On the subject of vaginal examinations..

[ohthegoats]

.. what do they do that might make them more painful than contractions? Why (apart from previous issues related to them), might they be so awful?

Signed,
Naïve.

I've often wondered this, I had two in each of my two births and didn't have any pain at all. All from midwives - didn't have any doctors around. Just lucky I guess?

I can imagine a sweep being painful (although I know they aren't for everyone), but 'just' a vaginal examination? 'Just' in inverted commas because I genuinely have no idea.

My sweep hurt like a fucker but any other examinations were not bad at all. Just a bit of rummaging around.
To be fair, I've had quite a bit of ferreting done up there (other medical ishoos) so I'm not that fussed.
I'm guessing it's people who have not been messed with a lot before? Or who have medical problems or possibly psychological problems with the whole deal.
It's such an intimate thing I can see it being traumatic and even painful for some.

It can be very uncomfortable to have someone examine your cervix. Add on top of that embarrassment and/or previous trauma and it can be a thousand times worse.

And to be fair, even in the best circumstances it can prove painful if the person doing the examining is rough and not gentle.

I remember my first smear being AWFUL. Just cried and cried when I got home (my poor dad got it!) - painful and quite intimidating.

I've had coils put in since then though.. one involved me passing out. Erk, maybe I should be worried.

I think too that it depends on who does it. The midwiveswere very ggentle but the male doctor who broke my waters was a bastard, I was very close to kicking him in the face especially when he told me to caln down.

I expect discomfort but not mega pain, part of the reason I'll be asking for a mw to do all my examinations this time as much as possible, any male dr will be a last resort I'm afraid.

especially when he told me to caln down

Oof, I hear quite a few things like that. Can you put in a birth plan (in so much as they are a plan), 'Don't patronise me'?

Related question from another naive first timer: how does the pain/discomfort of an examination or a sweep compare to a smear test (my only current point of reference)?

I have to say I've been a lot nore mouthy in this pregnancy, I've been referred by my mw and dr a few times to fetal assessment unit at hospital and each time I've been patronisingly told "I don't know why you're here we can't really do anything for you", same thing happened in my last pregnancy and I just took it, now I tell them if they have a problem with me being there I'll be on my way and write a letter to the head of midwives. That soon shuts them up.

I was patronised by aforementioned doctor and one midwife during my last delivery, told to calm down, catch a grip of myself etc when I was crying (not screaming) during contractions. Some HCPs must think a womans vulnerability during the whole process entitles them to talk to you like a child. I won't be taking it this time and my DH has strict instructions that if I'm in too much of a state to deal with it then he will speak up for me.

I like the idea of putting that in the birth plan though

I find internals v painful. I struggle not to scream when I have a smear done and don't think I managed to another it when they were rummaging around when I had a mc last year. It may be something to do with a retroverted uterus (ie. they are prodding in the wrong direction as the cervix and everything is at an odd angle). I had a several in my previous labours (no complications but didn't know I could ask to avoid them) and they were less painful than smears but more painful than contractions.
I have a high pain threshold and will grit my teeth and bear whatever I must but I will ask to avoid them where possible this time.

Very painful, and I did a 30 hour labour with only gas and air.
Not going to have any this time round unless there is a clear indication.
I'm not bothered in the least by smears or speculums/having my coil in and out, but I found internals during labour horrendous. Also being on my back was hideous.

I agree about the back thing- being pulled out if 'the zone' to lie on your back for an exam is probably a large part of the problem. Also, all of my mw's were good at timing it but if you had a contraction during or even whilst in position for an internal, that would make it much worse.
I guess like labour itself, we all experience it in different ways.

If you don't want one say so.

You have the right to refuse.

They shouldn't be doing anything to your body you don't want.

Unnecessary VEs increase the risk of infection.

There are other ways to 'manage' labour.

Ie one to one care.

I had a sweep with my midwife at my 40 week check and it was completely fine, no worse than a smear. I then opted for a second sweep when I was examined for the first time in labour and it hurt like hell, I could have scratched her eyes out. I think she was just a lot rougher and didn't care.
I only had one other examination and that was when I had an epidural in anyway so didn't hurt. I'd never have a sweep again, but then again when you're overdue you just want it all to hurry up!

I had one in my first labour because they didn't believe I was in established labour (was 9cm) , being on my back during a contraction was massively painful. None at all in second labour as it was v quick, and have put in my birth plan no routine ones this time, and if there is a good reason for one discuss it with me first.
I've had an awful lot of rummaging in the course of 4MC and gynae procedures/investigations, and I manage labour by being upright and mobile and in the zone.
HCPS should always be prepared to justify why a VE is necessary, and "because our protocol says every 4 hours" is not a good reason in my book.

Ah OK, this is making more sense. For some people it's less about the actual examination, it's about the position they put you in for contractions/disruption of your zone stuff.

I had no preconceptions and very little knowledge about vaginal examinations in labour, never had a problem with smear tests, have had treatment for abnormal cells etc without any real problems before. But I found the examinations during labour absolutely unbearable, to the point that with the final one, I was sobbing and shouting and telling the midwife that I couldn't do it (was coping fine with the contractions). She insisted very forcefully that she had to because otherwise she wouldn't be able to say how far along I was, so I let her and it was just agony. I still feel upset about it now when I think about it. So for me it wasn't a psychological thing or something that I'd got worked up about prior to labour or whatever - they just bloody well hurt like fuckery.

I am fine with smears etc, but found both the sweeps and the internal exams during labour massiveiy painful. Don't know why - I assumed something about pg/labour made that area more 'sensitive' in some way...

Midwives or doctors for that matter do not need to do a VE just to establish how far you are dilated. Any competent HCP worth their salt should be able to judge this without resorting to unnecessary internal examinations.

A VE is of no value or benefit to a labouring women. Any HCP that bullies a women into an exam just because of policy or sheer incompetence should be reported and punished.

That's interesting, PicandMinx. Far too late for me to do anything about it now (it was years ago), frustratingly. ASmidgeofMidge, your experience sounds similar to mine.

I wouldn't agree that any competent HCP can judge how far someone is dilated without an examination.

I've cared for multips who you'd expect to be making good progress when in established labour. Been with them 1-1, palpating contractions which have felt strong, 5:10, woman has been making all the right noises and after 4 hours there's no progress because of a malposition.

I've also looked after primips who come breezing in laughing and chatting. Don't stop talking during a contraction which are barely palpable. Examined them thinking they'd be going home and they're 9cm.

I'd like to think I'm competent, being qualified a number of years, am a senior midwife. I don't examine everyone and will leave it where I think I can.

OP, if you're having examinations before you've got into established labour. Either due to an induction or to see if you're in labour ask for gas and air for the exam. If you're in hospital that is. Community midwife doing a sweep is unlikely to have any in a surgery.

So if the midwife is observing closely then there is less need for examinations? That's interesting - my midwife spent hardly any time in the room with me (other women to run around and attend to plus at least a few times she went out for a smoke - I could smell it on her) and when she was in there she was mostly writing up notes. Maybe if they hadn't been so short-staffed or she didn't have to have her fags it would have been different.

You will often get major clues to changes.

Women tend to draw their toes up when about 9cm/approaching transition. Or if they're standing they keep lifting their heels off the ground. Theirs a distinctive smell as a woman is getting close to being fully dilated. There's a red line between the buttocks which some women get which extends upwards as they dilate more, but to everyone gets the line.

Its easier to judge dilation without a VE towards the end of labour than it is in the middle. But its correct that you can decline examinations if you choose. I do feel that they do have their place if their use is well judged.

a distinctive smell as a woman is getting close to being fully dilated

Ooh, interesting. A smell similar to what?

A friend of mine who has had 6 children of her own, and been birthing partner for others, has said that in her experience it's obvious when things are at 10cm and ready to kick off. She knows herself, and said she can tell with other women too, just by their behaviour. I'm sure everyone is different, and it's just her experience, but it's quite interesting.

Ha ha. I asked about the smell and the only answer I got from my MW friend was 'well it isn't roses'. I am assuming it is something slightly 'meaty'/fleshy!