Do I have a say in whether the midwife checks how far I’m dilated?

[LibbyAshleigh]

So, I know how they check the dilation of the cervix when a woman is in labour. And I am in no way comfortable with that, I can’t express how much I don’t want them to do that when I go into labour. I’ve been told ‘oh you won’t care when you’re actually going through it’ but I 100% know I’ll very much care. I read that it’s a routine thing to check but it isn’t mandatory, but I was wondering if anyone else has had an experience with this? Has anyone else felt the same way?

OK, I'm feeling a bit dumb here. Have had three babies, none of them c-sections. But until reading this post, I would have sworn that checking dilation isn't an internal exam. I thought they just look at you down there and make a visual assessment. The point being that, with so much else going on - a LOT of other things I remember in GRAPHIC detail - checking dilation was just slightly encouraging/depressing news on how everything was progressing. During a day of heightened emotions, OP, you may find it hardly hits your radar. But of course, if you make an informed decision not to have one, that's perfectly within your rights. Really good luck, whatever you decide!

OP you don't need to say on this thread ofc, but if it is about past trauma, here are some things that might help -

• You don't 'need' or 'have to' do anything. Ever. There is always another choice, even if that is a very very unpalatable one. Thinking that way may help you feel you are more in control, so 'I am choosing to have an induction based on medical advice' rather than 'they told me I had to have x'

• For internals, if you do have them, read up about how abuse survivors can handle them. I personally insisted on the room being clear of everyone but a female MW and I lay on my side, not my back. I also delivered one of my babies this way. It made me feel less exposed and vulnerable.

• There are other ways to check on progression of labour as well as dilation. More experienced MWs and homebirth MWs will tend to know about these. You may wish to consider asking if you can be assigned a more experienced MW and depending your medical situation, you could consider a homebirth too.

• There may be consequences to refusing a VE. But, there may also be consequences to having one that turns out to be unnecessary. For example, do you think it would significantly compromise your mental health, bring back past trauma? Don't answer that here, but if you think it might, ask to be referred to your perinatal MH team locally.

Good luck and ignore the more judgemental posts here. You have the right to bodily autonomy and no one else can take that from you.

and have read up all about how to have the perfect birth

you mean when they didn't die and neither did their baby?

read up all about how to have the perfect birth

Yeah. Or maybe just women who have birthed multiple babies fairly recently and are sharing their experience. Do you realise you may be sneering at someone who has survived rape or childhood sexual abuse?

“Oh I do love all these people who know so much better than the medical professionals, and have read up all about how to have the perfect birth.

Honestly - when you have a baby, you get it out any which way you can - as long as it comes out in one piece and alive. Believe me, I had the perfect birth plan - no drugs, in the pool, la la la. By the end I actually remember saying - I don’t care if it comes out of my fucking ear - just get it out ”

So you consented to the medical interventions that were offered? That’s as it should be.

I refused an exam when I went in the first time. Due to waters having gone. They were a bit surprised but didn't pressure me.

When I went in the second time 8h later I just knew I had to consent to the exam for them to believe I was in full blown labour. As a ftm I could see on the MW face she didn't believe me. Turns out I was 8cm and got straight in the pool and on the gas and air. Her face was a picture.

I think you need to go in with an open mind to every possibility. They won't do an internal more then needed but sometimes it's what's needed and it's better to be safe and make sure baby and are you are ok.
I didn't enjoy my internals but I'd rather they know exactly what's going on so they could treat me accordingly.
X

Hmm I don’t think it’s about being “open minded” so much as being fully aware of the risks associated with not having a vaginal examination under the particular circumstances at the time (there may be no risks if eg in early labour) and what alternatives may be available to give HCPs the information they are seeking. This is what being fully informed is about. It’s ok to be sure about not wanting an internal examination, and making sure you have clear and impartial information (so no guilt trips) about what your decision means is sensible.

I didn't have any with either child but they were both normal labours & straightforward. There are other ways of observing how far labour has progressed, and you can express a preference now and play it by ear on the day.

Absolutely your choice you do not need to have an internal. And if your are advised to have one I would have your birthing partner be ready to question the necessity for one if you are unable to ask yourself. It is 100% imperative you are asked for consent before they perform any checks or procedures. Failure to do so as another person has stated is assault and if we are going to go for the correct legislative offence sexual assault by penetration. Regardless of their professional standing they cannot stick anything including their fingers into your vagina without your say so. Unfortunately there may be circumstances were it really is a necessity but always ensure you or your birth partner are given all information to enable you to make an informed decision.

There are risks to having an examination as well! Accidental rupture of membranes, and introduction of infection being two of them.

I have only had to actively refuse examinations twice. The first time was to insert a pessary for an induction/medical management in 2nd tri. I desperately didn’t want to be there and I certainly didn’t want to be messed with. There was no risk, so I did it myself. The second time the midwives wanted to examine me (after my waters had broken, but before I went into labour) so they could manage their shift pattern. I wasn’t prepared to be put on the clock and make infection, induction more likely for staffing reasons.

I didn't have any with dc1. I had a home birth and just said I didn't want any and to stop asking me, so they did. Dc2 was born before midwife arrived so none then either.

My dm is a midwife and she said she only does them when she's concerned or is asked how far along the patient is by the patient. She doesn't think they are necessary for most women and thinks it can also slow down labour.

You could look into the purple line method of monitoring dilation? They just need to see your lower back and your bum but no touching required.

I absolutely hated it having this done, it was close to the edge of as much pain as I could endure (and I've given birth to two large babies with only gas and air). My body hates being on my back when I am labouring, I like to move around, stand, rock, and lean forward, and they got me to lie motionless on my back each time. It made me tense up and broke my flow and also affected my trusting relationship with the midwife. I don't actually know the reason they do it other than 'to monitor how dilated you are' - I don't have enough knowledge to understand whether that's a necessary thing or not. If I went through it again I would ask a lot of questions about why it was necessary, when it was necessary, and if there are alternatives or at least alternative positions I could be in while they did it.

Good luck OP.

@LibbyAshleigh please ignore all the judgemental comments on this thread - there are a lot of posters on MN who are incapable of understanding that not everyone's world view is the same as theirs. Agree with a PP to read the Milli Hill book. Also (if you can afford to) look into getting a doula.

I absolutely did not want any VEs (I also decline cervical screening - discussions on that cause similar sanctimonious comments regarding how could someone not... mostly from people who haven't understood risk factor stats). I had a meeting with the head of Midwifery regarding birth plans and she was absolutely fine with putting that i wanted minimal intervention all over my notes - again as others have said, there are lots of ways for them to assess externally the progression of labour. In the event, I had a C-section last week, two and a bit weeks after pre-term premature rupture of membranes (complicated by breech presentation - which meant i couldn't be induced even if i would have consented to induction - i wouldn't have!). i had to stand my ground not to be examined regarding the leaking fluids too. They admitted me for observation and diagnosed by inspection of pads, so again, VE was not necessary, just convenient to them - and some HCPs made that obvious in their attitudes (including one registrar who tried to get my DH to do his dirty work for him - my DH was clear and reiterated that I know my own mind.)

Good luck OP - feel free to DM me if you like.

Haven't RTFT but I'm a midwife, and really I just popped on to say - of course you don't have to have vaginal examinations. Any midwife worth her salt will have other tricks and tools up her sleeve to help her assess how far dilated you are. Dilation of the cervix is actually only one small part of what a midwife considers when assessing labour progress. It's YOUR body OP, you have complete autonomy and call the shots. If you don't want anyone putting their fingers inside you then it's absolutely okay to say so. I would suggest you contact an independent midwife local to you and ask if they can come and do some birth planning with you to help you be aware of your rights and identify what matters to you in your labour and birth.

I was really worried about this too. I did hypnobirthing and they reassured me you don’t need to agree to this. As PP said, it will be harder for the MW to gauge how far along you are, but this is your choice.

In labour the midwives were also really supportive of this and didn’t even ask me as I had written in my birth plan not to.

As it happens as time went on I actually wanted to know, so they did some VEs and it was absolutely fine.

“ As it happens as time went on I actually wanted to know”

This happened to me - I didn’t arrive at the hospital until fully dilated but they believed I was still in early labour and I believed them (not having any experience to go on) but I was having such strong contractions that when I was eventually seen I asked them to check. In retrospect I think it should have been obvious that I was in transition when I arrived, and a midwife who had seen me on my way to the maternity ward saw me the following day and said that she had thought to herself “there’s a woman who’s going to give birth very soon”

There are loads of things you get told while pregnant that won't be true for you. Off the top of my head, some of mine were:

You'll be screaming for an epidural

You won't care if a bus load of tourists come in

Dignity goes out of the window

You always need stitches

You forget it instantly

The baby will distract you from being checked for tears

You always poo

You'll be convinced you won't have another

None of those happened.

None of those happened for me, either. I have a habit of keeping my babies in until I’m comfortable. I have spent transition setting my stage before now - arranging the room, lighting and personnel to how I wanted them to be, explaining what I wanted and needed in terms of positioning, privacy and who was to be allowed to see what. Once everything is how I like it and I felt safe, out shot the babies. I think the idea of being out of control is massively damaging. We give more dignity, privacy and choices to cats and dogs having their kittens and puppies than we do humans.

I was the same, not for reasons of trauma but because I felt I didn't want any unnecessary interference that could make me more uncomfortable and slow down labour. I put on my birth plan that I didn't want routine ones but if there was an actual concern then I would be open to the discussion. As it happened I had to ask them to do it, they were reluctant as they didn't think I was far along, and wanted me to go home - half an hour drive away. I was 9cm 🙄

Definitely read the positive birth book, it's excellent. It's not about 'the perfect birth' it's about knowing your options, how to stay calm when things aren't going to plan and so on. A lot of people seem to think that birth shouldn't take into account the woman actually delivering.

None of those were true for me either GummyGoddess.

“ As it happened I had to ask them to do it, they were reluctant as they didn't think I was far along, and wanted me to go home - half an hour drive away. I was 9cm”

This is almost exactly what happened to me

I despise those attitudes- ‘Oh you won’t care if 50 strangers come into the room at that point!’ ‘You leave your dignity at the door’ ‘You just have to put yourself in their hands, they know better than you and they always know what’s best. They will only do things that are essential for a healthy mum/baby’

It all just builds women up to be completely submissive, question nothing and accept being treated with no respect for her privacy or dignity.

It also suggests that the medical staff have no obligation to ensure dignity, privacy and informed consent if the woman has reached a state of “don’t care”, which absolutely is not the case - it’s still not a green light for them to do whatever they want to you. I had to move rooms at one point and would happily have wandered down the corridor naked if it got me there faster but the midwife held a sheet around me because it was the right thing to do.

Yeah you get a choice, and yes it's annoying being checked regularly but it's for the health of your baby.
If something went wrong and they didn't check...who would you be blaming?
I did get a bit annoyed with the regular checks during my final hour (of 3) where I was purely pushing...but I knew why they were doing it and wanted to know my baby was ok and not in any distress etc