internals

[violet59]

For reasons I won't go into here, I really wish to avoid any internal exams during labour. How good/confident are midwives in using clues like breathing, vocalisations etc to assess how you are progressing? Do they try to insist them even when things seem to going well/or when first arriving? obviously in an emergency/problem I'd suck it up but I'd rather avoid them just to check how fast I'm dilating/as routine.

Oh, I meant to add I realise that you need one if you get an epidural etc, but I hope i can manage without one.

@loopmumsy
what did you mean by:
Even with the first one (that put me off so much!) they only wanted to do one becasue of very specific circumstances (all HBs)

the (all HBs) part I did't understand that -in all hospital births or home ones?

I have real issues with internals too. Make sure you speak to your midwife (each one if you end up with more than one) and if you have a birth partner/DP get them on board to reiterate it too.

Inductions can require a lot more internals (I had a meeting with the consultant where this came up last week) so you might want to think about whether this is a route you feel you can go down.

I have a meeting at 40 weeks with the consultant to discuss what we should do if I go overdue. I have fought for the option of an ELCS if I feel I can't go to induction (I had a traumatic time last time for various reasons but the number of internals I ended up having - not a normal situation I hasten to add - have definitely caused me some further issues).

I always put at the top of my birthplan that I don't want internals, or vaginal examinations to check progression etc... (This isn't because of any trauma, just that with DC1's birth I went found the v.e.'s really irritating and they took the focus away from me feeling what my body was doing and responding accordingly.)

Despite having some complications, such as PRoM and premature labours, I haven't had a problem getting my hospital midwives to respect this. I've got quite lucky with my midwives though, I think.

Your body, your rules. Just make sure your birthing partner understand why you want this, so can communicate it if you can't (such as a change of midwife half way through).

have a water birth.

they tend not to do any internals then.

I also have no internals on my notes. In my case they would do massively more harm than good and you'd probably have to sedate me first. This is in a country where internals are very routine (not UK).

Try to educate yourself about how long is too long with 'no' progress and learn things like if you still feel the urge to push when on all fours with chest down you're probably fully dilated.

Any good links for reading up on this GFAM? I would prefer no internals but i will need to fully brief dh on why if he is to be my advocate..

I got most if my info from books - Ina May Gaskin is wonderful, and I have another one which I think is called active birth which has given me lots of info. Whether this works or not remains to be seen of course!

There's plenty of info why internals shouldn't be routine though, including risk of infection.

GFAM's comments have reminded me on an observation I've made.

A lot of my friends seem to get told by their midwives "you're ready to push now" and then push for aaages with little happening, often ending up with bad tears. For me, I don't push until I get an overwhelming urge to push; my body tells me when its time. My pushing has never lasted longer than 3-4 minutes, and I haven't torn. I'm sticking with my approach.

You can request not to have internals although there might be situations where it is important they still have to be done with your consent. My last 2 labours I have not had any and was very much left to my own devices, able to push when I felt ready and the midwives were completely happy with that.

You will probably need a quick internal immediately after delivery though as the midwives check to see if you have any tears/grazes that might need suturing.

for my second labour i didn't have any internals at any point, tho i hadn't requested it. i was in the natural birthing room, so maybe it was taken for granted. i was on a ball and/or on all fours all the time so maybe what Gold says enabled the midwife to decide to leave me alone?

I don't think using breathing, sounds, etc is very reliable. I had a failed induction and the MWs reckoned my ctx "looked" good, but I didn't dilate properly at all as they found on doing internals.

my midwives were sympathetic to my aversion to internals and were very sympathetic. and i agreed with each one that if i told them to stop they would. then i used breathing to calm myself and it was ok.

the internals dont last very long at all fwiw.

there was only one midwife i had who was really horrible and so i refused an internal (for induction) from her- i insisted so they got another midwife to put the pessary in and then unfortunately i still had to put up with her for the monitoring the rest of the day.

its worth knowing that the internals once you're in established labour are much easier becuase everything is opening up anyway.

Its not the pain of them I'm worried about, its the psychological effects/emotions that worry me and that it would totally slow down or stop labour and make things worse. Any gynae exam is an absolute ordeal for me, can't imagine how horrific it would feel like in such a vulnerable situation. I really don't think I'm the kind of person who would feel differently just because I'm in labour, although I know people say you won't care, I don't think I'll be one them!

Can you talk to a midwife specialised in caring for traumatised women during labour? And is it any better if you have a midwife you know? Can you meet with two or three midwives who will be in shift when your due date approaches so you'll know at least 1 person on each shift and agree that they'll look after you?

I've had long chats with the peri-natal psych department about this and, like you, internals are and will always be a psychological ordeal. What's important is that if they're necessary I know they'll be done sensitively by people who don't think I'm over-reacting, only if it's really absolutely necessary and by a midwife I know and trust.

If your situation is anything like mine it's horrible playing the card and explaining it all but HCPs are very understanding and a lot more willing to bend the rules.