Refusing / declining vaginal exams during labour - experiences please?

[worriedwretch]

Stemming from my other thread about having long OP labour and being at 4cm for hours to be told I'm not in labour and given no pain relief - whilst contracting every 3 minutes and the second HB MW being called for - only to be examined and still being 4cm and bein sent to hospital for failure to progress to then be rummaged about in like a washing up bowl by THREE doctors one after the other and again being told I'm not in labour - to then go from 4cm to delivering Baby in 10 minutes -

This time I would like to decline being examined -
An I would like some confidence in doing so.

No experience but I would say it would depend on how every thing is going, if the baby is ok and whether you want to have drugs. I wished they had examined me which is odd cnsidering how medicalised my births were, I was in a lot of pain, had either pethadine or diamorphine cant remember which one, I wasnt examinied first and then went on to have dd2 minutes later resulting in a floppy baby who had to spend the first day in an incubator for no reason other than the drugs, I was very dissappointed with myself as I had caused it.

I can totally see why you would want to minimise examinations, I think they are only supposed to do them every 4 hours or so anyway.

I would say as well second labours are very different to first ones, I was in labour for 37 hours with dd1, dd2 was 4 hours.

I would discuss it with your midwife befre hand and see what she says, whether it is an option and hat should give you the confidence to actually stick to your guns. Whatever you do I hope it goes well :)

oh, this is my 3rd - and no option to have any thing other than gas and air or the pool at local MW unit

if i wanted pethidine i would have to go to hopsital

I do remember pointing out that they were quite painful for me, and saying 'do you really have to' and that put them off a couple of times (although I was being induced, so sometimes they just said that they really did want to to see if the induction was working)

More forceful than that I have no knowledge of.

I found that in fact it was me begging them to examine me with #2 + #3. On both occassions they had decided that it would be ages, on both occassions they were wrong. I would say trust your body and when it feels as if you might be transitioning then ask to be examined. I can understand not wanting too many, I think that for me on both occassions it was when I felt that all I wanted was the baby out NOW was the time to be examined.

Just a thought - but if you opt for birth in the pool, they won't be able to examine you in the water, will they?

And as far as I am aware, they do not have the right to examine you without your consent, so if you refuse or decline, they can't force you.

Have you considered talking to your midwife, or to the head of midwifery at the hospital, and explaining how bad your previous birth experience was, and why you are so unwilling and unhappy about the prospect of being examined vaginally when you are giving birth this time? If you can feel that you are being listened to and understood, that might help a bit, and maybe the midwife would be able to help you write a birth plan that outlined clearly how you want your progress to be monitored, and under what, if any, circumstances you would consider having a vaginal examination - so you could feel a lot more in control of what is happening to you.

I've read a lot of posts on MN by people who have had relatively simple labours, and who have refused internal examinations. I would definitely consider it if I have another baby, as I get the feeling that a lot of it is making sure that you're progressing according to a non-existent textbook labour.

issue being it will be same MW delivering this time as it was last time... tad hard to talk to her

Do you want no vaginal exams or to keep them to a minimum? They can be useful to dertermine position of the baby (when you first go into hospital) and also confirm full dilation but none are vital.

No one has the right to examine you without your consent. An experienced MW should be able to tell how you are getting along without having to examine you. Look at this for instance: birthsen.tmdhosting930.com/?p=1605.

You don't need to be examined to see where in labour you are - there are other external signs and your behaviour/vocalisations/breathing should clue a competent MW into how far along you are without actually needing to see/feel how dilated your cervix is.

Even if they measure you at 10cm it doesn't mean you are ready to push if your body isn't telling you too, and if you are 4cm it doesn't mean labour is going to last another 6 hours.....

the thing is, both labours Ive been 4cm for HOURS - refused pain relief, or just fobbed off about pain relief and told that it will be hours and lay down and sleep, then gone on to have my baby within minutes, no direction to push - my body has just done it

I wanted to refuse exams.

When I got to the hospital they wouldn't let me use the birthing pool unless they knew how far along I was on - so I agreed. Was the only one I had during the whole of pregnancy and labour though not counting being stitched up at the end

So you having an exam and finding out you are 4cm doesn't mean anything really as it might be hours or minutes until you deliver. Sounds a bit pointless to me!

truthsweet the problem is that as soon as you refuse "standard" procedures you become a higher risk pregnancy and birth as you are deviating from the ideal.

In my case it was said that getting in the water too early could stall labour, so this hospitals guidelines were that a VE must take place before a labouring woman is allowed to use a pool. You are allowed to refuse treatments /procedures etc, but so are the MWs.

Getting into water can stall labour if done to early but a good MW should be able to spot that pretty quickly and get you out and moving if that's the case! I know my doula could tell if I spent too long on the birth ball doing one type of movement as it started to slow down my labour so she would encourage me to move in a different way, walk about for a bit, etc. If a doula can do it, a MW must be able too!

The 'ideal' though isn't actually evidenced based, given that the evidence shows that non-interference with quiet, dark, familiar surroundings and familiar people supporting the mother are the physiological norms for labour for mammals (humans being mammals too).

Bright, noisy, strange places with new people and lots of intervention have a deleterious effect on the cascade of hormones and the birth ejection reflex that is needed to expel a baby with the least amount of problems to the mother and baby. Obviously intervention is needed at times but to start interventions without any evidence for it is just bizarre - first do no harm etc!

It doesn't bother me if refusing non-evidenced based care makes me 'higher risk', if I am refusing them to lessen the risk for me

So in essence the truth is you can refuse examinations but you do so with a gun to your head and the threat that they won't allow you to have pain relief / access to certain facilities...

Isn't that technically coercisive and therefore only consent under duress?

Exactly!

So if I refuse VE then I am declined pain management. Awesom.

Worried - Would you consider a home birth? When it is your pool, the midwives can advise on whether to get in the water, but not withhold or instruct. It puts the decision making power on that one back in your hands.

Home birth not possible. Living in a building site

Craps.

Totally and utterly not possible?

Or do you have any understanding relatives nearby who would vacate for you? You can homebirth in someone else's home too if it is close enough!

I'm 38 weeks - surely too late to find a pool?

You can get birthpools on ebay (new). I'm sure you can get one on a next day delivery if needed.

Just a warning about pools and refusing ves. I got out of mine to have a VE and was much further on than anyone thought (head was there). DS had his hand on his head and needed wiggling help - I had a quick and easy 2nd stage, but we could have had real problems if I'd stayed in the pool.

You'll probably be able to get a pool on next day delivery!

"So if I refuse VE then I am declined pain management. Awesom. "

NOT true ... you can still have gas and air and non opiates

I am not a midwife but I do know that if an opiate is given too close to 2nd stage it results usually in a "floppy" baby as opiates are a respiratory depressant. .... do you really want your baby to be in intensive care after birth if MW aceeds to a request for analgesia without checkin progress first.

Labour is an "inexact science" ......... its not always the case that observation will tell how far along a woman is in labour . Although in general it might be possible - we women are individuals and apart from the transition stage which is the most universal we deal withthings differently.

All my labours were different and with the second one especially observation was very wrong. The midwife though I was asleep but in reality I was "meditating" ( concentrating on my breathing) and maintaining a calm which belied the fact that I was dilating steadily and almost at stage 2 before "waking up" and wantng some gas and air for a bit.

Of course one can refuse examinations but please dont do it because its an inexact science...... it is still a good guide to progress even if not to timing.

". do you really want your baby to be in intensive care after birth if MW aceeds to a request for analgesia without checkin progress first."

This misses my concerns entirely.