Saying NO to an examination...

[peeapod]

I wanted to share my experiences from yesterday but didn't really want to so publicly. I hope this helps someone here as I can write more open and anonymously.

So yesterday I was experiencing tightening pain across my tummy. These started at about every ten minutes and wasn't disapearing after a bath or relaxing etc.

They were pretty damn painful and when they got to every 6 minutes it was decided that it was best to go to hospital to make sure everything was ok.

When I entered the assessment unit on the ward I was asked to undress from the waist down and cover myself up. I did so, but when the midwife came in she was like you'll need to take your knickers off. I said uh, why?

She said, so I can examine you. I said what do you mean? She said well I need to know how dilated you are and I can only do that by examing you.

After explaining that actually thats the exact reason why I am booked in for a C section next week (and completely freaking out over these pains because I have such a low pain tolerance) she huffed and said well you wont get a C section based on a few contractions. I stood my ground (with my ohs help) and she eventually said that she would go and get the doctor to explain it to me.

When the doctor came in he was really lovely. He showed us that the monitor I was on wasn't recording any contractions, and that thats what its job was (as well as recording baby's heartbeat). He asked if he could feel my tummy which I agreed too, luckily it co-coincided with one of these pains and he was able to reassure me that these were just very severe braxton hicks because he couldn't feel any tightening of the uterus.

I just wanted to share with you my story because I really think its important for women to be 100% clear on examinations, especially internal ones. I was in such a vunerable position and it was just assumed that I would consent. The midwife wasn't able to deal with my refusal without resorting to threats and misinformation, which without my partner being there could have forced me into consenting to what would have been an incredibly traumatic experience, could have actually started labour and increased the risk of infection. Ironically if I had consented it would have actually made my C section more in doubt because thats the reason why I needed one..

If anyone is in a position they don't feel comfortable in whether thats in labour, pregnancy or anywhere remember that no-one should have the power to force you into consenting to things you really don't want to do. Especially remember that its your body and your boundaries and that health professionals need to respect that.

I don't look on it as the midwife or the doctor being in charge of my care, but I see it as a collaboration and a negotiation. If a procedure needs to be completed in a certain way and only that way I never assume, and I always ask questions and I always feel 100% comfortable before I consent to it. In case of emergencies I try to plan in advance and my oh also knows my tolerances etc.

Work with the professionals, they might know whats best clinically but they don't know you and your personal situation.

Good for you OP for standing up for yourself and saying no. When I was a student MW, we were taught to get women naked from the waist down as soon as possible. If she resisted, two MW would "ambush" her and "persuade her" to comply.

On a related but slightly different issue, in my last pg I had low placenta and therefore had late scans. Despite the scans showing clearly that nothing had moved, the sonographer insisted I needed an internal scan and said she would have to tell the consultant if I refused (and gave me a cat's bum face). I was made to feel as if I had no choice and submitted, but cried all the way through it (the last time I had an internal scan, I'd had a MMC and it brought back awful memories). It didn't tell the sonographer anything she didn't already know.

This pg placenta is also low and I have refused internals this time. I'm clearly having another ELCS (baby is also breech) so what's the point? Luckily this time the sonographer asked rather than ordered and didn't make a fuss when I said no, but it brought back lots of anxiety.

The lack of respect and general way that pg women are frequently treated as silly little girls really annoys me. Good on you for standing your ground when examination clearly wasn't necessary.

I had 2 ve when in labour with my ds. They didn't hurt at all , were very quick and I barely noticed them. That was just my experience. I would never have thought to refuse them as I wanted to know how far along it was.

Interestingly I find Pap smears a lot more painful.

Hope this helps others

I too had an internal scan at 8 weeks pregnant too, which spotted that the amniotic sac hadn't fully attached to the placenta, so was put on progesterone pills. I suppose maybe because it's so routine over here they are a bit more gentle.

I'm in the UK and have had (over my several losses and closely monitored so-far-so good) over 12 internal scans at 4 different centres with various sonographers. They should NOT be sticking the wand up very far at all, and it should NOT hurt. It kind of rests about 2cm in.

Hubba The sonographer was doing it wrong, plain and simple - shocking on several levels (especially why is someone who cannot even use the wand properly dealing with higher risk situations).

Aren't VE's part and parcel of being pregnant? Yes, you may never need one, but you may also have complications and require one.

OP, perhaps CBT would help you address your fear?

I also can't understand how the midwife was wrong in this scenario. You presented with contractions, clearly not due yet, and she wanted to check and see if you were in labour. I can't see in your example how she was acting powerful over you. I would be expecting an exam in your circumstances, and certainly when they asked you to undress (this typically means everything) from the waist down. If you were in labour and they knew then you would have had your section there and then (presumably). Or if baby was coming quickly then perhaps not. Why put your insistence of not having a VE over the potential health of your baby?

I had one very painful internal - but I had been pushing for four hours and the consultant needed to feel the head. Once he felt it, I was rushed to theatre for forceps as DD had a compound presentation. No way of knowing that without an internal.

The point of this is that VEs are Not part and parcel of being pregnant.

Making a single guess at dilation of the cervix by feeling it with fingers does not tell anyone whether or not you are in labour, in the op's case.

IMO it is wrong to deny you medical care when you feel you need it on the basis of one subjective and easily changed measurement such as dilation. There will be plenty of women examined in awful pain then denied care because they are not open enough, and on the opposite end plenty of women subjected to unwanted procedures because they are deemed to be too open. If someone is concerned or in pain and seeking care they should be treated as a whole person not just a cervix. There are many downsides to internal examinations, pain, risk of infection, risk if breaking waters, risk of premature labour, risk of elongating labour.....I suggest you try having a poo when someone is sticking their fingers up your bum every time they see you to see how far down it has gotten...

MummytoMog I had a compound presentation for my second baby. I knew it without an internal and so did the mws, confirmed when baby became visible.

I knew it because I could feel it myself with my hands and also could feel a scratching sensation inside. I mentioned that to the mws, and as they knew that the baby had already gone from back to back in early labour to loa during second stage, yet second stage was taking a long time for me, and I had a very active wiggly baby at all stages, they suggested my baby might have a hand or shoulder up. We did a bit of wiggling to see if the baby would move but pretty wedged by that point so was born like that and stayed like that for the next few days, arm on the head and would cry if you moved it.

After my 1st baby I refused every VE offered or ordered even in both twin PGs too. They were not needed, and I have never been checked for dilation except for when I was in active labour and then it was only once to get a rough idea of when I could push without tearing etc.

During my 1st I totally felt the midwife held power over me she was aburpt, I was made to feel my concerns and question were silly and unimportant. I was to put and shut and let her do what she "had" to do. As a pregnant 18 year old I felt like a child being scholded. She was a midwife, and she was in power because I did not stand up for myself and allowed her to feel like she was in the right.

"Why put your insistence of not having a VE over the potential health of your baby?"

I fail to see your argument here? Submitting to a traumatic and ultimately unnecessary procedure would have had done more harm to my baby than not submitting, remaining in control of me and my body.

I was put on a heartbeat monitor, which also measures contractions. I had my blood pressure, urine and tummy assessed as well as temperature and my heartbeat. Baby was and is healthy. They managed to prove that I wasn't in labour without the exam, proving that it wasn't needed in this case.

I am fully aware that on thursday when I have a C section that I will need a catheter and some form of check or something down there. I am not going to refuse this because I have done the research and I know its essential for the safety of the operation. However, when I go to my pre-op on wednesday I will be making it very clear how difficult and traumatic this aspect of the op is going to be for me and I will be discussing ways to reduce the impact of this.

It is about choice, power and control...

Traumatic?

How so? It seems the issue here is not the midwife but your fear of being examined.

I've been examined many times, both pregnant and not and never thought this to be "traumatic". If you genuinely have a phobia, then I really do recommended CBT.

If the OP says something is traumatic, then why not believe her rather than quiz her? If it is traumatic then no doubt explaining the reasons why to potentially hostile forumites will also be traumatic or triggering.

It is about choice, power and control....

^^ This

CBT may or may not help OP. But for what its worth, I also find it traumatic and CBT won't help me. I have had a few VE's/Internal ultra sounds in my time and the ONLY thing that has helped me get through this is a full explanation as to why this has to be done, and also the knowledge that this is the only/best option to take as all others have been exhausted.

As OP pointed out, VE's are not always needed, and despite what a medical professional may say, alternative means can be used to get the same outcomes. I am due to give birth soon and I most definitely do not want any VE's unless they are medically needed and I (or my OH in an emergency) knows why and agrees. But its taken me a lot of research to actually understand that I have a right to say 'No' and a right to choice on this - all the medical professionals I have encountered so far just see it as a normal part that everyone has to go through. Which in some cases is not true.

I think if I knew I was in labour I would want my level of dilation to be checked so I knew how far I'd got. but if i was unsure if i was and there is a less invasive way to check, like the doctor did, then surely it's reasonable to expect them to check that way first! It's good to know that we don't have to have an internal to find out.

People questioning whether or not an examination is traumatic wtf??? its a totally individual thing, you may not have a problem with it but some people might find it horrific for all kinds of reasons, past abuse or rape, previous pain during an examination, feeling insecure about your lady bits (some women have a major complex about this and won't even let their partners look) and the list goes on I'm sure.

I had my first ever internal at 7 weeks at the epu when they were looking for a source of spotting, it was not pleasant, maybe not traumatic (may have been if it was a male) but not something I'd consent to if I had to go back for more Spotting.

Mitchell I agree however on the topic of the internet, it can get risky is when there are threads(and you do find them) overwhelmingly 'you can/should refuse xyz it's your right...it is never needed' (often from women mourning/traumatised) and it can become very easy for people with trauma (people like you and me) to cling to that line, basically ending up leaving things quite late and then it all happens anyway but with greater trauma.
E.g. I find certain scans and blood tests enormously frightening: but like you I researched and asked, and logically (given my history) it was for the best I bit the bullet and went for it. Had I not, had I exercised my right to refusal and something was wrong, I would have felt more comfortable at the time. But in the long term, issues could arise in a far more daunting way.

I always read up and ask for a second opinion if I am 'iffy'. Always. But reading up has made me very aware of when things would be better done although they could result in me crying and panicking. I have to censor myself away from certain 'it's my right to control' type forums (there are some far, far in excess of mumsnet out there) because it's almost what I 'want' to hear. And in the long run, I know logically illogical patient-say-so is as dangerous physically as a junior HCP getting all gungho is emotionally.

I/my DH have to frequently start medical appointments with "Squizita/I finds medical examinations extremely frightening and may start to shake and cry. Please explain and ask as you go along. She/I have a huge amount of knowledge and am quite reasonable and ignoring her/me because of the crying is not on." We have learned to start appointments this way: most times the HCPs are completely understanding and when they are arrogant, it makes it clear DH and I are alert and clued up.

The link on the first page isn't a UK source, I'm fairly sure it's from a university somewhere in Asia. Before people take that as gospel truth for every birth in the UK.

If anyone is feeling alarmed after reading this thread, I can offer an alternative view. I'd never had an internal before I got pregnant; I know I'm very tight down below, I was incredibly nervous about internals. As it was I ended up being induced, and saw no reason to object to the internals because I wanted to know how I was progressing (and it was necessary for the propess and prostin tablets).

The midwives were lovely, gave me plenty of warning, told me what they were doing, there were always two present - one to do the examination/insertion, the other to hold my hand or rub my shoulder and encourage me to breathe and relax, making sure I was alright. I was given the option of stopping, resting and trying again every time, and I was also given the option of refusing an examination. I found them painful, but never once felt powerless.

During labour I had a few examinations, I was induced by drip in the end so they had to check I wasn't progressing too quickly. I also had my waters broken; a woman on the ward had told me a horror story not unlike the one in this thread, about how horrendous it'd be, I'd need gas and air, I'd need such and such, as soon as it was done I'd need an epidural.

I had paracetamol a few hours before my waters were broken and it felt like a normal examination - even less painful, actually - and I didn't realise she'd actually started the ARM until my waters went. The examinations following that hurt so much less - including having a clip put on DD's head to monitor her - and I was still always given a choice and always told, if I wasn't comfortable, we could stop and rest.

I'm not saying there aren't bad midwives, and people who find these examinations horrendous - but it isn't always the way, in case people are reading this and panicking.

(and FWIW I'm young, shy and was feeling very vulnerable and nervous by the time I was in the labour room - so not an assertive person by any stretch of the imagination)

Everyone is different, and every experience will be different.

thanks moomin, I never intended to scare anyone. It was merely meant to be informative and potentially empowering to some women...

Sorry if thats not a UK source, I still found it very useful, and relevant to practices within the uk.

I honestly thought VE's were part and parcel of labour and it's the best indication of how far you're progressing.

Many women think they're nearing birth, then are given an internal and realise they're in the very early stages so are sent home to progress further there instead of wasting time sat around a hospital.

My friend for example, midwives and ob's were not convinced she was so close to birthing and had her on a ward. She demanded a check, was fully delated so was whisked to the birth suite.

I fully understand why people do not want internal examinations and I really do empathise with those who find them traumatic, but how do healthcare professionals get past these barriers then? genuine question.

I also know VE's are important to determine foetal position to ensure baby is in the right position etc. How would one go about this?

and to check for cord prolapse too

Routine ves in pregnancy are not only useless but potentially dangerous. I had an incompetent cervix and the instant it was discovered it was made v clear by the consultant that there were to be no internal exams of any sort due to risk of infection. Over the following week before I delivered I had to refuse exams umpteen times by midwives and junior doctors who saw them as so routine that they forgot to ask themselves whether they might actually be dangerous in some situations. I was dilated for a good while (weeks) before going into labour, had I been in a country that did routine ves in pregnancy, there's a good chance an infection would have ended the pregnancy before the stage of viability.

I agree squizita, randomly googling things (actually this goes for everything!) isn't healthy .

But I personally feel its a shame that a lot of people are not even aware that they can say 'No - I want this explained why before I consent', and its even more of a shame that some HCP's think that by you doing this is you being deliberately a pain in the arse (which in this pregnancy I have had a lot of experience of).

I however do not advocate the people who say 'no, I know best' - without a constructive dialogue on the matter as I agree that this can be just as dangerous / non-constructive as a HCP who forces something that doesn't need to be done.