Anyone refused internal examinations in labour?

[NiceCupOfTeaAndASitDown]

I am planning on politely saying "no thank you" to internal exams when in labour with DC2, I'm not looking to be convinced otherwise; would just like to know if anyone else has done this (especially if not their first baby and had them with DC1) and your experiences..

The 2 midwives I have discussed it with have said its very difficult to know how labour is progressing without VEs but I am quite happy to let my body do the talking. I've read about the distance between the fundus and uterus increasing by 1 finger depth for each 2cm dilation and a line up a woman's back that extends from the buttocks upwards by 1cm for every cm dilated she is - DH remembers me having this in my first labour so I'm hoping it will reappear - I just want to get on with labour without worrying too much about time constraints (plus it really hurt last time and I felt held me back) - so...

Did you come up against any trouble with your refusal? Do you feel it worked for you? If you changed your mind, why? And do you regret it?

Many thanks in advance

Not quite the same, but I asked for minimal VEs with DS. I wanted things to progress naturally. I had one when I arrived to ensure I was in established labour (as it was only 2 hours since my first pain) and one when I started feeling the urge to push. It was a good compromise for me, I feel the midwives may not have wanted to admit me so soon after the onset of labour without an examination; when my body told me to push I still had a lip of cervix which hadn't dilated so I'm very glad now I consented to that one!

For me it was the perfect balance, and my midwives (hospital birth) were happy to go along with this. :)

Thanks rockchick I had the cervical lip thing with DS at 9 3/4cm dilated - I asked the doctor if I could push through it and he said yes so I did.. 2 hours later he still wasn't out (ended up being delivered with forceps) so maybe it would be a good idea to ask/accept being checked when I feel I want to push. I'm not adamantly against them, I just don't feel like they're always completely necessary (for the mum at least) - I would be interested to know if anyone has been admitted/turned away without/because of a refusal of a VE - we are relying on family for a lift to the hospital roughly 30 minutes away; I don't plan on going back home once I'm there!

I didn't have any, and that was with a VBAC. Midwife was amazing, just seemed to work out how far along I was from other signs. Then I said I needed to push and she said 'go on then'! That was in a birth centre though, very hands off. I didn't have any pain relief either - she didn't offer any and I didn't get round to asking!

Thanks eglantyne I'll be in a birthing centre too so will hopefully have a similar experience. Can I ask what other signs your midwife used? Mine just look at me blankly when I say "there are other ways, aren't there?" - I think they know of them but don't use them IYKWIM

I asked for minimal ves at my homebirth and ended up only having one when the mw arrived. When I said I wanted to push she knew I was ready because of how I was behaving so just told me to go for it!

My midwives are very aware of my reticence for any kind of touching and have put it in my notes. I'm lucky as where I live the NHS are really positive for home births and they try their hardest to get you the midwife you've seen all the way through. The community midwives get excited by them (her words!) as they've seen their ladies through from start to finish. I like that attitude.

I'm planning on just refusing to get out of the pool so it would make examining me tricky anyway. Heaving a reluctant massive preggo woman in the throes of labour out of a pool will be nigh on impossible
They didn't seem bothered that I wanted it in writing in my folder, home births here have a very relaxed and matter of fact attitude which has done wonders for calming my labour fears.

I went for minimal VE, and there were no problems in the MWs agreeing (home from home unit). IIRC, they did it once on arrival to see where it had got to, then no more. I've no idea what signs they looked for after that!

I think they look for signs that you're being a bit irrational and noises that you're making (grunting was a very encouraging sign apparently). I cried a bit and puked when I went into transition which the mw was very excited by!

Hi can you explain a bit more about the finger gap for 2cm dilatation thing as I don't understand, the funds is the top of the uterus so they don't move away from each other as they are the same thing iykwim? The 'purple line' is a recognised phenomena but not every woman gets it, and you need to be in an accessible position tosee it, ie in the pool on all fours, or out of the pool on all fours is usually the best place to see it. Behaviour tells us quite a lot but can also be deceptive, you can decline all VE's and I've looked after women who have done so and conversely have looked are women who haven't declined VE's but I've felt no need to do them. The only VE I think is very useful is that initial one, it tells us whether you are in established labour and gives us a baseline to work from but if you don't want it then we can muddle through. Good luck.

I've had two labours/births and never had an internal examination. I didn't specifically set out to not have any with dc1 but in labour I didn't let anyone near me . But things were obviously progressing quickly so I guess the MW weren't too concerned.

With dc 2 I wrote on the birth plan not to do internals unless there was immediate concern about me or the baby. Again, things were thankfully quick and obviously progressing.

Have not had one for last two births, one with first as mw didn't believe I was ready to push...

Not having any next time, am sure labour progresses better without disruption.

Freddie I think I've used the wrong word then! I'm talking about the gap between your uterus and I guess your ribcage? I will try and find a link :)

That would be great thanks. Love another tool in my toolbox!

www.studentmidwife.net/fob/assessing-labour-without-ves.21416/

I was on all fours at home last time when DH spotted the purple line. DS was back to back and I progressed from 1cm to 9 in 2 hours so I'm guessing it appeared as quickly. Once I got to hospital they made me lie on my back, I'll be in the birthing centre this time... Hoping they'll allow me to move about so if it's there it'll be easily visible again!

Thanks for the link.

I had an internal when I arrived at the hospital but I can't remember it being uncomfortable at all. The next one was when I was 10cm and I felt nothing .
That was it - they didn't ask to do any others. I would have hated to be examined early on as I am someone who is nearly off the couch with a smear test so I was pleasantly surprised at the lack of pain or discomfort.

I stated no VEs unless medically indicated with DS2. Nevertheless the first thing the MW did when she arrived (was a homebirth) was ask me to get out of the pool to be examined. I said no thanks as it was very obvious that I was close to giving birth, and I had DS about fifteen minutes later. It must have even been obvious to the MW as she phoned for the second MW straight away...so why the need for a VE? I don't need anyone's permission to push thanks, my body was doing all the right things. In the end I didn't push at all - had no urge to - but he rocketed out anyway. I would do the same thing again.

provincial this is exactly my reasoning, I think it's often just done as a matter of course, I do wonder how much is necessary. I totally exhausted myself last time pushing when and how I was told, then hit the 2 hours they 'give' you and wasn't allowed to push any more - got taken to surgery for a forceps delivery with epidural and episiotomy (stitches then got infected and had several weeks of agony) - I only discovered this pregnancy that that is known as 'purple pushing'.. I really want to try allowing my body to know when it's ready to push. I've read that naturally your body will only push for a maximum of about 6 seconds so it makes sense that by being 'encouraged' to push for 10 seconds at a time you'll tire yourself and baby out.

Did you consciously decide to wait for your body to do its own thing or do you think you were just comfortable enough to let it at the time?

I had been on a day course of hypnobirthing-type relaxations etc and found it enormousy helpful. I did relaxations etc at home and when I went into labour I was astonished at how sleepy and relaxed I felt. I didn't consciously do anything and not pushing was not a decision - it was just something that happened. I think the relaxations helped me to overcome my own terrible first birth and fear of giving birth and let my body do what it needed to. I suppose I was lucky that it was a relatively fast labour (4 hours start to finish) and I wasn't in any pain until crowning. I can highly recommend doing something similar eg hypnobirthing if you have any fears about giving birth - which wouldn't be surprising given what you went through last time. Oh and I had a trainee doula, which also helped as she explained to the MW about my birth choices and made sure she didn't hassle me when I said no to the VE.

Sorry, long post....

An experienced midwife will often be able to determine the stage of labour you are at by your breathing, vocal sounds and other external physical signs.

Here's some pointers written by a Doula in Israel:

1. SOUND. The way you talk changes from stage to stage in labor. With the first contractions, you can speak during them if you try, or if something surprises you, or if someone says something you strongly disagree with. You may be getting into breathing and moving and ignoring people ? but if you really want to you can raise your head and speak in a normal voice. When the contraction disappears you can chat and laugh at people?s jokes and move about getting preparations done. During established labor, There is very little you can do to speak during a contraction. You feel like resting in between, you are not bothered what people are doing around you. As you near transition and birth, you seem to go to ?another? level of awareness ? it?s almost like a spiritual hideaway. You may share this with someone else, staring into their eyes with each surge, or you may close them and go into yourself. In between surges you stay in this place. It is imperative for birth assistants and partners to stay quiet and support the sanctity of this space: there are no more jokes, and should be as little small talk as possible. Suddenly, the sounds start to change involuntarily: you may have been vocalizing before (moaning, talking and expressing your discomfort, singing, etc) or you may have been silent. Listen ? there are deep gutteral sounds along with everything you have heard before, just slipping in there. You are about to start pushing.

1. SMELL. There is a smell to birth, that hits towards the end of dilation, during intense labor, just before birth. It is a cross between mown hay and semen and dampness. It has a fresh, yet enclosed quality, and is pervasive.

1. IRRATIONALITY. I love this clue ? it often is a sign of transition. It always makes me smile, and I always warn women about this phenomenon so that when we hit it during labor I can remind them that what they?ve just said is irrational, and that I told her this would happen, and here it is! Relax, it means we?re nearing the end. Sometimes a mother will say she wants to go home, she is done now she?ll come back and do this later, she wants to put on her trousers and coat and go out the door. A mother who wants a natural birth and has been coping brilliantly will suddenly say she was crazy and needs pain killers right now, or that she didn?t want another baby anyways, who said they wanted a baby? Some will just curl up and say they?re going to sleep now. If she does this, that?s okay. The contractions may die down, get farther apart, and maybe she (and the baby) will get a few minutes of sleep. This slowed down transition sometimes freaks out doctors or hospital midwives and pitocin is offered ? try to see if you can put them off for half an hour. Send every one out, lie on your left side propped up by pillows and have a little nap before pushing; it is such a wonderful gift.

1. FEEL. Here come some of the more fun tools that you might not have heard of before! Think about the shape of the uterus. Before labor, the muscle of the uterus is thick evenly around all sides, above, below, behind. As the cervix starts thinning and dilating, all that muscle has to go somewhere ? it bunches up at that top. The top of the uterus thickens dramatically the more the cervix opens. During a contraction, at the beginning of labor, check how many fingers you can fit between the fundus (top of your bump) and the bra line ? you will be able to fit 5 fingers. As the top of the fundus rises higher during labor, you will fit fewer and fewer fingers. When you can fit 3 fingers, I usually tell mothers they can think about going into hospital as they will find they are around 5cm dilated. At 1 finger, you are fully dilated. (Awesome, huh! Here is a blog post by a woman who describes in great detail checking her own cervix just before she went into labor.)

1. LOOK. There is something called the ?bottom line?, which is shadow that extends from the anus up towards the back along the crease of the buttocks. It begins as 1cm and lengthens to 10cm, and it?s length correlates with cervical dilation. Why not look down there before inviting a stranger to put their fingers up inside you? It makes sense to me. Here is current research verifying the existence of the bottom line, and in their trial it was measurable and had acceptable accuracy for 76% of women checked.

1. GOOEY STUFF. Also known as bloody show; there is usually one at around 2-3 cm dilation, and it can happen during the beginning of labor or a few days before hand. Sometimes it?s hard to know what is or isn?t a show, since during the days before labor the amount of vaginal mucus increases in preparation and this can be confusing. A show is up to a couple of tablespoons in quantity, so quite a lot. It can be clear, but is usually streaked with pink, brown, or bright blood. If there is more than a couple of tablespoons of blood then you do need to go straight into hospital to make sure the placenta is not detaching, but if there is just a bit and then it stops, then it is just show. There is a SECOND show at around 8cm dilation. This second show means that birth is near.

Doulakate I've read this online, it's awesome! It's really helping me feel confident in saying no to VEs but both midwives I've spoken to seem unaware or unwilling to acknowledge these things. My regular midwife said she'd be happy with my decision if attending me in labour but warned me that not all midwives would feel the same. I wonder why these other methods aren't commonplace - perhaps they're time-consuming or just not as reliable. I just feel it's unnatural to have something put up my cervix when someone is making their way down!

provincial I don't have huge fears as such, it's kind of a fear of the unknown (because nobody ever knows how labour will turn out) but with an idea of how it might go so a little fear of it going the same way (I'm very keen for it not to) - I won't be able to attend a course but have been listening to a natal hypnotherapy cd and hope this will help. The only problem is I keep falling asleep - hopefully its going in on some level! I do believe in the theory that birth hurts because of fear which leads to tension, but I do need to keep reminding myself that it's all natural and my body will know what to do if I allow it to, perhaps this is because I had so much unwanted intervention last time, who knows? I hope I am able to relax and go with the flow a little this time, I'm thinking the less distraction/intervention the better really

There are definitely other ways of seeing if labour is progressing well or not and in a relaxed woman who is coping well you can make a pretty good guess by just spending time with her and observing her.
The difficulty as a midwife is that if I have more than one woman I will not be able to spend time with her and there may be pressure on beds so need to know if the woman is actually in labour or not. For me in a birth centre this happens sometimes but not really often, labour is unpredictable and with the resources that the nhs has these days there is often not enough staff for one to one care for the entire labour.
Another concern is that sometimes we have undiagnosed breech births, this is not a common occurrence but when it does happen it is often found out about when the mother has an internal. Obviously in many people feeling the abdomen gives a good indication of the fetal position but in someone who is a little overweight it can be really difficult to tell if it is definitely head first or not. Even in someone of a normal weight they can be missed, especially if the baby is lying with its feet up by its head.
If someone is anxious they can appear to be in established labour when they are in fact in very early labour. Sometimes a woman can arrive very distressed and after dimming the lights, supporting her and encouraging her for a while she will visibly calm down and you can get a better idea of what is actually going on.
Whilst I agree with most of the stuff from the Israel doula, I have never heard about the fingers between the fundus and the breasts thing, i'm afraid I think that is totally inaccurate, as the fetus descends the fundus gets lower not higher. This is something I have observed before but having read it yesterday I specifically looked out for it last night just to check and low and behold the fundus got lower as the fetus descended.
As a midwife I am happy to care for women who don't want internals but it concerns me if they aren't happy to have one if there are complications. Sometimes as I have said it can be difficult to not know for sure what is happening due to organising which midwives go where but then that is not the problem of the labouring woman!

I didn't have any with DS2 in hospital. I laboured standing up and the midwife only occasionally used the doppler to check on his heartbeat. She was happy just to leave the rest to me as she said my body would know what to do - and she was right!