Do you have to have internals when in labour?

[milkybarkid]

Hi, I am currently pregnant and have a baby due very soon. I am worried about labour, but not for the same reason most people are. I am dreading having internal examinations. Are they essential when in labour? I know that its important not to start pushing until you're fully dilated and they can tell by an internal if you are dilated or not but I would really like to avoid them if at all possible.

No they are not essential, and if you do not want to have one then you do not have to. I would advise you, however, to read up around the issues, and to keep a slightly open mind about it. There are times when a VE is a very useful tool. But there is no reason that you should have to have one just because it is "hospital policy". I would try to let you have more info, but I'm in a hurry - I expect someone else will comment. If not i will try to get back toyou later (probably tomorrow).

You are entirely entitlted to refuse them. They can be helpful, but are far from essential.
The idea is that it's believed that once you get to 3cm you are likely to be in established labour & to keep dilating, but before you hit 3cm, that you may be better off waiting at home.
Also, even after you hit 3cm, if you don't seem to be progressing, an internal may be able to confirm that... but to be honest, many people dilate very rapidly at the end, after seeming to have little progress (dilation wise) for hours.
My midwife didn't do internals when I had my homebirth, except when she first turned up, just to see if I had at least hit the 3cm mark. It can be so demoralising to be told you're not progressing, when you just don't a standard 1-2cm/hour pattern -- and most people don't progress in that textbook way. So I would tend to conclude that they aren't essential, not that important at all. Maybe Mears can offer a better, profressional opinion, though?

Hi you sound exactly like me i was terrified of the whole experience but i done it! You will have to have an internal examination when you first arrive at the hospital so they can see how far dilated you are ! I hated having it done and screamed but after that i had the epidural so when they done the next one i did not feel a thing. You wont be able to escape an internal unfortunatly as they need to see how far dilated your cervix are!
Is this your first?
I thought i could never do it but it is something you have to do as it has to come out so theres no escaping that fact. to be honest i was that scared but when i came out i said i would be able to do it again...... If i had not had the pain relief that i did then i would have never of done it. I am a baby though so take no notice you will be fine just go with the flow and listen to the midwives there lovely . goodluck.
P.s when is your baby due?

I cut and pasted an article I read... I am fairly sure the author would be happy for this to be publsied (at least I hope so).... but I can confirm you can decline a vaginal examination (VE) .... to those of of you who don't know this - some women (not saying this is your case Milkybarkid) who can't stand "VE" can have been a victim of sexual abuse/rape in their past.... so don't be too harsh in judging why a woman really doesn't want a VE. Abuse is more common than we think.

Here it is :
Vaginal Examinations
An unnecessary intrusion
by Emma Lewis
An experienced midwife should not need to use vaginal examinations.
An inexperienced midwife should be learning how NOT to need them by not doing them.

Modern midwives are loosing the skill of knowing - they are busy doing.

Performing a vaginal examination communicates to a woman that the midwife does not believe in or trust natural birth.

A vaginal examination interferes with the body?s natural birthing flow. It is highly invasive and, many women feel, abusive. Myth information around vaginal examinations needs to be dispelled.

Women need to understand how utterly irrelevant such measurements are. It can take weeks to dilate a couple of centimetres and minutes to dilate the final ones. Or any combination.

This is not most women?s belief or understanding. Too many women at vulnerable times have had a vaginal examination, sometimes at their request (not understanding the irrelevance of the measurements) and have been told ?only? four centimetres dilated.

When they have been working hard, are struggling.... tired... hurting... this can be the final straw leading to requests for help which lead quickly to more intervention.

If a woman could truly understand how unreliable and unrealistic this gauge is.

For some women it is helpful to check themselves over the weeks, days, hours leading up to the birth of their baby. This way they learn the beautiful, gentle, subtle changes that are occurring. Softening. Thinning. They can feel movement. Progress.

A greater gift a midwife can bring is to encourage and support a woman to let go of measurements and expectations, centimetres and minutes into surrender. Go with the flow. A magnificent crash course for motherhood!

A mother will know if anything is not all right with the baby. Her baby communicates through her. A woman supported, listened to and in tune, will communicate this with the greatest of clarity.

No mother needs permission to push (ie allow baby to move down), from anyone other than her own body - through which baby clearly communicates.

?Wild woman, mother, midwife and healer? (beautiful chant gifted to women through Jeannine Baker)
We are all all of these.
We know.

This article was originally published in ?The Mother? magazine.

Thanks for your replies so far. I actually have two specific reasons for not wanting them. I am very ashamed about a couple of things that happened to me in the past.

Dreams, because of this shame and embarassment I don't want to say when Im due cos Im afraid if I give too much info someone might identify me. There might be a mumsnetter who knows me.

Okay, deep breath... here goes

A few years ago I was raped and I feel very guilty about this. Not only do internals remind me of the rape and upset me, I am afraid that the midwife will be able to tell that I was raped and I dont want them to know as I feel Im too blame for the rape.

Secondly, and this is the bit thats really hard to admit, I got pregnant by this man who raped me and felt it would be best to have the baby adopted.

I feel so ashamed, rightly so, but I felt that I would not be able to care for her properly as looking at her just made me think of the rape, even though I tried coping by telling myself that something positive had come out of the incident, I just kept thinking about him.

I have not told anyone about the adoption, I have private antenatal care and have said that this is my first baby. I know I should have told the truth and now am regretting it in a way because my main fear is that when I have an internal the midwife will be able to tell that I've had a baby before.

I dont know what Im more worried about, whether its what she'll think of me for lying or what she'll think of me for giving my baby up.

Please try not to think badly of me for what I have done, I know it was a terrible thing

pupuce our posts crossed. Thank you

Milkybarkid.... there are many issues around women who have been victim of abuse and rape during labour... have you talked to a midwife about this?
I have personally looked after (I am a doula) 2 women who had been victim of sexual abuse (on was raped the other molested as a child). One "thing" that some women have in common is that they really do not want to have their bras removed during labour (bear that in mind as an "innocent" aneasthetist would want to do this to insert an epidural). So informing your birth partner of this is very helpful. He/she can make sure your bra strap is lifted but not removed. You CAN put in your birth plan (and remind you partner to make sure they read your plan) that for personal reason you willnot agree to a VE. You may also be very uncomforatble about student/male medical staff (midwife and docs).... bear this in mind.
Do make sure you select carefully who will be with you in your labour.... it can make a world of difference to YOUR experience.

As this will be your 2nd labour.... you might labour so quickly that no one will have a chance to examine you.... and certainly 2nd labours are FAR LESS in "need" of VEs.
Good luck - and don't be too hard on yourself.... we do what we can with the information and support we get....
Hugs to you....

pupuce, thanks so much. I wish I had you as my doula! I dont suppose you know how much they can tell from an internal, do you? I am terrifed they will find out I have had a baby before and I will have to tell them about the baby I let down

Please don't feel ashamed about giving a baby up; have you seen the abortion thread also on Mumsnet and how powerfully people feel about it? What you did was admirable, not something to be ashamed of. I have 3 relatives who gave up babies for adoption at birth (one also because of a rape) and none of these women did anything wrong. They just felt certain they couldn't give the baby a good life; they made a huge emotional sacrifice for their babies. Plus, re rape...victims often blame themselves for what happened; it doesn't matter where you were, how you were dressed or how you flirted beforehand; if they had sex with you & you told them you didn't want it, it is NOT your fault.

I hate to say this... but I think MW will be able to tell just by looking at your outsides that you had a baby before (somebody correct me....), but women's bits are said to change a lot after having a baby.

Thank you zebra. Its nice to know that not everyone feels badly of me like I do of myself. I cant get over the guilt though. I am so ashamed but I have to try not to let it take over my life so it doesnt affect the way I feel about this child.

I did wonder the first time I saw my midwife if she might guess by seeing my belly although she has never said anything. I hope she doesnt know, although she probably wouldnt judge me for it, i am worried that she'll think I'm horrible. I also thought she might tell when the head didnt engage until later but it actually engaged at the same time as it did with my first

milkybarkid - I do so feel for you. I got pregnant accidentally whilst a student, and had the baby adopted at birth (14 years ago). Obviously there are many very different issues involved with a rape, but like you I felt issues of guilt, and fear that people would judge me ... especially when I came to have a baby of my own to keep. (I agree with zebra and others here that there is no reason for you to feel guilty at all.)

I did tell the midwives and my health visitor about the previous pregnancy/birth/adoption ... I think it is important that this is on your notes, as a second labour is different from a first. I didn't feel at any point that any of the medical staff were 'judging' me in any way, either at the time of the original adoption, or the subsequent births. For me it was particularly important to tell my HV, as I had suffered PND the first time, and was concerned about that occurring again. (It didn't!)

Anyway, I hope that helps. For me the second and third births did bring back a lot of difficult memories from the past, and you need people around you to support you at that time. I think being open and honest was certainly the only way for me. Does your partner know about the adopted baby?

PS I am a regular poster here, but have changed my name for this.

thanks roisin, its nice to be able to talk about this even if it is just through mumsnet. Yes, my partner knows and luckily is very supportive

That's great news about your partner.

milkybarkid - Choosing adoption was an incredibly brave thing to do. As Zebra said, have a look over at the "abortion statistics" thread. You are an incredibly brave woman to have reached this point of your life (new partner and a gorgeous baby on the way) after everything you have been through. The rapist is the one who should be feeling shame - not you. I wish you all the happiness in the world and sincerely hope you get the kind of birth you want. xxxxxxxxxxxxx

Milkybarkid, I am so sorry you feel so worried and sad. You have no reason at all to feel ashamed. You survived an awful crime (nobody is ever to blame for being raped - ever) and came through it. You gave the gift of life to a child who will now have a good life thanks to you, and the gift of a child to a couple whose lives will also be immeasurably enhanced. The only person who has suffered is you - how could you be ashamed of your sacrifice?
If you do want a Doula (or even Pupuce, who you can see is very intuitive, if you live anywhere near her) I'm sure Pupuce will help put you in touch with one. Nobody could possibly judge you for what you have been through. I really, really think you need to talk to someone such as the counsellors at the Rape Crisis line so you learn that you are not alone, that you are not to blame and that you are a good person. Please don't let a criminal rape your spirit as well as your body. I wish you good luck, happiness and joy with your new baby.

Milkybarkid, I really wnat to echo and support what Batters and Aloha have said. I think you are brave and can be proud of yourself, you have lived with something violent that was not, NOT your fault, and you gave your baby a happy healthy start in life. NO-ONE would think badly of you for having your baby adopted.

I am pleased that your partner is aware and supportive. Could you make a special appointment with your MW and explain how you feel? Remember that MWs are working with women at the most emotional and intimate moments of their lives. They must be very used to supporting women with all sorts of difficulties and memories, they deal with birth, and death, and all the MW's I know have gone into their work because they like working with WOMEN. The more the MW knows, the more she will be able to help you sensitively, and help you feel strong as you anticipate your new baby.
Good Luck, and many congratualtions on your pregnancy.

milkybarkid what you did was give a number of people the best gift you ever could have. Firstly the child. You are incredibly brave to have finished through a pregnancy after a horrific experience. Secondly for the family who have since been blessed with this child.
One of my best friends growing up was the child of rape and was adopted out. His mother traced him when he was 18 and even though it was quite hard to come to terms with the fact that he was a child of rape, even he could understand how his birth mother couldn't keep him and he had a wonderful upbringing with the couple he still calls Mum & Dad.
I can't imagine that anybody would think less of you for what has happened in the past.

Milkybarkid, I think you have shown yourself to be phenomenally brave and good-hearted.

It's not anybody's place to judge you, your past, or your actions. If you feel uncomfortable with the midwife who looks after you, then you can ask for her to be changed. That's one of your birth-partner's jobs, and if he's uncomfortable talking directly to her about that, then he can talk to the person in charge (sorry, can't remember the 'title' and insist that you have a different midwife. Sometimes you do need to be very insistent, but, like I say, that's his job.

I had a bad experience with my first birth, and was very worried about the next. When I was about 33wks with the next, I had a long, private and completely confidential talk with the liaison midwife at my hospital. Apart from a note that we had discussed labour nothing else whatsoever went in my file. It helped enormously, because I learned that what had happened in the past would not necessarily happen again, and, most importantly, that I could choose not to be cared for by one of the midwives I had had previously. When I came in, in labour, I saw the midwife I had liked previously and told her that I wanted only her to look after me, and that I categorically did not want the midwife that she had just assigned to me. She accepted that with no fuss whatsoever. I also learned in my session with the liaison midwife that I could insist on having a minimum of internals, particularly as this was going to be my second vaginal birth. She suggested that I put it on my birth plan, just as Pupuce said. I only had the one, when said I wanted to push, and I allowed it because I felt comfortable with that particular midwife. She also did my stitches, rather than getting a stranger to do them.

I suspect that telling the hospital that this is actually your second vb may make things easier for you, as they may not be so insistent on 'procedure' in that case. You do not have to tell them anything about the circumstances or the child if you don't want to.

Sorry to blahblah so much, but I thought maybe my experience would help you. I do hope everything goes well for you.

bloody emoticons!

Milkybarkid - WOW!! You are a wonderful person!!! And an example to sooooooo many women out there.

As for the internal exam.... For me it was pretty crucial. I started getting the urge to push and it wasn't until they gave me an internal that they realised I was only 8-9cm dilated. Had I carried on pushing then my cervix may have gotten very swollen and the baby might have stuck there! As it happens they physically pushed back my cervix (ouch!) and I pushed normally.

You've been given a lot of wonderful advice here.... that I can't match, but just wanted to let you know one benefit to the internal exams.

Good luck with the birth.

Sorry, just realised that you're having private antenatal care, so things I said about the hospital etc may not be relevant, but I think the principle still is.

For me the internal exam at the start was the worst bit of giving birth...I would definitely refuse if I had another child.

Do not be afraid to say what you do and don't want while giving birth, it is your body.

Good luck, and sorry to hear what a hard time you have had of it.

Scoobysnax
xxx