Did you know you don't have to have VE's in labour?

[TheMule]

Hi all. I've actually posted a media request too as I'm writing an article about consent in childbirth. I'm not getting much response so I hope you don't mind my asking here too. I'm just curious to know how many women are aware that they don't HAVE to have procedures such as vaginal exams in labour to check dilation - unless of course they want to. I often hear women express surprise when they are told that they are not compulsory. So I'd love to hear your thoughts or experiences on this or any other issue related to freedom or consent. eg if you did not know that you could decline, if you tried to decline but met resistance, or if you declined and wished you hadn't! Thanks for your thoughts everyone, I realise this is a sensitive topic. I'm writing for the Telegraph online. I'm Milli and I write about birth and run an organisation called The Positive Birth Movement. Email me if you don't want to comment [email protected]. Best wishes, Milli x

Great article. Thank you.

I was aware that I could decline a VE, but I had no problem with them, so I accepted. I was examined twice in both labours and for the same reasons: once on admission and once before pushing to check I was fully dilated. Checking for full dilation has obvious benefits, but using VE for triage purposes on admission can be misleading. With my first, I had to beg the midwife to do it as she didn't believe I was really in labour and was going to send me home; I was 5cm. With my second, I knew delivery was imminent, but my midwife relaxed because I was only 6cm; DS2 was born 20 mins later.

I knew I could refuse and it did me harm, we got an infection. Ended in an EMCS, but none of that made me feel as much of a failure as the images on the PBM's Facebook saying, "have a hormone cascade, not an intervention cascade" did.

I know I'm a bit too late now but I'm shocked to see how many others this has happened to. I thought I was the only one! I had 2 ves without consent or even any warning. Not even a hello and suddenly there were fingers in my vagina! I would have consented but they couldn't be bothered to ask.

Very interesting thread. I'll be giving birth to my first in a few months and I have to say that the descriptions of the VEs as very painful is alarming. Could someone explain why they are so painful? Is an internal exam in labour like a bi manual exam, for example, or is there an extra dimension to it?

Well the cervix being stretch does often hurt. VEs on their own less painful but if the fingers are in and you're given a helpful 'stretch' then 'ouch'.

However, the most painful aspect of a sweep is the position you are required to adopt for it as contractions on your back are more painful, plus the having to move from where it is you are going into yourself to cope.

I'm hoping to just be in a midwife led unit. I live in Sweden where you never see a doc unless you have complications, so mlu is the norm here (although it's in the hospital proper so instant access to all technology if needed!)

I'm fine with just a normal internal exam but I'd be very miffed indeed if anyone tried to hurry things along with an unwanted stretch or sweep!

Making a huge assumption here but Sweden are supposed to be a lot more advanced at the midwife-led stuff and most likely know a)when a VE might be necessary and b)how to do them unobtrusively whatever position you are in.

I'm hoping so! I'm not NHS bashing at all but I've found that hcps of all types here have more time per patient.

The 'I need to see a doc...' System runs on several levels. We have A and E, then we have 24 hour drop in centres, then we have walk in clinics for various things like minor injuries, then if you just need to see a doc about something non urgent you go online and get an apt. That can take several days to get but they will spend half/one hour with you as needed.

My midwife so far is very chilled out, although it'll be a different team at the birth itself. I'm work in a scientific/medical field so I hope I'm relatively well informed and able to challenge/discuss as needed (I did this recently when my husband was being treated for something.) certainly there's no 'on your back' ethos here- you're encouraged to move around etc. it's quite hippy, but we have one of the best maternal outcomes in the world so it must work!

What struck me through this thread is that women (rightly) are angry/upset not about the idea of exams per se , but of being talked over and treated as though they don't matter. I'm happy to have an internal exam if the reasons why are explained to me but the idea of any old person coming into my room, not making eye contact or explaining themselves and just getting on with it, is pretty horrific. I really feel for you all, and I'll think about ways to reduce the chances of that happening to me. Perhaps a note in my birth plan along the lines of 'please discuss with patient any and all procedures ' or something?

I've actually been looking into hypnobirthing for this very reason - I'm not a die hard natural birth person - as a scientist I know full well the risks and am very glad for modern medicine- but I want to be as in control as I can. Mainly so that I'm mobile, lucid and able to speak/make these calls. I know that it totally depends how the birth goes, etc, but that's my aim.

Hypnobirthing isn't for hippies. It is for control freaks.

I was aware that I could consent and not consent to VEs. I don't think I had very many, and I was happy with the way it was approached each time. I wasn't made to lie on my back each time I was examined - the lovely midwife moved herself around me at all times during my labour.
I wasn't left alone for hours either - she popped out every now and then but really only for a few minutes. And she apologised that she'd not been with me more.
Lovely lovely lady. I do wish I could remember her name!

I did know.

Only needed one - in triage: 'would you like me to examine you to see how far you're along?' 'yes please'. Swiftly moved to delivery, no further exams offered/needed, I pushed when my body told me to, baby arrived swiftly.

It makes me very sad to hear of those women who have had VEs without consent. No one can put their fingers into your vagina without your consent. If anyone wishes to make a complaint, AIMS can help. They have a free booklet on making a complaint here: aims.org.uk/pubs.htm#complaints

and their helpline is [email protected]

I am well aware I can refuse. But I am not going to; for me there are worse things than VE.

For those posters who refer to people who say 'I had to have an epidural' implying that it involved pushy midwives, maybe its because women are made to feel like shit for needing or requesting birth intervention. If you're banging the drum about natural childbirth, they're not going to be confident in saying 'yes, I did want x, y, z' because lets face it you'd either pounce on them about unnecessary interventions or leave an unspoken opinion of 'well they're not as good as me'.

Of corse you don't have to! If anyone touches you without consent it is assault (unless you can't give permission then consent is assumed).

I did not know this when I was pregnant or in labour with my son. I consented to 1 VE when I first got to hospital as I was told by people I know that that is what they do when you first get there, so I expected it.

But half way through, as my son was further down, a midwife checked me without asking. I looked down and she was just there. But I thought nothing of it as I just assumed they don't ask or wait for consent anyway, like 'just let them do their job' sort of thing.

I also didn't know that they can apparently tell from external signs (whatever they are) that you are in a position to push. No one checked me to see if I was fully dilated so was confused when I was told I could push without a VE first as I had heard you can cause damage to your cervix if you aren't 10cm.

I had a big bleed so I assumed that it was because I was told to push too early by a hasty "midwife" (she was training, I wasn't told) and caused significant damage. But I don't even know as I wasn't told the findings of the post-partum assessment/examination afterwards.

Does this make sense? And is it normal?

But after having a birth debrief, I made the assumption that they just wanted my son out, hence the midwife quickly checking me a 2nd time to see how far I had to go. I think I was lucky to have maybe escaped an assisted delivery after my son's heart rate had dropped. It turned into a panic I think as they realised my son's heart rate wasn't recovering at all.

The emergency scenario at the end of my son's birth left me absolutely traumatised. I knew nothing about what had gone on or why. I was left to fill in the blanks and my mind went crazy. I didn't even know my son was at risk and they said that they would let me know if they were concerned but in the end... they didn't so I was led to believe the intervention was uncalled for! That caused my trauma.

Also about consent...

I consented to an episiotomy but didn't necessarily KNOW what I was consenting TO. Before I had my son I thought an episiotomy was a small cut to the skin about 1cm-ish. But what I got was not that; I didn't know she was actually cutting my muscle to bits!

And afterwards... All I got told was 'we just need to check you'. Okay I thought, whatever, I thought they were just going to look.

BUT... I was NOT expecting a full on intrusive examination! It wasn't explained and my consent was not obtained at all. My legs were thrown up, they started prepping stuff and didn't even tell me what they were doing, or why, didn't warn me that they were stitching (I just felt it going through my skin as I groaned in pain!) or even WHAT they were stitching. I had 5 injuries but knew about 1, the episiotomy (and even that, I didn't know why it was there!).

Now... is that fucked up or is that fucked up?

I don't know but if I was the one that had just injured a woman during labour, I would have some consideration to mention WHY I did it in the first place and what else needed stitches, not leave her just lying there in pain playing a guessing game as to what is being done to her body!

I'm not being funny but it felt like they were trying to climb inside me!

I was well aware even for my first at 20 yrs old that nothing at all can be done without consent, mainly thanks to my mil who told me I didn't have to be induced when they said. From reading this thread it would seem not many women are aware of implied consent, ie, midwife saying something along the lines of 'we need to check you before we get the anaesthetist down for your epidural' and woman lies down and cooperates. She doesn't have to sign anything or have pros/cons explained. She just consents by not declining.

I urge those who have posted such distressing tales to consider asking for a review of what happened. Many hospitals have a 'Birth Reflections' or counselling facility, where people can go through their notes with a midwife (not the ones they met in labour) to see what happened, why it happened, and whether there is cause for an official complaint. There often is, but many people don't like to do this. However, in my experience as a midwife, things don't change in maternity care unless mothers and their partners complain. But it needs to be a specific complaint, and it can accompany praise for what went right. Midwives are human - they make mistakes - but sometimes it's the whole system that's wrong, and things happen which are against NHS/hospital's own maternity policy. The outcome then can be better care for all, as well as understanding, justice and closure for the mother concerned. www.aims.org.uk/complaint.htm

I don't get how people don't know you can refuse. You can refuse any medical intervention! Why would ve be any different?

I complained when my son was about 2/3 months old. But I only had half the story... Not once did they offer me a birth debrief! I didn't know they existed until I went on to the Birth Trauma Association 3 years later because I had never come to terms with it.

Now I know what happened and why it happened I know what they could've done to perhaps prevent my emotional distress that I suffered for ages. Therefore I am complaining, or informing them, about what happened and how it affected me as an individual, a person with rights and a mum.

I think it's diabolical that I was discharged from hospital with injuries I knew nothing about, not knowing why they panicked, not knowing I lost a lot of blood, not knowing why they intervened and cut me, not knowing why my baby was blue and limp and not knowing that my babies heart rate had dropped.
I was also left in the "responsible" hands of a training nurse acting as a midwife. They did not tell me she wasn't a midwife, or ask for my permission for her to "handle" my first birth. She did absolutely nothing to put me at ease, she looked lost and really didn't seem that confident in what she was doing, but she is all I had. When the panic started I thought that she had messed up somewhere and caused it all, because it seemed no one was looking over her!

Giving birth is such a personal thing to "butt-in" on so an explanation should be given as standard routine for all births that ended up being emergencies and/or with intervention ie. EMCS, assisted deliveries, inductions and episiotomies.

(I heard some don't see an episiotomy as intervention. But that episiotomy made me feel violated as I was led to believe it was unnecessary as no explanation was given for anything - it's not a natural thing, so YES it is intervention!)

The midwives in our mlu adopted a kind of mother-knows-best role. I was treated like a child who didn't know what was best for her. I told them it was very difficult and painful for me to get onto the bed for the VEs but she just ignored me and while she was there she said 'I'm going to break your waters' I would not have consented to this had I been asked and I didn't have time to stop her. Everything was 'I'm going to....' That is not asking permission that's telling you. I didn't really care how many cm I was. I also found it very misleading as the #cms didn't correlate at all with how close I was to giving birth. It turns out my baby was in a bad position so 10cm or 1cm made no difference until his position improved. So basically lots of pain and intrusion for absolutely no benefit.