Internal exams

[GoooRooo]

During my DS's birth I found the internal exams excruciating. Much much more painful than the contractions. As a result I had an epidural just to endure the pain of the internals and deeply regret it. I also find smear tests painful (although the never believe me when I tell them that) and my mother does too so I think it just must be the way I'm built.

Anyway, I am dreading the internal exams during the birth for DC2. Can I refuse them? Is there any other way for them to tell how dilated I am?

Yes you absolutely can turn them down. But no there is no other way to check your progress.

I found them excruciating as well in my first labour. I turned down a couple during the early stages when it was clear we were a long way off. The midwife was a bit about it but they can't force you into it.

Towards the end we agreed to one which I found didn't hurt at all. And then dd was born...

Discuss it with the midwife looking after you when you first get to hosp. It's your body and they cannot submit you to any examination without your consent

Thanks Turtle. I had a three day labour last time, waters went then I was induced after contractions didn't start naturally, and went through seven shifts of midwife. I hate to think this is a battle I may have to fight over and over again with multiple midwives.

I was told by a supervisor of midwives that it is not only ok to refuse internals but that they are often unnecessary and only done in order to put something in the notes - you can go from 3cm to fully in half an hour or 3-4 in 12 hours then to fully in an hour so how dilated you are doesn't necessarily indicate how long you have left.
The subject came up after it emerged that the need to induce so many hours after waters going is actually related to having an internal (which introduces infection risk) and if they don't do an internal and you don't have a bath, you can wait much longer before infection risk means you should be induced.
This was at a home birth group which this mw attends regularly so I assume she is of a non-intervention bent anyway.
You could put in your birth plan that you don't want 'routine' internals.

Well the guidelines say that vaginal examinations should be every 4 hours as a maximum in a normal labour with no risk factors and every 3 hours in more complex situations. Of course you can decline them, HCPs can only offer not demand that you comply. If you put it in your birth notes that you would prefer not to have them I am sure they will do what they can to accommodate you.

There are other ways of determining progress in labour, the purple line here and also see here for other ideas.

A good midwife will always try and make you feel comfortable.

I was really concerned about internals in labour as like you I have always found them v. painful. Also I had v. severe SPD (was in a wheelchair) so didn't really want anyone touching me other than strictly necessary and was anxious about opening my legs at all. In the end I put on my birth plan that I found them painful so preferred them to be kept to a minimum and they were actually pretty good about that - they did one on arrival (about 6 am), one to confirm that I'd dilated enough to move to the labour ward (about midday) and one to confirm that I was fully dilated (about 5pm), that's all. The first one was fine (excellent, v. gentle male midwife) - uncomfortable but really not bad; second one was painful as she had to try twice and was a bit brusque about it but not too awful as I was on gas and air at that point anyway; third was fine though they but a tube in to drain my bladder at the same time which was a bit unpleasant. They did them with just one or two fingers if they can and they were all quite quick. I know that they intentionally delayed a 'scheduled' one a couple of times because of the note in my birthplan so I think it is worth saying something about it. Obviously I was having a v. straightforward labour so they were comfortable spacing them a bit more widely.

Could you maybe put on your birthplan that you are not comfortable having an internal without gas and air? Even if you're not planning to use it generally, it does help I found and also gives you something else to focus on.

My MW said the same as Fairy's. She also said she regards it as a success if she gets from start to end of a labour without needing to do any. Because it is only ever a snapshot and because there are other ways of monitoring you. They don't need to know how dilated you are.

I have the same issue you do and my MW was very understanding (as was the nurse on my smear. I think the fact that it was five years overdue was a clue ). She has also confirmed that I can put in my notes that I won't agree any internals I do agree to unless they ensure that I have gas and air available, as I find that very helpful pain relief.

I am currently 40+4 and am contemplating the whole 'sweep' issue for next week. Urgh.

This are all really helpful replies - thank you all! Sadly I have started bleeding today at 10+2 so now just hope I make it as far as full term.

If I do, I definitely will make a note on my birth plan.

I do t like gas and air - it makes me feel really sick - so that's not an option but I am happy to suck up the pain if absolutely necessary if they can keep the internals to the bare minimum.

Sorry to hear that. I hope it's a false alarm.

One thing to think about putting in your birth plan is that you won't agree to internals based on lapse of time (i.e. just because it has been four hours since they did one) and that any request to do one should be accompanied by an explanation of the clinical reason. You may decide to agree if it's "We are slightly concerned about the heartbeat but think you might be fully dilated and ready to push, in which case it's much less of an issue" but not if it's "We just want to check where you are"

I didn't have any during my second labour - my midwife didn't offer/attempt any at all until I had been pushing for 45 mins (VBAC situation) and at that point she offered to check if there was a 'lip' that she could push back. I said no and she didn't press me, simply suggested I change position to be more upright. This worked a treat and DD2 was out in 10 minutes.

I took a Hypnobirthing course when expecting DD1 and was taught by a very experienced and senior midwife who said basically the same as mentioned by a PP - she was in general fairly anti-internals unless absolutely necessary and as she explained it, an experienced and competent midwife can tell what stage you are at by other means. Her view was that internal exams should not be routinely performed (as they seem to be in most hospitals) unless there was a specific reason to do one. It actually makes me quite angry that this isn't widely known and understood - there are an awful lot of people out there who believe that internal exams are just necessary and have to be endured as part and parcel of every labour. This simply isn't true.

I am so relieved to read this post as the internals were the only part of childbirth I found traumatic even with has and air. It was no surprise as I think I have mild vaginismus and can't tolerate smears. I think I will have to have an internal before I get in the birthing pool though? ( if I'm that lucky!!) how did everyone find the attitude of the midwives when refusing internals? I hate having to be difficult!

This is very interesting.

I actually had an opposite experience when they just wouldn't examine me, and I had to ask to be examined. Apparently I was handling the pain too well and they didn't believe I was in active labour. And when they finally examined me I was 9cm

I found internal very unpleasant too, and with intense contractions it is extremely painful to lie on your back as well. Even my baby's heart rate dropped during the exam, but was fine after I got upright again.

I wish they examined me earlier, as I wanted to use birthing pool. I did use it in the end, but only while pushing, so no pain relief for the horrible transition.

I think as it's your second DC you yourself will be more aware how you are progressing so you can refuse the earlier ones, and maybe just have one to confirm you are fully once you get an urge to push?

Good luck with your pregnancy, hope all goes well