Internal Examinations

[ItsAllGoingToBeFine]

This will be my first and due to various issues I think I am likely to find the whole state of undress thing fairly traumatic. The last thing I want is to have a midwife giving me internal exams as well. (I find smear tests painful, invasive and humiliating)

Are they necessary? As far as I was aware labour takes as long as it takes, therefore degree of dilation is more for interest?

And surely if the baby is in distress it'll be picked up by heartbeat monitor, and is not related to dilation?

If I were to refuse routine internal exams what are the implications? Under what medical conditions might they be definitely required?

I only had 1 VE with both of my DD's - it was done when I first arrived at the hospital and they asked my permission first. I found that I actually wanted to know how far along I was. You don't have to let them do anything you don't want to though. Maybe explain your fears regarding VE to the midwives when you arrive and see what they say.

So after watching One Born Every Minute last night, can someone please confirm for me - when they check how dilated you are, do they just use a couple of fingers (like Joy thought they would, and I thought they would!) or do they indeed get quite a lot of their hand in which is what Joy's husband said they did

Itsallgoingtobefine
Well done for bringing this up now.
I think I know what you are going through, you sound like me!
You need to have a very supportive birth partner who knows exactly what you will and will not tolerate and to be your strong voice for you. Get that into your head and coach them because you will need that during labour.

For me I also did NOT want any males in the room due to other issues.
Why don't people just take what we say straightaway on face value. i.e. I don't want want any males in the room = Oh they're alright they've seen it all before!
Well NO, I DON'T WANT ANY MALES IN THE ROOM!It's not them that's the issue it's me and keeping me in a calm state during labour.
It was my problem but why do I have to explain why to every single person in the world. Just listen to my request.

I understand completely and can only reiterate. Get someone on board and coach them thouroughly.

ItsAllGoingToBeFine
Thankyou for starting this topic, My first baby is due at the end of June and I share your fears. It has helped me no end reading this thread. We'll get through it x

A couple of points from my experience.

I know I had a VE when I arrived at the hospital and one when I got into the delivery room with my mw, tbh after that I can't remember having one. That said I did arrive at hospital at 9cms, obvously didn't do me any harm not having one til then but i was very realived to know I was that far along. (also if you want a epi I don't think they would give one without knowing how far you are along)

It was a good job I did have the one in the delivery room as the mw was able to tell that me cervix needed moving as was preventing the baby from coming through properly. My understanding after the fact that that could ahve caused real problems if not resolved.

btw I am embarassed to say that before my baby I had only had one smear. I was so upset by the first one i had i couldn't face it again. (I am in my mid 30s) I have had one post baby and am so glad. I really do feel that having gone through giving birth and all that is involved I can open my bits up for an MOT now

Well, I plucked up the courage to talk to the midwife today (she reckons I have vaginismus )

Anyway, the no internal examinations part of birth plan she disagreed with totally She said "but you have to be examined when you come in so that we know if you are in labour".

I disagree with this, if I hold off going to the hospital until I need pain relief and am having regular contractions surely I am in labour? I wanted to argue the point but couldn't face it today

Some of you have said that if everything seems normal routine VEs are not necessary. What can I offer the midwifes other than VEs to keep an eye on my progress?

If I am doing fine, and baby's heartbeat is fine does it matter how dilated I am?

If I feel an urge to really push that I can't fight do I need to have a VE to tell if I am fully dilated?

The midwifes I have spoke to seem to feel I have no options on this - I would like some alternatives I can offer them so that I have the confidence to refuse an unnecessary exam...

Thanks for all your help and support throughout this thread

Oh good grief, hire an independant midwife and have a homebirth is my advice. They're much more likely to be happy with no routine VEs.

See this page for other ways they can tell your progress.

I agree with you, that if you've laboured at home and got to the stage where you want proper support/pain relief, then you are definitely in labour! It may stall and all die down again, but that could happen at almost any dilation!

Some women get the urge to push before they are fully dilated - and the pushing actually helps dilate further. Other women are told not to push before 10cm and tire themselves out with desperately trying not to push. Others get to 10cm and are told to push - they tire themselves out pushing for hours without the urge, by the time the urge comes they have hit the wall and need assistance.

Read this page about pushing for first time mums, it says some sensible stuff.

Keep reminding yourself, the midwives cannot tell you that there is no other option - they have to have your permission, you have the right to refuse.

In hospital, if you were wondering about a labouring in water for pain relief, they would probably not like you to get in before 6cm, so would want to do a VE for that. If you were at home, however, you could get in whenever you wanted to (bearing in mind that getting in too early can stall labour of course).

What I don't know is - are they within their rights to withhold gas&air etc if they decide they can't tell without a VE whether you're in labour or not??

They can't make you have an exam so if you don't want them, then refuse. I have put on my BP that I don't want them unless there is a genuine medical reason to have one - finding out how far dilated I am is not a genuine medical reason for me, and if my body needs to push then push I will.

If they don't listen, stick your pants back on until you really have to push! ;)

Seriously, you could print this off and show it to your midwife when you next see her: www.nice.org.uk/nicemedia/pdf/word/IPCNICEv8.7.doc - it's the NICE guidance for intrapartum care - pages 25/26/27 say that VEs should be OFFERED (and at what point they should be offered) but it does not say they are compulsory.

It's not your job to offer alternatives to the midwife - they should already have those, and that shouldn't include getting the doctor to try and bully you into it!

I would love to have a doula or IM, unfortunately this is just not financially possible.

With all the support I have recieved from you guys I am feeling a lot more confident about pushing for what I want, and will make sure DP is suitably clued up so he can speak on my behalf.

Thanks for all your help

blonde36er thats a really useful link! I will definitely be printing out and highlighting the relevant sections!

If you think a doula or IM would help then you loose nothing by talking to them - trainee doula's charge a lot less, and many IMs are very happy to agree payment plans and/or work on a barter system (ours was desperate for decorators, IIRC - we couldn't help, but nearly came to an agreement over air miles! She's also had her freezer stocked by another client. There's often something if you both have the will and flexibility). If nothing else, your local IMs may well have had dealings with your local hospital and so may be able to advise who to talk to and who to avoid...

You might find these phrases by Mary Cronk useful for reminding Drs and MWs (and yourself) that they don't have the divine right to do what they desire. It makes me feel stronger and more in control to remember them, and to remember that a VE performed without my consent is assault - and I'll remind them of that if necessary!

There are benefits to a HB - many women find that as they're on their own territory they feel far more able to dictate terms than they would in hospital. You'll also have a MW with you and only you - which makes it much easier for them to assess how your labour is progressing than if they're popping in and out.

I only had one internal, when i first arrived at the hospital and to check in part that i was dilated enough to get into the pool. probably very lucky i guess but i do remember telling the midwife to fuck off when she asked me if a i minded turning onto my back later so she could check how far along i was. I had no intention of moving to a more uncomfortable position.

I guess it all depends on how you are progressing. if you've been labouring for hours and hours then it may be reasonable to see if you are actually dilating. if your labour is going along swimmingly on it's own you don't really need checking.

stick to your guns though. it's your body and nobody can make you do something that you don't want to do.

I didn't have to have a VE with either of my DDs to check I was fully dilated when I wanted to push. I was just told not to push until I felt the urge.

OP I sympathise I really do and i hate these things as much as anyone. But I really think you need to overcome this fear not just in case VEs are necessary in labour, but for the sake of your future health. Most 'women's problems' will require VEs. Is there a sympathetic practice nurse, midwife or female GP at your surgery who you could discuss your fears with?

I agree with AshleyFanjo - I think the best thing you can do in the run up to birth is to keep an open mind. It's fine to have strong views and a birth plan but things may not go to plan.

All the very best.

I've developed a complete phobia about them now because I've had a vey complicated pregnancy and had to have 6, Last one was last night due to suspected bleed, Every time I bleed they have to check Cervix is closed and swab taken.
I think I've actaully developed physical phobia because It took them like three atempts and I was a sobbing wreck by the end of it. It's now terrified me about the birth, anybody found any way to comfortably overcome these kind of phobias, does hypnobirthing work someone suggested it to me to help feel more relaxed with all asspects of the pregnancy.

Like most women I am really not a fan of VEs, although I wouldn't say I have a phobia of them. I don't know if it's any consolation to those who are worried but I had a VE when I was in labour and I didn't even realise it! I was on my knees using the gas and air (which was great for me) and I remember the MW telling me I was 10 cms. I turned to DH and said "How does she know?" and he said she'd checked me! She was so quick and gentle and the gas and air was so effective that it didn't even register. As other people have said, when you're in labour your instincts take over and things that might once have frightened you sort of fade away. For example, I hate being naked but I just stood in that labour room and stripped off without a shred of concern simply because I was too hot and the feel of the clothes on my skin was driving me mad. I pooped everywhere I could not give a monkeys. Honestly, it's like you get tunnel vision and so many things fade into the background.

That said, do be prepared to stand your ground or brief your birth partner to do it for you. I definitely feel that first births are too intervention-heavy and I was determined to avoid intervention at all costs. My MW was excellent and very encouraging but then another more senior midwife was called in because there was meconium in my waters. Because the equipment was faulty they were having trouble picking up DS's heartbeat, although the small amount of monitoring they were able to do showed he was fine. But this older midwife started talking about ventouse and episiotomy and I very forcefully told her in no uncertain terms that I was not having either of those, thank you very much. In the end they were not necessary (something I instinctively knew myself) and I had very minimal tearing. Had I listened to her I would have had an episiotomy wound to contend with. The first, better MW congratulated me privately later on how assertive I'd been and implied that the intervention the older MW was suggesting was completely unnecessary. I felt very vindicated by that, but also a little angry that if I had been more shy or afraid I could have ended up with a very different birth.

I would always advise to go with your gut. I needed to push but I said nothing to the MW I just went ahead and did little pushes. I know now from what I've read that that probably helped me to dilate the last couple of centimetres. If I'd asked the MW about it I'm sure she would have done a VE and told me it wasn't time to push yet. Bollocks, I need to push and it felt good to push and I think it did the world of good. Go with your gut.

OP doula UK have a hardship fund for people needing doulas who can't afford them.

I also second the trainee doula route, I'm a trainee based in dorset, if you are in ny range I'd happily meet you to see if you might want me to support you. Trainees only charge expenses for births.