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

horrified to read some of these stories, I had dc4 seven months ago and not one VE was done which had surprised me as with the previous 3 I had had them when I had asked for pain relief,

With dc1 I was told that I needed a VE to start induction, I consented to that one, but not the others and actually said 'no, I do not want you to do that'. I was told I had to accept or risk loosing my baby, I was told that I hadn't progressed and I couldn't have any pain relief without a VE. I was actually threatened with a CS after refusing for 5 hours and when the consultant went to do a VE my daughter was almost crowning. I got hold of the gas and air seconds after being profusely apologised to. With dc2 I allowed VEs to avoid the same situation, labour stalled, and even though I gave consent to VEs I did not consent to 'stretch and sweeps' which, aside from being excruciatingly painful, were given with every VE including at 8cms. This time I will be standing my ground and demanding that my wishes are respected. There have been other things I didn't consent to in both births and also afterwards.

avocadotoast It was brought up in discussion at my NHS ante natal classes. I also requested a hospital visit, as was told they no longer do them as standard to prevent infections (perfectly understandable). My midwife I see at my appointments arranged it for my husband and I and we were shown round the midwife led unit by a lovely midwife (hoping I get her!!) who answered all my questions, no matter how silly they seemed, on everything from their routine procedures, to advice on snacks! If what they say is true then I feel very lucky to be giving birth where I will be, especially after reading this thread. My husband is being drilled on being my advocate if labour makes me unable to communicate!

Before my NCT classes I didn't realise that a lot of what is presented as compulsory before and during labour is actually very much a matter of choice! I had written a detailed birth plan and then a single sheet of bullet points control freak, moi? that DH could hand to our admitting midwife, so that what I wanted and didn't was clear from the start.

I would very much like to have avoided all VEs, however I also very much wanted a water birth, and I had looked into my hospital's track record of water births and found that they did fewer than 15 a month (out of approx 100 births) seemingly because a lot of people don't meet the criteria, one of which was that you must be 5cm dilated. And there's only one way to tell that for sure!
So I resigned myself to the pay off for a water birth bring that I would have to endure one VE. Without it I'm sure I could have fought and insisted etc, but I wouldn't have had the energy.

I had the VE on admittance which hurt like hell (mainly because I hated to be on my back - it was the only time I was in my whole labour) though the midwife was quick and very sensitive about it, and I had consented, and I was 4cm which earned a pass to the labour ward.
Once we got to the pool room, the midwife said that I had to be 5cm before I could get in, so I asked how long the pool took to fill, she said 45mins, so I said 'ok then, you fill the pool, and once it's ready we'll just assume that I've moved on another cm shall we?' And that's what we did.

Once in the water it was 3hrs til pushing, and another hour until he was born, and I didn't have any other exams. My birth plan had said I wanted to be observed with mirror only, and not to get out of the water unless I wanted to. I also asked for low lighting and no conversation , and that was honoured too - it was a very peaceful birth to be honest, I was very lucky.

So yes, I knew I could refuse, but I considered at least one exam a necessary evil, and I would have consented to others had there been concerns at any point about the baby.

I don't know if they still do this, but the Edgeware Birthing Unit did tours that involve you taking turns at climbing into the (empty) birth pool and to move around and find comfortable positions. It's a tad embarrassing to be sure, but it sets you up well for when you arrive nervous in labour and the place feels familiar and so does the pool (pre-filled and lights dimmed when you phone to say you are coming in).

Nessalina There are good reasons for being in 'established' (I hate that word) labour when you get into the pool.

However 'established' labour is not a number of cm dilated.

I know I sound proper contrary but for births no.2 and 3. I put in my plan that I was in established labour when I said I was, and should be treated accordingly.

The downside of having your wishes respected is that though the midwife for no.2 did treat me as being in established labour because I simply told her I was, she didn't actually believe me as she had none of the evidence she was used to.

And though I was 'allowed' in the pool, as per my plan, having not even requested gas and air yet she was completely taken by surprise when on entry my waters broke and baby crowned, and there was no time for another midwife to be called.

With my first, I had three VEs, each four hours apart, and they midwife kept saying, yup, more dilated...3, 5, 7cm and then when she came to do the fourth, she realised something was wrong. Turned out, she got it wrong ALL day and I was only 2cm!! Totally threw me off, and needless to say things did not go as planned after!

Starlight - that's a great way of putting actually, which I shall definitely adopt next time round. You'll know I am when I say I am

Yes, I was aware that getting in the water too soon can slow down labour, which is why they put a number on it, but even without her checking me again I was pretty confident after the extra hour that the pain had intensified enough that I must be 5cm or more. It's amazing how much you understand what your body is trying to tell you - I found it very liberating

I could tell when things were going to start moving and I was fully dilated, and I said to DH and the midwife, right we're nearly there now, he's on his way down, and they humoured me, but I could tell they thought I was being optimistic. I was right though!

lizanne I've just had one NHS antenatal class that lasted all of an hour and half... No mention of anything really!

On the website for the unit it says:

"Women are assessed in the Maternity Assessment Centre on admission. From there, women can either be sent home with advice - or referred on to Delivery Suite or Antenatal Ward depending on the stage of labour."

That single word "assessed" has me a little worried now...

I'll have a word with my midwife during my next appointment, hoping she might be able to give me a bit more info.

When I was in labour the midwives and doctors were great at making sure they had my consent - anything they wanted to do was presented as "we think it would be a good idea to do X thing, because of Y reasons. It would involve us doing Z to you. Would that be all right?"

I wish the midwives who talked to me about induction had taken the same approach (rather than lots of language about what they'd 'let' me do!)

I knew I didn't have to have a VE, but it's a different story when you're there on the labour/ante natal ward. I had one a few hours after being induced at 37 weeks and it was the most painful experience of my life, worse than recovering from the emergency C-section that followed. It was horrendous and I think that was mainly because my body wasn't ready to be induced at all. Add to that the consultant shouting "what are you crying for? I have to do this", and you can see why I will definitely be refusing a VE in any future pregnancies.

Nessalina It sounds like you did a pretty good job of advocating for yourself anyway.

I was at the birthing unit for just an hour and a half before dd was born. If I wasn't allowed to be admitted before VE, or refused the pool, it would have been several more hours before she was born and a likely blue-light transfer.

As it was I arrived, mw showed me filled pool and room, left me in peace for 20mins, came back to find me on my knees and offered me gas and air which I refused then brought me a mat for the floor, took my blood pressure after seeking consent, and then when I said I wanted to go into the pool suggested I had a wee first.

DH offered to make me and mw a cuppa, and when he got back baby crowned, head out, body out, picked up baby, breastfed baby whilst placenta delivered, cord cut, drank still hot tea in still-clean pool.

3rd birth similar but at home and sack tangled up inside me requiring annoyance of handing baby over whilst I had a rummage.

Dc1 (hospital birth) they asked for my consent but didn't offer any explanation why or if there was an alternative option. I didn't think to question them so I agreed. One of the worst parts of my very straightforward labour was having to lie on my back for the ve.

Dc2 (home water birth) the midwife turned up, sat down on the sofa and let me get on with it. Dh said she got up a few times to check how things were going using a mirror but I never noticed this and she didn't touch me once. I definitely preferred my second birth.

Thanks for the replies to my question about VEs post-birth. My own reluctance about them is due to the invasiveness, not particularly due to their effects on labour. In fact my first birth hit problems because of a badly positioned large baby who failed to descend. I'm not currently pregnant or TTC but if I attempted a vbac I'd actually welcome close monitoring of the position so I could go for cs sooner rather than later if it happened again. I'm not sure to what extent its possible to assess this without VEs?

I will definitely be making it explicitly clear that at no stage does consenting to a VE mean consenting to a sweep. Already had that nasty surprise sprung on me...

How is the midwife to know when your ready to push? You could push to early and damage your cervix?

Unless a very medicalised birth, You shouldn't be pushing unless you have absolutely no control to stop it. The midwife can tell by the change in your breathing, the position you take up and the sounds you make.

I felt so sad reading this thread, especially ToothFairy87's post about smear tests. In my midwifery career (I'm now retired) I found that some mums found vag exams excruciating, but I didn't know why. I would try to be as gentle as possible, and was appalled at the rough treatment or judgmental attitudes of some other practitioners. I have since learned a lot about various vulval problems which can cause pain on examination, including smear tests. The Vulval Pain society has loads of information about these conditions, including a guide called Smears Without Tears which I helped write. It can be found here: www.vulvalpainsociety.org/vps/index.php/downloadable-info2/smears-without-tears-smear-guide/downloadable-information-accessible

There is no clinical evidence for routine internals to check readiness to push (unless epidural etc)

What penguin said. No. Of cm dilated doesn't tell anyone about readiness to push or otherwise. Using that when the mother isn't ready leads to a prolonged and exhausting second stage requiring eventual assistsnce and causing the mother to think there is something wrong with her body as she felt no urge.

I think I did know they needed consent but i wouldn't have felt confident to refuse them iyswim.

I really really wish I refused consent for the procedure they did to take a blood sample from my then unborn dds head - that was horrific and in the end pointless.

In the end I needed an emcs, I vaguely remember a consent form being thrust under my nose to sign for that but by that point it was life or death for me and dd so not much choice really!!

I was aware that I could refuse a VE and throughout my 72 hour labour I said no to a couple, whilst I was feeling particularly cantankerous, uncomfortable and grumpy. It was not an issue, my MWs were more than happy to oblige and came back when I was feeling more agreeable

From what I understand, if things are going as they should be, it should become overwhelmingly obvious when you need to push! A VE may confirm it, but is entirely unnecessary at that point. The urge to push comes from the baby's head pushing down on your pelvic floor which can only happen if it is descending through the cervix and you're fully dilated or as near as damn it. There's an interesting article here about the the fact that women wanting to push and being told they shouldn't yet can really muck up a good birth experience.
Personally I never actually pushed actively, I pushed spontaneously - once he started to move downwards at the end of each contraction there was a push that I had no control over whatsoever - it just happened! Very weird experience, but the muscles just took over and sorted it out themselves! I've heard anecdotally that a woman in a coma could give birth - the body has everything it needs to do it on its own so long as all the muscles are functioning. I think that's why although it's damn painful, it's endurable, because it's pain that's supposed to be happening in order to get it done!

Sorry, Ness, but what you've just posted is not right.
In my first labour (back to back baby) the head was putting pressure on my cervix, which wasn't fully dilated. My cervix became swollen. Whichever caused it, I had an involuntary urge to push long before my cervix was fully dilated - around 6cm. It was horrible.
Whilst I didn't enjoy the experience of VEs, I'm glad at least that I knew what was happening.
Having said that, it is entirely the choice of each woman experiencing childbirth to make their own decisions.

Mine, how did having VEs tell you or anyone for that matter what was happening?