Calling all midwives - Internal examinations during labour

[micegg]

I am due in April with DC2 and have started thinking about my birth plan. Last time I was in labour for about 10 hours so think I had 3 internal examinations. I understand that these are to assess progress but also gather they are normally carried out routinely in accordance with hospital protocol. I think this is about 4 hourly? I just wondered what you would think of someone refusing these routine examinations and if there could be any implications. To my mind they just tell me whether things have progressed but unless the baby is distressed does it matter if we have this information? The baby will just turn up when they are ready with or without knowing how dilated I am. Surely it will pretty obvious when I am fully dilated. I just want to cut down on any examinations I may not need. Does anyone know where the idea came from to crry out these examinations so routinely. Is there really any advantage? If the baby is in distress I can see the point but in a normal labour I just question it.

Thanks

I am having my baby in a maternity unit, and have been told they dont do internal examinations, and that there are other ways of determining how I am progressing without doing that. So I would assume from that, that internals aren't always necessary. I was also led to understand that they have to ask your permission before doing one anyway, so you could refuse if you wanted to.

Not a MW but have included in my birth plan that I only want an internal exams if there is a specific medical reason, not just routinely. Talked it over with my MW and NCT teacher and they both agreed that would be fine.

I had countless internals with DS2 (despite putting on my birth plan why I would have genuine problems with them ) , but with DS3 I had one when I got to the hospital (at my request as I'd never actually gone into labour on my own I didn't really believe that it was "it") - and I was just under 3cm......I didn't have another one.

makingnosense - thats interesting. Goes to show they are not actually necessary. They did ask me but when you are on the throes of labour and its your first you are not always in the right frame of mind to weigh everything up. I like the idea of specifying to only have the exam if medically necessary rather than routine. It seems odd to me that they are carried out routinely. Must be some reason for that.

Had both my boys at home so not sure about hospital protocol. But I was examined once with DS2 at my request - we didn't want to slow labour bay getting into the birthpool too soon. doesn't mean much though as I was 5 cm's and baby was high up and facing the wrong way - after 1 hour in the pool, he had turned round and come out! If we went by the book that suggests 1cm per hour I wasn't anywhere near giving birth at 5cm's!

A phrase our Birthlight teacher drummed into us was "what would happen if we Don't do that" she wanted us to feel able to say no to stuff that was un necessary during labour.

JingleyJen- exactly.I was too scared about the whole thing last time and went for the head in the sand option. This time I want a birth plan and want to question everything. I enjoyed my last birth experience but it was very medicalised - epdiural, catheter (hated that), internal monitoring, drips, etc. If thats what happens again the so be it but I want to understand why this time.

Message withdrawn

I don't really mind them. I find it a relief when I've been in labor and them come and say "Oh you're 7 centimeters". It gives me that sense of making progress. I think I like knowing that the end is near.

You are absolutely right to question routine VEs and you are perfectly entitled to refuse them (and anything else they care to 'offer' you, for that matter). They must have your consent before doing one. I would not think twice if a woman in labour said she didn't want VEs - there are plenty of other ways to tell how far along you are. I'd find it quite refreshing not to do them, tbh!

The 4-hourly thing is pure hospital routine, nothing else, and there's no reason why it should be that way. It's all about 'getting you delivered' within a certain timeframe and it drives me nuts, tbh. I often think VEs are for the benefit of the hospital staff, not for the woman. Frequent VEs are also an infection risk, even if done wearing sterile gloves.

If a woman wants a VE, that's fine. They can also be useful in getting a 'baseline' - for want of a better word! - at the start of labour or before certain procedures (i.e. giving pethidine) but 'by-the-clock' VEs are totally unnecessary and invasive, imo.

Write a birth plan and don't be afraid to put in big capital letters that you do NOT want routine VEs. It's a perfectly reasonable request, but unfortunately mws/docs do them so routinely they sometimes forget that there are other ways!

IME they are done more to pick up if you're not progressing (ie dilating) than if you are without necessarily having to wait until bub or mum are in real distress. I never had any problem with them even though I found them quite painful it was comforting to know I was progressing and that all the pain was achieving something. Not sure what a 'non-medical' reason for doing them would be , it may be hospital routine but there's still a medical reason for doing it as opposed to being for fun.
If you don't want one you can refuse, I chose to trust my mws

On the othe rhand i had no internals when i went in too hospital to have dd as midwife said she could tell by looking at me that i wasn't too far along
It was a good job someone popped into my room to deliver my lunch as she went to get someone to check me at which point my waters broke whilst i was still wearing my own clothes and i had to hobble down to labour ward to give bith 15 min later and missed my water birth
Think i may have preferred at least one internal to check hence home birth booked for this one due next Sat!

As a midwife I would be happy to avoid internals if there were signs of progress and no complications or problems. In fact I frequently suggest to women that they don't have them as soon as they arrive although a lot of women want to know how they are getting on. Of course in someone having a second baby if you leave it two hours there is a good chance that they will deliver in that time. In my trust I think that the policy is to do one within two hours of admission and then four hourly after that. In my experience community midwives are much happier to watch and wait, whether at home or in a community unit. I personally did not have one with either of my two, first one I arrived two hours before delivering, told mw that she could do one if she wanted but she was happy to wait, second baby at home same mw again happy to wait as all progressed well.