Vaginal examinations

[Jurassiclover]

Hey guys,

Just wondering if anyone here declined vaginal examinations in labour? If so how did you get them to admit you in early labour? I know they often want you to be 4cm before they'll admit you, but what happens if you're not wanting to be examined and therefore wouldn't know how many CM you were?

Thanks guys!

I got them to strap an ambulatory monitor on me to monitor the strength of contractions after 2 hours as a compromise and had it written in my notes that I would only wish to be asked re internal examination if medically essential (which the "active labour" thing isn't at all) or at my request. Just be firm and make sure your birth partner is an assertive person who will say "she said no do not ask her again".

I'll keep that in mind thank you! That's part of my worry, as DP isn't the most assertive person, hopefully he will advocate for me I the moment but I'll definitely have to work on being firm myself I think, its my 1st so I'm feeling a bit vulnerable with it all!

To be honest what I learned from loads of research is that having an assertive birth partner can make the difference between you looking back and feeling like you had the most control as possible over the choices available to you in the moment and being "done to" by professionals. And the feeling of not being in control of your labour choices is one of strongest predictors for trauma and post natal depression. You may not be able to think straight or verbally communicate by the time you reach transition. So talk to your midwife about your preferences and get your partner reading up about his responsibilities to you in labour! It's time for him to step up!

I had a really bad experience with an examination in my first so asked for none in my second. They were fine, they monitor contraction strength with a thing on your arm.

They knew baby was coming just the same!

I didn't want anyone near my cervix either. Not even my independent midwife.

The problem with that was, when I called her to my home, twice, she didn't actually believe that I was in labour. I was meditating and taking the pain very well and didn't let her check. So she left.

Before leaving she completely gaslighted me and even wrapped me in duvets and hot water bottles to "give my uterus a break". Because apparently it was all prodromal. I told her so many times I take pain well and was just dismissed.

She convinced my husband it wasn't happening. I lost the faith of my birth partner. My contractions were manipulated and depressed by the pressure and heat placed on my uterus. She told me to sleep. I was actually in active labour.

After several hours of having my confidence shattered into tiny pieces whilst I lay in this hot cocoon I angrily told her to come back and check. She was still talking about giving me herbs to put me in "true labour". She examined me then acted like she'd had an electric shock. I was beyond 9cm and my contractions were more than 20 minutes apart - because she was so convinced she was right. Because my uterus had been forced to "break" rather than allow my labour to naturally progress as it should have. The bond between me and my husband was shattered because he also didn't listen to me. It was a crap way to begin parenthood together.

I ended up having a 37 hour traumatic labour with hospital transfer. I was so exhausted with pushing between >20 minute contractions, long labour, I was hallucinating. Only narrowly missed episiotomy. The ob was fighting the midwives to get to me but thank god they stood firm.

I refused cervical checks because I'm a survivor of sexual abuse. But it really is the lesser evil just to get it done.

@Flittingaboutagain yeah I'm definitely going to get him to do some research on his role as I can imagine a supportive birth partner is a must! Thank you for your advice!

@Granohlaa oh that's reassuring! I'm hoping the hospital will be fine with it as I'm sure many other women request no examinations so hopefully my experience is the same!

@littleredberries I'm so sorry you had such a horrible experience, that sounds so tough! I am worried in case I end up with a midwife who won't take no for an answer, hoping since I'll be in a hospital setting I can always ask for someone else if I don't get on with the person caring for me or ask for second opinions if I feel I need it, hopefully it won't come to that though!

No problem. I'm sat here with my newborn baby girl and can honestly say although I didn't get the home birth I wanted as she was a prem surprise, all the prep around these and other potential choices meant I had a really positive experience overall.

I only had 1 vaginal examination in labour with my first. I was progressing fast and had a history of bleeds from my cervix so they didn't want to / need to do more.

With my second they didn't do any as the midwife said they are pointless for non first births.

My advice would be to state why you don't want them done rather than just 'don't want'.

Allow them to check you in other ways and communicate how your contractions are feeling.

Think about a level you're comfortable with. Would you agree to one when you arrive and then no more for example?

I declined internal exams in my 2nd and 3rd labours, both hospital births. They didn't measure the strength of contractions, my second was a very fast labour and it was obvious I was in active labour when I turned up with very close intense contractions. I had a tens machine which helped me to measure the gap between them as well as being fantastic for pain relief for quite a good part of it. With my third, it was very stop start but I was still able to avoid any internal exams. I think they treated me with more respect as someone who knew what she was doing. I didn't get that the first time, it shocked me that you can be talked to like you're a child in a labour ward! We had a doula for both 2nd and 3rd births and I think her presence made a big difference to how staff were with us. It makes them more accountable I think. I know it's not affordable for everyone, though if you find a doula in training that you get on well with, they usually have lower fees. For us it was totally worth it and worth saving money on some other baby stuff to be able to afford it. I do think avoiding internal exams was crucial in having a better experience and being able to stay focused on your birth, not just worrying about how many cm dilated you are. It made me feel more in control of my body and I think that's so important in having a positive birth.

Also depending on the hospital it may be quite unusual to refuse examinations, especially if it's your first baby. I think it's good to be really clear at the beginning and to be prepared for some initial resistance, as they may try and explain to you why you must be examined. In my first labour it wasn't even explained to me that it was a choice, they said, 'I'm just going to examine you now, OK?' But they didn't say it isn't essential, it just makes it easier for us to judge how things are going.

I really hope your experience will be better and you're more prepared than I was in having thought of it, but I do think it's good to be ready with a clear line that you don't consent to internal exams and knowing that they can work around it, whatever they might say.

@Flittingaboutagain sorry to hear she was prem! Very glad you still had a positive experience though, that's definitely reassuring knowing you still got a positive experience despite things being different!

@Twizbe that's some really good advice thank you! I think I may possibly manage one on arrival if they're very persistent it needs done, so that's definitely an alternative to think maybe we could just have the one then no more, I hadn't considered that, thank you!

@Superwomble I do fear I'll be taken less seriously with it being my first! But I'm hoping if I'm assertive now and lay it out from the start I'll be okay! I definitely agree in that I think I'd have a better labour not worrying about how many CM I am, or if I've "progressed enough" by their standards! I'm expecting some resistance but hoping if I explain its a firm boundary then that'll set me up well! Thank you for the advice!

After a hideous, on my back, monitor belts and examinations every 30 mins (or so it felt) birth with DS1 I made it absolutely clear with DS2 that I wanted a water birth, no belt monitoring and no examinations after the first one. I arrived at hospital and was already 8cm, stripped off, got in the pool and remained totally submerged the whole time so nobody could touch me again. I gave birth about an hour later and it was completely blissful and lovely. I'd never actually said about this but I also didn't get the thigh injection and the midwife let me hold my new baby until the cord stopped pulsing and I'd passed the placenta before she cut the cord. (Not sure on the accuracy of those details as I was staring at abs kissing DS2'the whole time and have never really researched what happened since but it was something like that).

I declined them with my second, I had put it in my birth plan and mentioned to the community midwife in advance. I got a phone call from the chief midwife who wanted to check my reasons for declining and explained that there would be certain circumstances where they would highly recommend an examination. In the end the birth was straightforward and no one mentioned having a vaginal examination. I had a home birth though and didn't ask for any pain relief until I was pushing.

The evidence for checking how dilated you are to see if you're in active labour (and how it is progressing as a routine procedure) is actually pretty crap. You can be 2cm and then quickly move to ready to push or be 4cm and stuck there for hours and hours etc so there are better more holistic approaches. It's just an old school method they like!

@Yrevocsid that sounds like such a lovely birth! I'm hoping I can use the pool then just refuse to get out and avoid examinations that way if needed!

@55378OO8 I'm speaking with the consultant today so I'll be sure to make sure it's recorded somewhere, hopefully I have no issues!

@5475878237NC yeah thats part of the reason I want to decline them! I've done plenty of research so I can argue my point if needed, hopefully I don't need to though

@5475878237NC

The evidence for checking how dilated you are to see if you're in active labour (and how it is progressing as a routine procedure) is actually pretty crap. You can be 2cm and then quickly move to ready to push or be 4cm and stuck there for hours and hours etc so there are better more holistic approaches. It's just an old school method they like!

This is basically what my midwife said with my second.

I think with my first it was needed due to bleeding and already known issues with the cervix, but I was ok with that

Good luck @Jurassiclover. I explained my reasons to the midwife and she said it was fine and seemed to agree with me! I also had a water birth which is great if you want your own space.

I had 3 total examinations during my birth with DC, the midwife said they only usually check once every 4 hours and not before. However I had requested the 3rd examination early as I was not coping with the pain and she was hesitant but checked and I was 9cm which actually reassured me to know the pain was near the end and justified. It was reassuring, it's not all bad being checked I just wanted to clarify that because there is a lot of scare mongering on mumsnet about this. During labour I never felt the checks but I was sought consent each time.

I wouldn't necessarily recommend this but my approach was to put off going into hospital as long as possible 😆 I was timing my contractions with an app which was saying "active labour" for a good 2 hours before we headed to hospital. When I arrived i luckily saw a smart & experienced midwife took one look at me and said "do you feel like you need to push?" and got me into a room. I did then consent to an exam about 2 hrs later cos my second stage was really long & slow and she wanted to make sure I wasn't pushing without being fully dilated. I point blank refused to get out of the pool though so she had to lean into the water and check me with one hand while I squatted in the pool.

I wrote a birth preferences document beforehand, it was only half a page and the second line was something like I do not consent to vaginal exams unless absolutely medically necessary

I didn't plan to decline them but I didn't want them in labour because I just didn't want the extra discomfort. The midwife let me get on with it (checked baby's heartrate with a doppler) - helped that it was a quick labour and they were having a quiet night so there wasn't any need to triage people.

They're gonna have to go there at some point, I don't see why it's such an issue? I liked knowing exactly where I was in terms of dialation and meant they weren't suddenly running around because they too knew where I was at.

@Mommabear20

They're gonna have to go there at some point, I don't see why it's such an issue? I liked knowing exactly where I was in terms of dialation and meant they weren't suddenly running around because they too knew where I was at.

Well no, they don’t really do they? I mean they catch the baby at the end. It is up to you whether you want to be practically fisted by a midwife checking your cervix

@HPmagic it's good to know you didn't find them too bad! It's not even necessarily the pain/discomfort that puts me off (although that's definitely part of it)

@goodnightsugarpop I'll probably stay home as long as I can (although thats the plan, we'll see haha!) I'll definitely be sure to write something like that in my plan!

@Twixxed ah thats reassuring that they were okay with it!

@Mommabear20 vaginal examinations are not compulsory, they don't have to go there at all

I understand and respect women's choices to accept/decline examinations, some feel it's a more positive experience knowing how they're doing but I had planned to decline all vaginal examinations to monitor progress because I personally felt I should be left to labour at my own pace without them trying to add pressure when not progressing at a rate they would like and they were totally ok with this and said they'd use their years of knowledge and experience to judge how things were going.... however, things changed and my baby was in distress with a low heart rate so I agreed to examinations as they were considering a c section if I was no where near delivering. I was happy this was still my decision and it was the right decision for me and my baby at the time, they didn't force it and explained the reasons for wanting to do it (not for just monitoring). The only negative I had was when the doctor examined me again WHILE I WAS PUSHING because he was concerned what position baby was in and it was absolute agony. I asked him to stop several times but I was ignored and he continued. When the midwife needed to examine me before this I had asked her to stop during a contraction but she needed to feel if the head was coming down while it was happening. She stopped to discuss this and explain the reasons and yes it still hurt but it was done with my consent. Had there been any more examinations after that I would have flat out refused! In future I plan to decline again (unless there is a clinical need) but will ensure I ask questions first and make it clear if I say stop you stop or I'm going to kick you in the face!!

They never went up there at all for me. One of the most common "we just need to..." unnecessary interventions done because it's "routine".