KentOwl Vaginal exams (ve) are not compulsory and could be argued not to be neccessary. I think for the majority of women they are intrusive and not helpful.
I would argue only to have one when you are making a descision (for example, if you are birthing in hospital, but midwives suggest you are in early labour and should go home then a ve could show if you are in established labour or not (4cm dilated or more).
Also if you were having a homebirth, and you decided you couldn't cope anymore without pain relief and wanted to transfer in, then a ve could show you are near to giving birth or in transition (10cm dilated) so no time to transfer in.
Also if midwives are worried about abnormal bleeding or that baby is possibly breech or in distress, a ve could confirm babies position or if you are near to delivering.
But these scenario's should be explained to you and your consent gained, you could still say no if you felt you didn't want a ve.
Routine ve every 4 hours, is ime unneccesary, and does not tell you much, they use this measure to plot your progress on a graph (partogram) and to decide if action is neccessary (if you are too slow to dilate, not fitting the average pattern seen, you cross the action line, at this point they may suggerst more interventiomn, like breaking your waters or starting a drip to increase contractions). If your baby is posterior or in another presentation, dilation can be unequal (because the pressure of the head on the cervix is not even) so could stay at 5cm for many hours while the body is trying to get baby to rotate, the best thing to do is stay mobile and active (unless you are very tired). Breaking waters can make babies even more stuck as they then do not have a cushion of water to turn in, it also can lead to more distress as the pressure is greater on the babies head.
On the other hand, women can dilate very quickly, you could be 3cm at ve (so expecting at least 7 hours till you feel an urge to push) and be 10cm dilated half an hour later, this can make people try to minimise the sensations you are feeling and suggest you can't be as far on in labour as you think.
A ve can be asked for by midwives when you feel like you want to push, to check you are 10cm dilated (sometimes you get an early urge to push, or you have a lip of cervix that isnt fully dilated). This can be a pain, as some midwives dont feel confident to do a ve if a women is in any position other than lying on her back, if you are kneeling, standing or in a birth pool, this can be very disruptive.
It can also be argued that if you do have an early urge to push, or a lip that you could go with your body and push past the lip. So again, you do not have to agree to this ve.
Gothmummy As a doula I have seen stitches being done (and had some myself) that were very painful, I have seen others with no pain at all. I think the key is to make sure enough local is used and that doctors/midwives wait until it has fully taken effect before they start (I've seen this at the dentist too, mine sends you out for 10mins after the injection before doing a filling so it has time to work). There is no reason why it should be extremely painful and if it is, I would tell them to stop and give you more local. You could request a spinal if you were very worried.
S x