Intimate examinations

[ImYourMama]

I didn't know where to post this, I recently went to hospital with really bad abdominal pain at 20 weeks pregnant, and after a couple of hours a male A&E doc said he needed to do an internal examination to ensure my cervix wasn't dilating. He didn't really take any care and was very rough we me, I was in tears and bruised DHs hand from gripping so hard. It sent me back to an incident in my past and I've been having flashbacks since then. Im now terrified of intimate examinations! Being my first pregnancy - how often are these done in pregnancy and what is it like during birth? It's so important to me to try for a vaginal birth but I'm so scared of it being marred by flashbacks. Please help

Can anyone give me some guidance on this please

I didn't have any until I was in labour (well, long story, but I've technically never been in labour) - I always asked why they wanted, and made a call on whether I felt it was important enough based on their answers and research I'd done (this was unusual, some of the staff were a bit put out by this)

You can always refuse them, and if it hurts, do not keep silent - I had a trainee be much too rough and I yelled for him to stop, you need to do that, and your husband needs to be there to support you in this - I found that my DP was listened to when I was dismissed.

Make it very clear that they are to stop as soon as they are told (they always should, but many assumptions are made about what a pregnant woman consents to).

The best advice I can give is not to defer to doctors and midwives. Be firm, be vocal, and always make sure that you're clear on what's being done, why, and that they are to stop when you say.

first child: had stitches afterwards
Second child: a man broke my waters (mega painful) then after the birth my placenta wouldn't come out. So a man literally shoved his whole fist up and grabbed T and pulled it out.
Both horrible experiences but not very common I think.

How horrible! This was just one doctor and he was clearly rough in his approach - most will not be like that! I suspect a&e docs are not experts in such issues and aren't doing intimate exams every day - someone working with women in labour will be much more practiced and capable. (For the same reason I'd want a phlebotomist who does it every working day to take blood over a doctor who hasn't done it in a while.)

Can you ask for a referral for support with possible flashbacks? The Royal free in London offer a new uk wide maternity service for people who have experienced sexual abuse - they may be able to advice even if they are too far away from you to see them:
www.mybodybackproject.com/our-maternity-clinics/

You can also ask for a female staff member for any future intimate exams if that would be more comfortable.

At least speak to your midwife and see what is available for you.

In my area at 20 wks we go to Maternity Assessment Unit, much nicer than A&E as they're more experienced.

VE are usually done only when necessary. Try not to panic. Always let the MW or doc know of your anxietis.

Are you ok now?

Oh bless you.

I've given birth 6 times.
With no 4&6 I wasn't exaimined internally at all. No stitches etc.

With no 1, 3 & 5 just once.

I had complications with dc2 so very different.

Your experience sounds horrible. When you do go to hospital explain what happened & I'm sure you will find the staff sympathetic & understanding.

Take care.

If you are having flashbacks, I think it's worth talking to your midwife, and asking if you can have a session with your local Supervisor of Midwives to write a birth plan which takes your needs into account. I know people who have done this after traumatic births, past sexual violence or physical or mental health issues. There experience has been that birth plans done like this (with bits written by the SOM all over your notes) get taken very seriously when you are in labour.

You can always say no, or insist on a female Dr.

Chances are you won't even see a doctor & your midwife will look after you.

Jasper's advice is very good & I think would help to reduce your anxiety which is understandably very high.

They are only done in pregnancy if there is reason to do so - I had two episodes of false labour when I was 30-something weeks, and like you, they wanted to check whether or not my cervix was dilating.
I found internal examinations very painful too - the doctor was very nice and he said that the position and shape of everything down there can affect how uncomfortable it is. Turns out my cervix points slightly up towards the sky rather than straight towards the exit () so it's quite difficult for midwives etc to get to.
I've decided to refuse all vaginal examinations unless 100% medically necessary this time - there are other ways of knowing how your labour is progressing without digging around up there!

To be honest I'm always a bit scared to go against what's said, so questioning them about why I need an exam is going to be really hard, but DH will be a good advocate I'm sure, so I'll brief him about it.

The downside is I'm under consultant care and will likely be giving birth with a member of their team present, but my consultant (female) has already stated they can't guarantee a female doctor or even a female midwife

Thank you all for your comments, I'm hoping I don't need another one now until labour or induction and hopefully I can stand up for myself. I thought I'd dealt with my demons but pregnancy plays a strange game with my brain, my dreams have been full of flashbacks too. Hmphh :/

You needn't question them, as such. Simply saying 'Sorry, I'm not comfortable with that.' is usually fine.

How do you know if they're really insisting for a reason or if it's just routine? I don't want to explain to multiple people about my past and every time there's a shift change. I might make a card 'I really struggle with these examinations, please keep them to an absolute minimum' - do you think they'll accept that?

I would recommend talking with your MW, and educating yourself as much as you can about why they might be done and the alternatives.

This should be helpful in asserting yourself.

I've only been examined during labour to see how far dilated I was and stitches after. I had to have waters broke last time and the midwife on duty said she would rather a midwife did it as a doctor would be a bit clinical and not as caring or words to that effect

Yes - I think a card like you are suggesting would be a good idea.

Also - think about other things that would make it less traumatic for you such as

-female staff
-do you want them to explicitly explain why they are suggesting an intimate exam?
-do you want them to tell you what they are about to do or talk you through it as it goes?
-do you want to put headphones on and try to distract yourself, or have someone talk to you (maybe dh) about other things when it's happening?

You can add those to the card as well and ask dh to highlight the card to any staff that are working with you.

All of these things are actually helpful to the staff as it tells them how to make things more comfortable to you. They shouldn't just accept them, if they're worth their salt they should welcome and be grateful for he guidance as to how to do their job well!

You can ask them why they are suggesting what they're suggesting and if it is routine or for a particular concern they have. They have to tell you and they have to respect your wishes. Maybe try it out now and practice being more in control and saying what you need so you can hopefully feel more comfortable as things go on.

Remember the vast majority of people who go into health care actually have caring and compassionate motivations for doing so. They want you to have as positive and comfortable an experience as possible and want to be sensitive to your needs. I think the vast majority would be grateful for the help you can give them as to how they can make it as comfortable as possible for you.

You should always be asked about internal exams, and any health care professional should be able to explain why they want to do the exam before you consent to it. I only ever had internal exams to check on dilation during labour (I think 3 times) and once to to a sweep before labour. You can refuse a sweep, and they're not particularly effective anyway. You also can refuse internals for progress, and an experienced midwife should have other ways of checking progress.

Thank you LondonRoo they're all things to think about, I'll talk to DH and come up with a plan

You have the right to refuse internal examinations at any time, including during labour.

I would write clearly in your birth plan that these should be kept to a minimum or not at all and you would prefer it was with a female member of staff. Speak to your community midwife about this too.

Your DH also needs to be your advocate during labour, there will be times when you find it difficult to express your feelings- he needs to do it for you.

I've also found positive birthing useful, look up the daisy foundation.

I just wanted to suggest maybe going to see a hypnotherapist and seeing if they might be able to help you work through the trauma - a friend had something similar happen and found it really helped her.

I had three internals using fingers, one at 16 weeks due to my uterus being stuck in my pelvis, it was to ensure it had flipped out and if not to force it out. it was done by the consultant and was not nice at all, I also felt bruised afterwards. The next two I had done were following a leak of fluids at 24 and 30 weeks which were a lot less uncomfortable and then another at 37 weeks following reduced movements and painless contractions to see if I was dilating, she then did a sweep which was pretty sore. I'd recommend discussing it with your midwife and getting support for the flashbacks. I would also recommend avoiding a stretch and sweep if you go overdue, because it's rather invasive, although I didn't find it too sore, I can't imagine it would be a good experience for you. You can refuse internals during labour too.

Hi, sorry this happened to you. I had an internal done by in early labour by a midwife and it stuck with me as my least favorite part of what was a fairly traumatic birth. It wasnt particulaly painful but her attitude was not what i expected- probably the end of a long night shift! When she got ready to examine me i said i dont want that i want to first see what the monitor is doing to check baby and contractions. She answered 'you dont want me to examine you, whats the point of you coming in then!?' i told her through my contractions what others here have said.. Id read enough to know there were other clues to labour progressing! However husband encoraged me to go along with it and didnt want it to be a big deal.

Other internals i had were an attempted sweep which was kind and gentle midwife but too painful so i got her to abandon it, and when the pessary for induction was inserted which again was a lovely midwife but v painful (Actually first time i had sex post baby this was what i had flashbacks to!). I had several internals during labour but to be honest i dont remember those atall!!