaining what we're about to do or obtaining their consent, it is assault.
For procedures more painful and personal than that, it's even more important that there is respect, gentleness and patience, and that you don't push beyond the patient's consent, willingness or endurance.
It's good to hear about VEs done with this sort of professionalism. But I'm so sorry about the situations in which this has been lacking. Especially if they were completely avoidable in the first place.
It's procedure / I'll get into trouble with the Consultant if I don't / It's been a while since the last one / I have to write it in the notes that I've done it / I have to follow protocol so I don't get into trouble professionally etc - are not valid reasons to do a VE, especially if the mother is averse to it.
There are, of course, times and reasons when a VE is advisable. (Even then, if the woman says no, no means NO, and to push and push her to accept the VE is coercion and assault.) Time will tell.
I remember one (hospital) midwife who said, "You can tell how dilated she is soon enough - when you see head on view. Then you know how far she is dilated."
Julie - I don't doubt those mean things are as hard for you as they are for the patients. I have had problems with VEs since my PPH. They did manual removal and while I can cope with the absolute necessity of it at the time - I have still never felt so horribly violated in my entire life.
Do you think that if I mention this to my eventual MW that it might make it easier to express no means no without the guilt trips?
I haven't read through responses so I apologise in advance if I am repeating myself.
When you sit and watch and listen to a woman in labour she will "tell" you how far dilated she is. Unless for a medical reason there really isn't any good reason to be thrusting gloved fingers into a womans vagina during labour.
Having said that - when there is a lip this can be flipped over during a contraction and can save more invasive procedures. So there is a place for it if an anterior lip is believed to have happened.
I have only ever had one VE during labour with my fourth and it hurt like hell! I asked for it as I wasn't progressing as quickly as I thought I should... Anyway I was 7cms - very depressing for me. With the next contraction Eva was born. Soooo...
Anyway - I believe watching and listening are the best "crystal balls" to how a labour is progressing.
What - a manual removal without a GA??? How traumatic! I'm so very sorry for what you went through. I do wonder about what led up to the manual removal, I wonder if mis-managing or rushing the third stage led to the manual removal being necessary.:
I recently heard of a birth (VBAC) in which they calmly waited for 7 hours before the placenta was gently born. (Obviously when a placenta is taking a while, you keep checking the mother's uterus, bladder and vital signs to make sure all is well).
This is definitely something to discuss with your midwife when you interview her. If she is a good independent midwife, it's likely that she would do VEs very rarely anyway. And discussing how you want third stage managed is vital. The right midwife for you is the one who understands how traumatic these events were for you, and will do all she can to avoid VEs or messing with a natural third stage.
There are some important things that are necessary to make third stage as safe as possible for a mother. It all comes back to how the birth hormones work. You need the things that will promote the optimal flow of oxytocin, so that the placenta will detach and the uterus will involute.
They are:
* naked baby placed on mother's bare chest, between her breasts, skin to skin.
* breast crawl - baby's kicking actually stimulates the uterus to involute. Baby's suckling stimuates the mother's pituitary to release oxytocin, which causes the uterus to involute
* quiet in the room - no loud voices
* privacy for mother, father and baby to bond, again, this enhances her hormonal flow
* the room should be warm. Cool temps inhibit the flow of oxytocin. Make sure if the mother moves to another room (such as the toilet), that that room is warm too.
* the lighting should be dim.
* mother's bladder should be empty or nearly empty
Arbitrary time limits can cause much mischief. Once, at a birth centre, the midwives were getting nervous and talking about the injection because an hour after the birth, there was still no placenta. I gave my client the heads up about the way the midwives were talking, and suggested they have a cuddle together, with her sitting on the toiler, with the lights off (she liked the dark, and had given birth in near total darkness.) 5 minutes later we had a placenta, and she just dodged the injection. Sometimes just some peace and quiet is all it takes - the natural birth hormones get a chance to do their thing.
Sometimes there is so much angst about getting the placenta out that it's counterproductive. If you 'reverse the energy' and stop focussing on getting the placenta born, and give the couple time to cuddle with their baby in quiet, warmth and darkness, it often all happens. This is assuming there are no signs of excessive bleeding.
Sometimes movement and gravity (such as getting out of the birth pool, or moving to sit on the toilet (with a basin in it to catch the placenta)) can be all it takes to get some action. Other times, patience and time are needed. You don't always get that in some institutions and this can create problems.
I've had two interesting placenta adventures at recent births. At one, the mama shut herself in her toilet, and firmly spoke to herself for about 10 minutes, telling herself that the birth was over and she could release her placenta now. She told her body to stop bleeding and release the placenta - and it did! She had had a traumatic birth the last time, so this was part of her overcoming those old fears and tensions.
At another birth, the mother had had a very traumatic c/s the last time, and her homebirth was a huge triumph over many emotional issues. She had pretty painful afterpains and was getting quite distressed. The pain kept taking her back to the trauma of the last birth, and she was feeling guilty that she was in too much pain to be bonding with her newborn. I had a little chat with her and her dh, and we actually prayed together. Then the midwife came in and was able to gently persuade her to roll over onto her back. That's all it took. A little bleed (which is a sign that the placenta is coming) - and out it came. The midwives had been bringing up the subject of transferring to hospital for a manual removal by this time! But more time, and extra reassurance, and a gentle approach, was all that was needed.
(I realise that there are times when synto and obstetric help ARE needed - but if these other techniques can be employed and more drastic measures avoided - that's good, right?)
Have you noticed that when the birth is pushed and rushed, it seems more likely that there will be PPH and placenta problems? An unhindered birth usually (not always, granted) yields a safe third stage, because the birth hormones that are flowing in an unhindered birth continue to provide for a safer third stage.
With DS1 I had a VE to check what was going on after I'd been pushing for quite a while. It turned out there was a lip of cervix still so the OB held it while I pushed through the next contraction and his head moved through. I must say I didn't feel a thing!
Its a bit of a story. I had her at change over. It had been 4 and a half hours since anyone had come to check on me and they had ruled my labour stalled at the last check. For change over, they were all outside "discussing what to do with me" as the ob so casually said when he came in to watch her delivery in disbelief. Anyway - I buzzed them when I felt the head on its way out and the middies I had had all night came in to finish the birthing. They the did rush through the third stage using cord traction to get the placenta out. Then they vanished again.
Over an hour and a half later, my older sister who was an AIN at the time went searching for help for me because she knew there was something seriously wrong. When they got in the bluey weighed for something like 2.8l and that was before they went in after the clots and my bp was something like 50/30. I figured they wouldnt have been elbow deep in my uterus pulling out clots and looking for placenta bits if it wasnt absolutely necessary by then. I mean, they didn't do anything else such as an episiotimy or offer any form of pain killer. It just all happened and I remember all that going on, them telling me to stay awake and me not wanting to (thus not really trying to) because this is not a memory I wanted.
They did give me DD when she was born but then went and did the weigh, cleaning, etc etc. This is literally how I got her back.
Also funny you should mention temperature. One thing I always hated about the delivery suites there was that I was freezing cold!