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

I'm not speaking for every other HCP! I'm speaking for me and therefore disagreeing with that those who say 'midwives and doctors don't bother with consent for labour'. I'm a midwife and I DO.

The way you wrote your post was looking like you call the abused "liars" and are sticking up for your abusive colleagues. Do you accept these people are telling the truth about their experiences?

I'm not saying the VE gives information (although it can) it is my role to give information re why I want to do the examination/s.

Say for example, when I discuss analgesia I will explain that pethidine and diamorphine cross the placenta and can have an effect on the baby that includes the baby being sleepy following delivery which can mean difficulty in adapting to extra uterine life and problems with breastfeeding, therefore I might ask for consent for a VE to assess progress if a woman is requesting diamorphine. I then counter that with saying there are always babies that are born quicker than we expect so if we do give diamorphine and the baby is born soon after then there are many things we can do.

That kind of information giving is a massive part of my job and can lead to a lot of discussion re examinations. Some women will decide to accept the examination based on the reasoning above and will feel that on balance if they are cracking on they will do without the diamorphine, others don't and that is equally up to them, but without my role in information giving I can't say with any certainty that the implications are understood.

I'm not saying VE's are the be all and end all but they are a good easy to understand way of measuring progress and give everyone in the from a 'hard fact' to go with. And some women need that. Some don't and that's ok.

Bollocks Joan. That's not what I wrote at all. Of course I believe these women who have had terrible experiences. But I don't agree with the mantra that 'all midwives and doctors are lying abusive unprofessional arseholes'.

Some are. I don't deny it. But not all. And I can say that with certainty. But that is the same with any people in any way of life. I don't think scaremongering is going to help anyone.

Women can decline VE's, it's a midwife or doctors job to explain why they might feel as though one is necessary, if the woman says they would like to decline then anything else is assault.

Oh and another point, sorry I meant to respond, yes the midwife should absolutely be paying attention to what the woman says but many many women want it to be a two way street and want advice and guidance from the midwife, ideally they should be working together to get the optimal outcome. (By optimal outcome I mean what the mother wants - I certainly don't believe that having a heathy baby is all a labouring woman should be concerned about, her thoughts, feelings and comfort are just as important).

So you believe that some HCP'S are lying and abusive, good because it sounded like you were defending abusers.

Um no. I said don't generalise by saying EVERY HCP are those things. Because that isn't true. I don't think I ever said that none of them were.

I would like to know what hospital you work in so my family can avoid any angry staff who try to pit others down and work along side staff they know abuse and lie to and about patients and do nothing to help patients.

'By optimal outcome I mean what the mother wants - I certainly don't believe that having a healthy baby is all a labouring woman should be concerned about, her thoughts, feelings and comfort are just as important'

That's interesting. I see that the Mother's thoughts, feelings and comfort and wants being absolutely critical to ensuring an optimal outcome for the baby and not a consideration outside or in addition to this.

I think the problem is that it only takes one bad mw to totally change your experience and views.

I had a bad mw with DD1. She was appalling in many ways. When the shift changed, I had a lovely mw, but by then things were going down a certain route and couldn't be stopped.

With DS, I had the most amazing, wonderful, respectful mw. She judged whether I was in established labour by very politely asking if she could place her hands on my bump and back during a contraction. Which I had no problem with at all (I am sure if I had, she would not have pushed). She said she could feel the force of the contractions and it was clear labour was established, regardless of any need to do timings. We went from there. Brilliant woman.

The midwives attending me for my last two births were amazing. In fact the one at my second birth said she learned a lot from me - and liked some of the decisions I made about the way I birthed and would recommend it to other women.

The one at my first was caring but a bit inexperienced and made some decisions that weren't very good in a maternity department that was broke, understaffed and full.

The caring, inexperienced midwife who cared for me in my first birth, shook whilst she told me that she never saw the SHO deliver my baby by fundal pressure and that it must have been the pethedine. No idea why she said that as my husband was there and saw it and never had any drugs.

Her notes say 'SHO arrived, baby's head born'. Like the baby suddenly just got scared when he turned up and decided to come out all by himself because the doctor turned up!

As a midwife, I want all women I look after to have the safest and best birth possible.
VEs are indicated to perform in some labours, but not all. For example, if a woman is requesting pain relief. Certain types of pain relief are appropriate at different stages of labour. Also, if there is concern about fetal wellbeing, a VE is necessary to determine the stage of labour and whether or not delivery is imminent.
You can have a strong urge to push before the cervix is fully dilated, depending on the position of the baby. Pushing on a cervix that isn't fully dilated can prolong labour.
Spending more time at home in early labour can result in less intervention. It can be really useful to perform a VE, especially on a first time mum to establish if she is in established labour. Hospital isn't necessarily the best place to be if it's still very early on in labour.
I would only ever perform a VE with the consent of the woman I'm looking after.
There are other ways of assessing the progression of labour, although I find most women want to know how many cms they are and when their baby will be born!

I was never in established labour with ds according to the contraction times. I guess that is because he was back to back. Random respite periods with max 20secs contractions.

I and my dc have complex multisystem conditions. These issues I can assure you are chronic across the NHS and private medicine. It is not the odd bad apple sadly , which you won't want to accept as it will scare you and put you in denial. There are lots of badluck behaved HCP'S out there with issues and many with poor memories and open to confusion and human error. About half of hcp's Fuck up in my experience. our particular family favourite is to watch the liars tell us they understand our rare condition then slip up.we all look at each other and smile then know this hcp is not to be trusted. If they admit they don't know we trust them as they are likely not to harm us and research before they harm us.

Joan you are deliberately or otherwise misunderstanding what I say and reading things into it that just aren't there. I'll step back from engaging with you.

Starlight...

'By optimal outcome I mean what the mother wants - I certainly don't believe that having a healthy baby is all a labouring woman should be concerned about, her thoughts, feelings and comfort are just as important'

That's interesting. I see that the Mother's thoughts, feelings and comfort and wants being absolutely critical to ensuring an optimal outcome for the baby and not a consideration outside or in addition to this.

Whilst I do agree with this and try to keep it central to my philosophy, how many times has it been said or heard 'well you've got a healthy baby, that's all that matters' so I see it as being entirely possible to get the healthy baby without taking anything else into account.

Should be clear that I'm not advocating this approach, it's just whilst I see it as integral, some others don't.

'There are other ways of assessing the progression of labour, although I find most women want to know how many cms they are and when their baby will be born!'

Then you need a crystal ball, not a measure of cm dilation which tells you nothing of progress, or pain levels, or whether labour is established, or how long labour will be.

There are reasons to look down that end on occasion, but those reasons are not routine, and pretty rare.

If a woman can 'NOT' push then the body isn't ready. Expulsion of baby shouldn't be forced unless an epidural is interfering with the woman's sensations.

Oh I see what you mean Seattle. Yes. I agree. I think some caregivers during labour focus on the baby and his/her health etc. with the mother's experience as a bit of a side-issue. Baby is wanted out rather than in, in order to be assessed and attended to and almost 'ticked off'.

This seems to be the culture surrounding induction, timed labours, prevention of pain relief in early labour or access to the pool.

My view was that I didn't care how long labour was. If I needed the pool to give me some respite and a chance to gather energy for later, and it slowed things down, so what? Provided baby was still happy why rush things?

It's fine if the midwife wanted to advise that the pool would slow things down. Equally it should be fine if there was nothing wrong with the baby, for me to decide that on balance the pool was needed.

Penguins but can it not cause harm to push before being fully dilated? And some women can get that urge very early on, can't they?

Mostly if women get a very early urge to push it is odd positioning. I am not saying that a mother and hcps should never decide to do one if something seems 'off '. I am saying there is no clinical need or benefit to do them routinely at the point a woman needs to push. For the vast majority of women, if you wait until the pushing takes her over then that is all you need to do (obviously not with epidurals etc)

In both my unmediated labours, when I was pushing, I was pushing. If someone had told me to leave a comfortable position and leave the mental zone to check I was ready to push then I am pretty sure some choice language would have resulted.

Penguins If a VE isn't performed how can you tell that a woman with the urge to push is fully dilated as opposed to an urge to push due to odd positioning?

You don't need to proactively check. There is no evidence that that produces better outcomes. You might decide to check because, for example, contractions have been erratic and short and suddenly there is a pushing urge (or, equally, you might prefer to watch and wait). For most women, if a mw has spent enough time with her, there is absolutely no clinical indication for a 'just checking' internal to check readiness to push. None.