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

My experience was similar to Nessalina's. I didn't try to push, but I couldn't have stopped myself from doing it either. It just happened. And then the baby came out... I would say "on its own" but obviously I helped

Gosh mine how scary, I didn't know that could happen! I hope it all worked out ok?

I'm asking because my first was back to back but they never knew despite numerous VEs. I had the urge to push and the greatest pain at not even 3cm.

I did know and was lucky that my 1st birth (Edgware birth centre) I was allowed to get on with it - was in birthing pool from arrival at 8.30am, til giving birth at 6pm. I got through it with gas and air& hypnobirthing technique.

2nd labour (Whittington mlu) - arrived in very established labour, contractions agonising and 2_3 mins apart. Midwife tried to insist,several times on ve so they knew how far along I was and told me was necessary /essential - and on checking me on side of bed away from gas and air, so I had to keep stopping her to lunge for it. She was very pissed off with me about refusing ve (if it hadn't been for 1st birth I'd have given in) and tried to refuse birthing pool, but luckily combination of me snarling at her and dh advocating for me meant she backed down, altho she refused to let us have lights down low and sat close giving me evil looks the whole time! So I gave birth an hour later with my eyes closed! :)

I had no idea.........consent was never gained it was just expected as I was in active labour for so long, I lost count the amount of Dr's that just slipped on a pair of gloves and did the exam.

towards the end the consultant didnt even look at me, checked how far I was dilated and said to the other dr's this woman is never going to give birth naturally book her in for emcs.

Everytime I document anything I've done with a pt I have to state 'consent gained'. Do midwives and ob's have to do this? And if so, how many times has this been falsified?

I think I was asked for consent for the MW doing the VEs. The doctor did one mid contraction without seeking consent and I asked him to stop twice and he didn't.

He just said he had to do it

What's the point of being able to refuse, if they won't listen to you anyway?

As I have said before - MW and doctors don't bother with consent when you are in labour. I lost count of the number of VE I was subjected to without my consent during the birth of DS1. Every MW and doctor that came into my room put on gloves and examined me. They didn't speak to me or make eye contact. I was just a lump of meat, crying in pain and begging them to stop.

That's awful Beatrice. I understand that getting consent when someone is in extreme pain can be very difficult, but they should try. I wonder how some justify their actions

Beatrice that's it - lump of meat.

It's pretty hard to mentally get over someone doing that, in such a personal and intimate area.

Especially when they don't stop when asked (begged).

They don't justify their actions. They just don't give a shit. They have a job to do and they really don't care about you. They falsify your records. My notes were a complete work of fiction. But who is going to believe me? The MW and doctors were hard faced, burnt out and completely lacking in empathy.

So sorry Breatrice, though my first birth experience was the same. SHO ordered the midwives to 'get her on the bed'. Completely unacceptable language unless I was either dead or in a coma.

Please don't generalise like that. In your experience, and this is how you felt. I certainly "give a shit" and have NEVER treated anyone like a pice of meat. I hope you made a complaint about the horrific treatment you were subjected to and have sought counselling.
A VE to confirm full dilatation is a contentious issue amongst professions. In my experience a VE only tells you what the cervix is doing at that moment. Just because she is 6cm doesn't mean that baby won't arrive with the next contraction! Particularly with second or subsequent babies! Pushing on a partially dilated cervix can be stressful for mum and baby and can be exhausting and demoralising, not convinced that the cervix will 'swell' rather than dilate but have seen evidence of that in the past with suboptimal fetal positions. Having said that I would recommend a VE if a woman is requesting opiate or epidural analgesia and is feeling 'pushy' simply because of the effect on baby and mum if baby is born very soon after administering either (or whilst i am out of the room to get it!). Though again, it's never a guarantee.

I wanted to have a natural birth (ended up with a section anyway as ds was trapped in my pelvis). Labour was going very slow, had come in that morning and had been up all night with contractions. The next night the Midwife (horrible woman, but that's another story) offered to give me a tablet of some sort to help me sleep, (generic sleeping pill?) that could only be given before 6cm (I think because it made you groggy, in case labour progressed quicker after that point?) I hadn't had a VE in about 3 hours, when I was 4cm, so asked her to do another. She argued with me it wasn't necessary, but finally agreed. She looked quite horrified when she announced I was 7 cm. Think she could have gotten in trouble for that?

As a midwife I always ask explicit consent for a ve. I find that most women want them as they want to know how they are getting on. I personally have no problems if a woman declines although in 21 years as a midwife I've had very few women who have declined. If a woman seems unsure or unhappy about the idea I offer a wait and see approach but they usually ask for one before long anyway. I have had to advocate for women who have declined in the past as the co ordinator has wanted to know 'what they are doing'.

With regards to withholding pain relief, as midwives we are licenced to give pain relief to women in labour, so without 'concrete' information this can be difficult. I have been known to get a Dr to prescribe pain relief to get around this difficulty though.

Personally I did not have any ve's in labour with my first 2 children, I wouldn't have minded but I knew my midwife so well and it was obvious I was progressing so we left it. My third took longer so I had one just to see what was what, I personally didn't find it too painful ( was done in the pool though).

I find it shocking that women with vaginismus are told 'but you've had sex' such lack of compassion is inexcusable. If I came across anyone who said that I'd be having strong words with them.

maxbear - can I ask, what is the legal definition of 'in labour ' for your licence?

It was easy for me to decline because with my first I had all pain relief (except for epidural which I begged for and was refused) and found that nothing touched the pain. Rather, it impeded both my ability to concentrate and work with it and complain about it.

So, with no guarantee of epidural even if I screamed (and to be fair, not all epidurals work well even if given), and nothing else that gave any actual pain relief, I needed to ask for nothing for which I could be blackmailed for in my next two labours.

I didn't know this. I wasn't asked I was told it was happening and there were about six people I had no idea who they were watching. I was hurt and told off for squerming and not relaxing, he was angry I was calming his fingers. He was describing my swollen vaginal lips and getting others to view them. Severe PE. He ten jabbed me failing to get blood. By the time an anesthetic turned up I begged him not to try he said he had to as they were checking for organ failure. I blocked it all out until now. How horrible really. That baby is now a teen.

If you don't have a vaginal examination but feel the urge to push how will they know if you are fully dilated and should push or if you should try and wait a bit?

Nappyaddict - that has been answered up thread. There is no clinical evidence for routine internals to check readiness to push. It simply isn't routinely necessary.

I always gain consent for any procedure I do, even once I've gained consent before I actually do it I will ask the woman to let me know when she's happy for me to start. I also explain why the examination is required, be it for assessment, because it's 4 hours since the last one or because you're requesting analgesia which may mean different things depending on the stage of labour. Please don't generalise when you say that every midwife and Dr lies, falsifies notes and makes stuff up. It simply isn't true.

I should have aso put at any stage any woman is free to decline any VE or intervention that I offer and that is fine. But it's part of my role to offer it and give information.

Don't speak for every other HCP then. You are only 100% of the time in your own company not other HCP'S company to know what they do.

Feeling a bit pushy, isn't the same thing as the involuntary expulsion that a woman in a coma can do to birth a baby.

Unless you have had an epidural you shouldn't be pushing until you can't not.

'But it's part of my role to offer it and give information.'

Now see. I can see clearly that you do your best to give good care, but I do not see that as the role of the midwife.

Because:

a) What information does it give? How does it help the woman if it says nothing about how far along she is?

b) Surely the role of the midwife is to pay attention to the information the woman is giving her, not the other way around. The woman is and should remain, in control of the birthing process, not the midwife.