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.

There are also physical signs that baby is on their way (the bottom line for one!) that can't be 'faked' or induced by any means other than actual physical progress.

The thing is though VEs don't tell you how much longer it will be it's just a rather inaccurate snapshot of that moment in time. You may actually stop dilating/close up a bit after a VE or you may suddenly go into transition in a matter of minutes. That the MW doing the VE said 3cm dilated doesn't mean that opiates are 'safe' and there will be hours for the body to metabolise them, it just is a CYA for the MW and gives her a 'guess-timate' as to how long it might be before birth, it's not carved in stone!

VEs can also undermine a mother's faith in her body to labour - if mother is told she's fingertip dilated and she's been having contractions for hours upon hours she may think she can't do this for much longer or want to have an epidural as it's obviously going to get worse. She may not know her cervix was about to fully dilate but now the stress hormones have kicked in and it may well be hours to get to the point of about to fully dilate again.

truthsweet how do I say this to my MW - im very non assertive and normally just put up and shut up.

Can you write it into your birth plan and direct her attention to it? Any touching of another person without their consent is assault and my experience is that midwives themselves have been very careful to explain why they want to do the examination and let me havea think before agreeing. I suspect doctors and a bit more gung ho and less gentle ( one reason I didn't have any at my second delivery)

Worried - do you have a birth partner/partners? Because I would say being assertive on your behalf is a job for them! If you put it in your birth plan your husband/partner/whoever can just gently remind them of that, and you can always overrule if you have changed your mind.

thing is - last time I had two birth partners, neither of them did as I had asked and just went with the MWs....

DP was one of them last time.

I dont trust him to voice my fears for me when I cant.

Think will have to write it all out and stick it on my notes for them to all read in nice easy bullet points then I can just POINT to it mid contraction

I know you're 38 weeks, but could you try and find a doula? She would Know all your wishes and be able to communicate them.

I had a doula (and will be having a doula with this baby) so she just gently reminded the MW I didn't want VEs during a contraction (I didn't know you could decline consent VE I just knew I didn't want one during a contraction) so the MW did stop. DH if he had been in the room would have told her to stop as well but probably not so gently

I'd say that if you get asked to 'assume the position' for a VE you just say 'no thank you' and remind the MW to look at your Birth plan. They can't examine you if you don't lie down or take your pants off and if you have said no and they physically try to get you to lie down or force you to comply is medical assault.

If your DP is going to throw you under the bus while you are in labour then I'd be having serious words with him about who is giving birth!

With DD2's home birth, I phoned up in labour only to be told they wouldn't send out any MWs as they were all tired (it was the early hours of the morning) and I had to come in, I didn't argue I just handed the phone to DH and he dealt with it. He told them the doula was on her way, I was coping fine and he would call back at shift change when the new MWs would be on. He did and we got MWs

Hi worriedwretch I was actually about to start a thread about just this today. I had a rather over enthusiastic registrar try to break my waters last time and he seemed to forget that I actually have nerve endings when they proved impossible to break, he then went on to ignore me when I said I wanted the midwife to do a later VE. So I'm also keen to avoid this time round.

My main concern is that when I get to the hospital they'll either direct me to CLU rather than MLU or just send me home if I don't let them. I'm planning on speaking to my community midwife about this next week and then brining it up at my full-term appointment.

But I'm also interested to know what other people have experienced when refusing VEs.

My friend declined it. They didnt touch her after that till they really had to.

ahopskip - this doesn't really apply to WorriedWretch as she was talking about declining for other reasons. However, if it is a pain thing, a midwife pointed out to me recently that you could say you will only consent to VEs with gas and air supplied (i.e. even for early ones and if you aren't using it generally).

If you find g&a helpful, that might be worth considering for any VEs you do decide to consent to. I find VEs agonising (worse than crowning for me, which I thought was a breeze - and I can't imagine many midwifes who think it is reasonable to refuse g&a for that!). If they really want to do the VE they will get you the g&a, and if they don't then it obviously wasn't that important to do a VE and was just protocol/autopilot.

It's not really just a pain thing tbh. I just don't particularly want anyone rummaging round down there after what happened last time, it's a shame as I was never really bothered about things like smears, or the like before. Even if it was just the pain G&A didn't even touch the sides during the failed ARM attempt.

My main concern is what happens when I get to hospital in labour (I was induced last time so don't have any experience of the process). Is it routine for them to do a VE at this stage? And if so what happens if you say no thanks.

Like I say I will speak to my midwife about this, just curious about what actually happens when you say no to 'standard' proceedure.

I had a water birth and think i only had 2 VEs the whole time i was in labour? 1 was when i arrived at hospital and the other before the pool to check i was far enough gone. They were not mid contraction so did not hurt much (not compared to the stretch and sweep the day before!). Once in the pool they use a mirror to check on progress and a waterproof doppler thing for the baby.
Do you think you want none at all, or would you like one at some stage to gague how far gone you are, as that can help with deciding what pain relief you opt for next. Ie: i was fine with a TENS for early labout and had in my head that i'd avoid G&A until i was a bit further down the line (as i didnt want anything stronger), with the view to then get in the pool aruond 7cm. It was helpful at 4cm to know it wasnt quite time to crack out the G&A!! but i am a control freak.

Coral - I can totally see why VEs were useful for you, but I think the problem with them is exactly the benefit you describe. Say you try to cope as long as you can without pain relief. You reach the end of your coping ability and decide to ask for an internal. And they say you are 3cm, just as you were 6 hours ago. And the senior midwife who, when she came into the room to do the internal, seemed quite sympathetic, shuts down and pronounces you 'only' in early labour. That can be so destructive. It pretty much happened to me and I collapsed in a sobbing heap, and didn't really get my head back together for the whole of the labour. And yet, who knows, had I been treated on my pain and my behaviour, maybe they would been more supportive, and maybe my body would, at some point, have done a big change in dilation in one jump.

ahop - I think if you present at the hospital and are clearly in labour, thy will be less worried if you decline internals. It's if they think you might still be in the latent stage and you decline that they get really jumpy, because they might want to send you home. Did you have a fairly classic pattern of contractions last time? One of the reasons I would always have a home birth for my (hypothetical) third child is that my contractions were irregular right up to delivery, so that combined with refusing VEs could well result in me being sent home. I figure once the midwives are actually in your house the chances of them upping and leaving are less - they will tend to at least watch you through a few contractions first, and my pain levels and mooing certainly indicated active labour!

Yes to contract intensely and for the 2nd midwife to be called for and arrive -
Then to be told I was still only 4cm was pretty shit tbh

Basically im scared that once you have the first VE
You start the "clock" ticking on how they expect you to perform