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

It can also be actively detrimental if a woman is found to be 10cm and told to push when she has no urge to do so. That happens a lot more commonly than people realise. It is sometimes referred to by natural birth types as the 'rest and be thankful' phase (i.e. a little break for your body before the hard work of pushing begins).

Penguins basically what I am trying to get at is would you know without doing a VE that a woman is fully dilated and ready to push or not fully dilated although feels ready to push? And if so by what factors would make you know the difference between the 2?

I think you are missing the point of my answer. It is a complication which normally happens with accompanying warning signs (many and diverse signs. Not the sort of thing I can do a quick bullet point of ). A mw who has spent enough time with a woman should be able to have observed enough to suggest that, this time, a VE might be an idea. Or if there are no signs then that can be managed when the issue becomes apparent. There is no clinical justification for internals to check readiness to push as routine, except poor care up to that point. It is an obsession with data points instead of spending time with the labouring woman.

The point is, when the baby is coming the urge to push cannot be fought against. Baby is coming out even if you fell into a coma. The MW has no ability to stop it.

As long as you wait for that you will be birthing a baby. A midwife telling you you can't will have no effect.

Starlight was it you who said you had the urge to push early on? did you go ahead and push then?

Ds born in hospital - I was very aware that I could refuse but was bullied and terrified into doing everything they said. Ended in v traumatic c section.

Dd - had a truely fab independent midwife who said she didn't need to touch me at all, and didn't. Lovely home vbac with superb, expert care.

The uncontrollable urge comes if you wait for it. That is probably one of the most important reasons for NOT having a VE imo. Being told you are 10cm and therefore that you ought to start pushing means ignoring your body which is telling you nothing of the sort.

Yes, I felt the urge to push at 2cm. I was screaming the place down too. I have never experienced anything so painful in my life and was denied pain relief because due to VE I was diagnosed as not being in established labour. I was told to shut up and that things would get worse so I need to conserve my energy and save the painkillers until then.

It remained traumatic for a couple of hours until the baby found a better position and the pain eased and never returned to original level even at transition. Though I have had two babies since I still suffer with PTSD from that first and the midwives should have listened to me, not a 'measurement'.

The second thing that happened was they declared me ready to push at 10cm and made me push with very little urge. I was exhausted from all the screaming at beginning and needed to rest. I had no energy to push and no urge. I also think the baby was still not at quite the optimal position. Because it was taking so long they manhandled me onto the bed though I was asking to squat. It was refused with the midwife claiming 'You might tear!'.

So you see, neither times were VE helpful to me and my baby and I would say actually damaging. My baby was born grey and floppy *though midwife noted apgar as 9) and rasping breath, with a swollen head and swollen haemorrhaged eye lids.

He was diagnosed at 2.3 with ASD and later an expressive language disorder.

From what I understand, the position that you're labouring in can make a difference to the pushing urge. If you're lying on your back then there won't be the same pressure on your pelvic floor, so you might feel 'a bit pushy', and maybe want to be checked to make sure you're ok to do so, but that should be for the woman to ask IMHO not the midwife to suggest. If you're in a pool, or on all fours etc, then you may be able to get into the optimum position for your baby heading down through the pelvis and trigger the spontaneous pushing mechanism.
It certainly doesn't happen for everyone, and it wasn't even mentioned in our birthing classes, I googled it when I got home! At no point did I myself actually push, it was my body that did it for me - it was beyond my control, so I couldn't have stopped! The only thing I can compare it to is that feeling when you know you're going to be sick, and your stomach HEAVES? It was just like that. Like my uterus was heaving out the baby!
So essentially, if you're having that experience then VEs are neither here nor there - you're pushing whether or not you've been given 'permission' to do so.

I think it is a bit like pooing. You can strain and push it out, but there comes a point when it's just gonna come with no straining.

I was actively trying to hold dd in because we were almost at midnight and if she was born after it she would have had a cool numerical birthday . Also I was a bit confused because though it hurt I hadn't yet reached 2cm in my mind as we were nowhere near the pain level at that stage of my first so I thought I was gonna be shredded if she came out. It might have helped my confidence at that point if I knew I was 10cm rather than 1, but tbh it didn't really matter because brain had nowt to do with anything at that point.

Ha! Did you make it past midnight?

I didn't think about it actually, but DS was born at 00:12 and has a much better birthdate than the day before!

Starlight With your 2nd and 3rd births did you wait until it was uncontrollable to push? Did you get the urge to push before it was uncontrollable but wait it out until you didn't have to actively push iyswim?

basically what I am trying to get at is would you know without doing a VE that a woman is fully dilated and ready to push or not fully dilated although feels ready to push? And if so by what factors would make you know the difference between the 2?

Nappyaddict I think I can sort of answer this question for you. When it is time there are a number of other physiological changes that happen that can be observed, rather than felt for:

Changes to the Rhombus of Michalis

Anal pouting

The 'zone' - it's common to be in the 'zone' as labour happens, and once you reach transition this can stop. Transition is actually a brief period of respite before the pushing phase begins, and so sometimes the woman can seem to come out of a bit of a trance, ask for water / food, as a natural urge to prepare her body for the next bit. This is a good sign she's at 10cm, and if the urge to push comes after this then you can be relatively sure any cervical lip has gone.

All of these rely on the midwife having spent some time with this woman, and of course the woman having an active labour, in that it's easier to tell these things if she's not lying down on her back on a bed.

These signs aren't necessarily foolproof, but neither is a VE, as others have demonstrated from their stories a VE is only a snapshot of the cervix at a given time, and can change quickly.

Hope this helps.

Yes Nappy With both babies I waited. With dd I was waiting for midnight which I didn't achieve. I had the period of time during transition as described in the last post where I asked for a cup of tea with sugar which was made for me. DD didn't wait long enough, but I was able to drink a hot cuppa in the pool immediately after she was born.

With ds2 I had learned how effective waiting was but also how pleasant the sensation of waiting not to mention the piece of cake of the actual second stage when you don't push, so I just tried to relax. With him I did feel a bit pushy before he was ready because I had the thickest water sack ever and though the head wasn't on the cervix the waters were pushing. It just made me involuntarily grunt at the end of each contraction.

Also, as a woman, if you are completely undisturbed and truly listening to your body, you can kind of feel the baby drop down, like a lighting streak shooting up your spine, just before transition.

If a woman is expecting this, able to understand and interpret this then she could signal to the midwife or even tell her is able to speak (I was with both my last two as had no drugs at all and was a proper chatterbox throughout).

Starlight was it difficult or uncomfortable ignoring the urge to push and waiting for your body to push the baby out for you? I didn't get the urge to push until his head was basically coming out. I am interested in this waiting approach. So in that situation if the head is right there and the midwife can see it if you have the urge should you push or should you ignore it and wait?

I think I felt that drop down that you mention. I called for the midwife and said I think I need to push. She didn't believe me and got a bed pan thinking I needed a poo. Then exclaimed "oh I can see a head!!!

I was 2cm at about 2am so presumably they would have done another VE at 6am. DS was born around 5ish so I didn't have another one. I did actively push when I got that urge but he was out in a couple of pushes.

It never was uncomfortable not pushing when you had some urge. If anything it felt good as relaxing into it seemed to make it build up all the more stronger until it couldn't be stopped and then it happened without effort and fast.

I was annoyed with the midwife who wanted me to cough after the head was out to try and get the body out. It had only been out literally seconds and I wanted to wait for my body to build for the next, not do it artificially.

I was happy enough to cough the placenta out when asked though as it was still attached to the baby and annoying me being inside.

Starlight thanks for explaining so patiently

I think I have finally got it.

First women get the urge to push (they may or may not be fully dilated here), then they get a bit pushy, grunty, throaty (again they may or may not be fully dilated here), then if they ignore those things and wait it out the body will start pushing baby out involuntarily. This is when a woman is definitely fully dilated.

please correct me if I have got any of that a bit wrong

I don't think that is wrong nappy but birthing doesn't exist outside the environmental context. So I think what you write is more likely to happen in a undisturbed birth, - but very few are undisturbed.

Many include drugs, some are complicated by other health considerations and consequential essential monitoring, VE's can imo set the woman back for hours or interfere with her concentration and tuning-in resulting as either her no longer being able to cope when she could, or just stalling the labour whilst the hormones change from those conducive to those against the birthing process.

Try pooing in a room full of people with someone stopping you every 40seconds to check your nethers!? :). You might manage it if you could turn away from them and refuse their touching provided you could zone out and forget them, but not if you're 'brought round' frequently.

starlight is it ok to push during transition or would you not be fully dilated at that point?

what signs are there that transition is over?

It's probably okay nappy but I tend to think that the body knows what it is doing, and waiting is what gets the optimal outcome i.e. you've had a rest and given your body the chance it needs to get the right hormones into the right places so that the effort is minimal.

After my 1st I couldn't walk upstairs for 6 months without feeling out of breath, after my 2nd two I felt as if I could run a marathon just a few hours later.

midwifethinking.com/2011/01/22/the-anterior-cervical-lip-how-to-ruin-a-perfectly-good-birth/ This article is interesting. It talks about how pushing on an anterior lip is not necessarily a bad thing.