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.

A speculum should never be used to force a cervix open, it may, occasionally slide past the cervix as it is being opened but doesn't go into the cervix at all.

A speculum to force your cervix open? Hang on a bit- that wasn't a normal vaginal examination- could you go back and get your notes and find out what happened?

And I do hope all you people who have encountered midwives misusing their power have made formal complaints. It's the only way to stop it happening again.

but is it misusing their position of power to refuse pain relief if you're refusing a VE? because I was under the impression that she was just 'following procedure' and I had to lump it!

and if I'm right then my point wasn't that she shouldn't know how far into labour I was, just that there are many more documented ways to know this other than a VE, but any midwife I suggested this to seemed to look at me like I had two heads!

I'd be interested to know if what she did was above board or not, just so I know whether to fight my case another time or not...she obviously didn't believe I was in labour as at one point she asked me if I wanted to go and join the other women in the ward! I was like "why would I want to labour in a room full of people?!" her response was I might be more 'comfortable' WTF?!!

To be honest, I don't think any of the "alternative" ways of telling how far dilated someone is are even remotely accurate. But I also think that, while it would be important to know how far dilated somebody was for an epidural or pethidine, for example, I am sure that it wouldn't be essential to know for has and air.

I think you should ask at the hospital what the policy is about VE. You can refuse any procedure you want to refuse- and I am aghast that a midwife would withod gas and air if you did. Check. And, if appropriate, complain.

Lots of women labour and deliver in a birthing pool so how are they able to check how far along you are in there, surely ypu dont have to keep climbing in and out?

My internal examinations were painless, but the fact that I had to be disturbed from my 'zone' and made to lie on my back meant that having a contraction there meant I lost my focus completely and never regained it leading to the rest of the labour screaming and begging and becoming so exhausted that I had a long second stage and a subsequent assisted delivery.

I believe the whole negative experience stemmed from having an internal examination and so didn't have them in subsequent lovely births.

My experience is that if you refuse internals you get better care, as the midwife actually has to spend some time with you and getting to know you in order to use the observational skills required to assess how far along you are.

'Where I work and I'd say at most hospitals you have to be 4cm to be "allowed" in the pool.'

Bleugh. I hate that rule. Thankfully at the Edgeware Birthing Unit (wonderful place), even though the midwife was convinced I wasn't in labour when I phoned to say I was going in, I still arrived to a dim room and fully filled pool.

My next birth was at home and I was in the pool before the midwife even arrived.

'IME, MW will hold any pain relief hostage until you give in and have a VE.'

Yes. This is the main cause of my PTSD from my first birth. The subsequent VE showed me to be not even 2cm, though I was displaying all of the raising up on my toes, and screaming my head off behaviours. I was denied pain relief or the pool until they eventually insisted that I could only have pethidine, which I knew I would react badly to and did.

They said I'd fall asleep until 10cms. What happened is the pain never altered but my ability to express myself did. I was locked in a prison of trauma and had no escape. I never fell asleep.

If someone appeared to be in established labour and declined a VE I'd happily give them gas and air. The Drs would be going nuts on ward rounds though but my role is to be an advocate for the woman and I'd do my best.

Pethidine or diamorphine is more of a grey area. A midwife can legally only give it without a prescription to someone in established labour. One of the definitions of established labour is 4cm. We do practice defensively these days and I can see many midwives being worried to give it. If something went wrong and you're in court in five years time with a smart arse barrister wanting to know how you could be confident that the woman had been 4cm dilated when you hadn't examined her........

So you'd need a Dr to prescribe it

As for an epidural, its fairly unlikely where I work this would happen without a VE. Its far too simplistic to say its midwives abusing their power. I'd go and ask the shift coordinator if a woman could have one. What happens if here's two women wanting epidural a and the shift is so busy only one can have one? Which does happen. One woman is 6cm the other one we don't know? Who do you think the coordinator will say gets one? Even if The coordinator says ok I've got to get the anaesthetist on board. Who may well say no.

'If someone appeared to be in established labour and declined a VE I'd happily give them gas and air.'

But what if they 'didn't' appear to be in established labour, just in a lot of pain. Then do they get no pain relief?

Starlight, I hate the 4cm rule as well. Sadly in the nhs with our one pool for the whole hospital I can kind of see some logic for it. If women in the latent phase of labour are using it then the woman who arrives in established labour can't.

I appreciate for many the latent phase is just as painful.

In an ideal world there would be a pool in every labour room but that's not going to happen.

I think it is only when you have both gas and air and pethedine and therefore understand that neither bloody work for the pain, you can have much better labours in future. You can no longer be 'failed' by the pain relief myth.

I've never tried an epidural so can't account for that, but know that that too is unreliable as a pain reliever.

They wouldn't get gas and air if they don't appear to be in established labour. I'd have to ge a Dr to see them as midwives deal in normality. Its not normal to be in that much pain and not be in labour. So I'd need a Dr to make sure it wasn't appendicitis, gall stones, kidney infection, etc. it would be up to the Dr to decide what pain relief they could have.

Starlight, I'm sorry if they didnt work for you but they do for lots of women.

But how can you judge that a woman in established labour needs it more than a women in latent stage?

In most of my labours the latent stage was what I needed most help with. The part close to transition was noisy and dramatic but productive and 'happening'. I just needed to yell really. I didn't need any help.

Viva, gas and air worked for being stitched. I think that my first labour was just more painful than the average perhaps.

Certainly in my second labour (having had no internals), I was most surprised when I started pushing and imagined my assumed 1cm dilated cervix was about to shred.

I imagine they should have got a doctor Viva. But I was in the MLU part of the hospital and they were calling doctors who were refusing to come. The CLU was already over numbers and I had about 6 different midwives during my labour.

They eventually arranged the epidural I was non-stop asking for since I arrived but I would have to transfer to another hospital. I was 8cm at that point and I didn't need it then as my contractions had died down and I was getting some respite.

I've not had any children yet but (and I wish I didn't have to say this) I cannot believe how some of you were spoken to by medical professionals. If someone is carrying out a procedure and they are hurting you the response should not be "stop being silly" it should be for them to try and do something about it or stop ! I'd have gone ballistic if someone who was physically hurting me told me to calm down. Christ.

And that you were "forced" or essentially blackmailed to have any procedure at all.

I mean ofcourse I believe it I'm just

Starlight, I wish it wasn't up to me and in some ways it isn't. Where I work women in the latent phase of labour aren't "allowed" to be on labour ward. They're not even "allowed" on the antenatal ward and are supposed to go home. We do manage to sneak people in sometimes.

I wouldn't be able to keep someone on the labour ward. If I did and other midwives did the same we'd frequently need to shut the unit and divert women an hour away to the next maternity unit as we'd soon run out of rooms. Shutting a unit due to a bed crisis puts people at risk. Sadly you can't always do what you'd like to be able to do as you have to think aout the greater good. That's the restrictions of a crippled nhs. Its shit I know, but its reality.

If I ignored policy, what the coordinator told me to do, what Drs told me to and kept women at 2cm on labour ward and gave them gas and air or diamorphine I'd be disciplined and probably sacked if I kept doing it.

'If I ignored policy, what the coordinator told me to do, what Drs told me to and kept women at 2cm on labour ward and gave them gas and air or diamorphine I'd be disciplined and probably sacked if I kept doing it.'

I know that Viva. But would there 'really' be that many people screaming blue murder at less than 2cm? Surely they're the people that really 'ought' to be taken seriously as most likely to have mal-positioned baby or something else going on?

I've had two labours since. Both without pain any pain relief except for water. They hurt. I reached a stage where I thought 'This is rubbish and I've had enough' and honestly it would have been kind of nice to have avoided that with an epidural. But I can remember the pain of my first clear as anything. I wouldn't have left the hospital simply because I couldn't have. It took every fibre of my being to get there in the first place. I thought they were going to help me.

Luckily I only had to have one VE when I was in labour with DS as I arrived at the hospital and I was already 9cms dilated! My midwife was really calm and chilled out which helped a lot and she waited until I was between contractions to do the examination.

It was painful, but I think it was necessary for them to check how far along I was as my contractions were regular but not as close together as they expected them to be I think.

After that I got to go straight into a birthing pool which was lovely and have gas and air and an hour later DS was born :)

I wouldn't have liked repeated examinations though, one was enough for me!!

Not necessarily screaming blue murder but a couple a day coming in as the pains so bad they feel they need to come in to be told they're 1 or 2cm and they need to go home.

I think one of the big London hospitals now has a suite called "the nest" for early labourers to stay and get support. Probably not drugs though. But its a step in the right direction. Having a dedicated area and more importantly dedicated staff. I also think we ought to focus on antenatal education more so women are more prepared for the latent phase. I know all the preparation in the world won't help some as the pain can be so bad for them nothing would. But there are others who are beside themselves and I do think some of it is due to fear and panic. Never realising it would be like it is and being really scared.