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.

To me, this whole issue is more about choice than whether or not the OP or anyone else find being examined traumatic.

In my case, the ultrasound clearly showed this time and last time that a CS was necessary. So why was there a need for an internal scan? It wasn't that it was painful, I didn't say that in my original post actually - I said it was upsetting as it brought back vivid memories of a previous loss. From reading other posts from the OP, I'm aware that she had different and valid reasons for not wanting to be touched unnecessarily, and she's clearly said that she's prepared to cope with any necessary interventions, they just need to be approached sensitively.

I just feel quite strongly that pregnant women are often treated as silly girls and things aren't explained to us - we're just expected to hand over responsibility for our bodies and babies to medical staff who know better. I find it insulting.

thanks hubba, thats the message i was getting across. :)

But in the scenario the OP presented, had the dr who came in believed she was in labour, he would have had to examine her, especially given the fact she wants a section.

Zoe, your case is one in which YOU were more at risk of infection and therefore they wouldn't examine because of that. A wide spread generalization that "VE's are unnecessary" is a dangerous attitude to have.

A friend of mine went into labour at 32 weeks. Midwives told her it was her nervousness from having had a premature birth previous. They checked her, found her to be dialated, and were able to give her drugs to stop labour and steroids to develop baby's lungs. Had they not checked, she would have had a very premature baby again.

I went in at 34 weeks and hooked up was having regular contractions. They checked me and I was closed, no where near labour, and allowed to go home. It was just "Braxton hicks".

Two very different outcomes between myself and my friend. Both required a check.

I really don't get why people are asserting that's not true. Presumably you have been to medical school and are an experienced OBGYN?

This gives a very good explanation as to why VE (it's not in every case) may be needed in labour:

www.bellybelly.com.au/pregnancy/internal-examinations-during-pregnancy-and-labour-are-exams-really-necessary#.U2aZfYm9LCQ

During my 2nd labour - a young doctor walked into the room and examined me. Didn't ask for consent and didn't even say hello or introduce herself.

During my 3rd labour I refused any internal exams. This was respected and I delivered safely. I can ensure some of you that think "lay back and think of healthy baby" Is the sum total aim of you is lacking in compassion that actually medical professionals (and I use that term loosely) do buly and expect you to do as your told.

During my 2nd labour - a young doctor walked into the room and examined me. Didn't ask for consent and didn't even say hello or introduce herself

To me that isn't an issue with the VE though, that's an issue with that idiot doctor (not sure why you've mentioned their age btw) not explaining what he was doing and not asking for consent. Not the actual procedure itself.

I would always question why a doctor was doing it though, especially if it was a doctor in training because they may just be using you as a chance to learn - which is fair enough if they first ask.

I wasn't talking about ves in labour, but routine ones during pregnancy. The medical consensus is that they increase the chances of infection without benefit. Nobody knew I was dilated until I presented as a blue-light emergency, that is the point I was making- routine ves in the weeks prior to that might have ended my pregnancy. And indeed in the case of your friend in early labour too. It is possible to tell dilation via ultrasound. When I presented with bulging membranes, I was lucky that a consultant who knew what he was doing started by doing an ultrasound not a ve. The fact that in the following week numerous other more junior medics tried to do one even knowing my situation, and having 'no internals' written in big letters on my notes, speaks volumes about how ves are so often done where there is no clinical need.

It is possible to tell dilation via ultrasound

But are all midwives able to do this? I'm not sure if they're trained to or not.

This brings up the added problem of having more unnecessary medical staff. Most pregnancies don't need a doctor or consultant - so who would be there to read the ultrasounds unless they had a trained sonographer available all hours.

allisgood - I don't think anyone here is advocating 'VE's are unnecessary', or asserting that VE's should never be done in any situation (unless I am missing some ones post)? But in the same vein I also don't think that the opposite is true in that 'VE's are necessary'.

OP and myself, and others on here have all said that we would consent to a VE if that was the best/only option. And as you and others have pointed out with your very differing experiences - every situation is different and should be judged so on its merits.

As Hubba said, its about choice and being ask questions and be treated seriously, and if required able to challenge the necessity of a VE, and the alternative options that are available so informed consent can be given (or not given if appropriate/that's your choice).

I do think they are done too much - I hope I haven't led anyone to believe differently in my posts, if so sorry!

But if someone thinks they're in labour I do think they are needed.

I don't think they have ever examined me in pregnancy (now on dc3), unless I've asked for a sweep or it's checking to get favourability of induction. The only other times I've been examined is 1) when bleeding and 2) in labour.

"But in the scenario the OP presented, had the dr who came in believed she was in labour, he would have had to examine her, especially given the fact she wants a section. "

why though? if it is written in my notes that i need a section BECAUSE of this issue then dismissing it as irrelevant (the mw saying you wont get a section cos of a few contractions) is surely really not on, especially as the doctor was able to tell i wasnt in labour without any need for a ve..

im not going to blindly refuse things i dont like or cant tolerate but im not goiing to blindly accept them either. there needs to be a balance and in my case it was shown that i didn't need a ve at that point as im still sitting here typing and waiting for my thursday section (still in lots of pain though0

allisgood1 Sun 04-May-14 10:04:16
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?

Everytime I read this shit, I want to bang my head against a brick wall, until I pass out.

CBT is NOT the magic solution to complying with the wishes of HCPs. Not everyone is responsive to CBT.

And then there is minor point that pregnancy gives you a certain time limit on how long it takes for you to 'be cured'.

And this is what it comes down to: It is the woman who is viewed as being the problem. She is non-compliant and in need of being fixed and that its categorically NOT where the issue is and NOT why women like the OP have made the decision to have a CS.

The issue comes back to the original point that the OP made. It is about the total and utter lack of respect for women and the poor understanding of sensitivity regarding consent. As the OP points out, she is willing to deal with certain circumstances that will arise during her CS that are intimate in nature.

So what you really need to consider is why she will do that and why she has to raised questions in this other situation.

For starters the midwife made the most basic of mistakes in failing to read the OP's notes. Just because this is a psychological issue does not excuse the midwife concerned. What if it had been a psychical issue?

And then the midwife failed to observe even the most basic understanding of how you should acquire informed consent. Though communicating whats going on and why it is needed AND if there are alternatives available. This was not an emergency situation, so there is no excuse whatsoever for this.

No, the real issue is not that the OP 'needs fixing' in someway. As Peeapod so eloquently highlights, it is the system that needs fixing, so no woman EVER has to question or challenge why she needs an internal, because it is automatically clearly explained without conditions or undue pressure to comply. In short, HCP's need to actually observe the law rather than treating it with the utter contempt that is so sadly routine in pregnancy.

peepod not everyone needs intervention from a doctor in their labour though.

That's something midwives, doulas and people with an interest in pregnancy and birth have been trying to fight against. Over medicalised pregnancy and birthing techniques.

Peapod, you presented early with contractions. The midwife explained why she wanted to examine you (with a logical reason). Did you explain to her that you are scared of internals? You didn't make it clear on you OP, so it's a genuine question. Or did you argue that you didn't want one? Had it been the former then yes, she should have tried alternative ways of determine you whether or not you were in labour rather than making you feel like you were being forced.

I still assert that if they thought you were genuinely in labour they would have to check you to determine how close that was and if there was time for a section (or how much time they had).

allisgood1 Sun 04-May-14 21:18:10
The midwife explained why she wanted to examine you (with a logical reason). Did you explain to her that you are scared of internals? You didn't make it clear on you OP, so it's a genuine question. Or did you argue that you didn't want one? Had it been the former then yes, she should have tried alternative ways of determine you whether or not you were in labour rather than making you feel like you were being forced.

I still assert that if they thought you were genuinely in labour they would have to check you to determine how close that was and if there was time for a section (or how much time they had).

BULLSHIT. This is just another way to get to comply. Especially since they were able to establish EXACTLY the same thing without the need for the internal in the end. It was simply the easier way for them, without EVEN CHECKING whether there was any reason why an internal was appropriate or not. It should not just be up to the OP to convey this message, it is also the responsibility of the midwife to do her job and bother to look at a patients notes.

CBT may not "cure the fear", but it may actually give the OP coping strategies for dealing with examinations or procedures that may inevitably occur during birth. It's not a ridiculous suggestion IMHO.

Because redtoothbrush most pregnancies don't have intervention from a doctor. The midwife's are trained to find out the information they need that way. Instead they had to get a doctor to do the ultrasound. I don't think this can be done in every pregnancy. Staffing issues etc? Medical staff we're they're not really needed?

where*

PS Peeapod, are you making a complaint to the hospital? You should.

Red, it's a sad fact that midwives don't read notes. They should, but they don't always. My notes are full of shit anyway so they wouldn't gain anything from them. If I was scared of an examination, it would be the first thing I would say.

Imagine the scenario of the doctor coming in and saying "your uterus is contracting, the monitor is showing regular contractions, I need to see how close we are so I know how much time we have to get you down to theatre". How is this not a valid reason to examine?

TequilaMockingbirdy Sun 04-May-14 21:24:07
Because redtoothbrush most pregnancies don't have intervention from a doctor. The midwife's are trained to find out the information they need that way. Instead they had to get a doctor to do the ultrasound. I don't think this can be done in every pregnancy. Staffing issues etc? Medical staff we're they're not really needed?

So are we saying that potentially because of staffing issues that the midwife shouldn't follow the law and shouldn't check a patients notes before doing an intimate examination? It should be routine to properly know how to obtain consent...

Why does everyone miss the point here?

Stop making excuses.

Yep and it's because of staff shortages that women get left and babies die. Midwives are short staffed and overworked. One of the many reasons I went private with my previous children.

Nope nope nope.

I didn't say that. She absolutely should have read notes, although unfortunately some are as long as War and Peace and I'm sure we all know midwives don't have the time. Nothing wrong with the OP simply stating, sorry but I'm not having any VE's

All my posts are about VE examinations in general, not just the OP's situation. It's just not doable to have a doctor or sonographer at every possible or definite birth to be doing these ultrasounds.