Declining internal examinations during labour

[Umberta]

Dear mumsnet,
Has anyone out there had their baby and managed to decline the internal examinations?
Without going into too much detail, I know that it would distress me very very much to have a stranger move their fingers around in there. But I'm a bit worried that when I present at hospital in labour, they'll "need" to do this examination. I'm only 29 weeks now, but I was at my hospital's labour waiting room the other day (had to go there for something else) and I saw a lady arrive in labour with her husband...they made him go and wait outside the building while she was examined, to decide if she was advanced enough to be admitted (then they'd let him back in). If I refuse, I'm afraid theyll just not let my husband in or even make me go home.
I've just had my first NCT class and the teacher was lovely, but when I asked this Q her answer was along the lines of ways of making this examination less distressing...she really didn't get that I absolutely can't have it. I'd rather just have my own baby on the kitchen floor with no medical help at all, if necessary!
Basically I'm asking has anyone else declined these, and how was it managed?
Many thanks!

Yes, of course you can decline and my midwives were very clear about asking express permission each time. However there can be quite a few reasons they may want to do things internally, for example I had my waters broken, a clip put on baby's head to monitor them and ventouse suction cup. All required fingers near or in the vaguns. Please do discuss this with your midwife when you next see her and talk through the options.

I had an ELCS for this reason and was also told that I could decline any medical procedure that I wasn't comfortable with. I didn't want the risk of not being examined to cause any issues with the baby though hence the ELCS. You still have to have a catheter out in but that's the closest anyone got to me.

I had a friend who requested this. She has a number of medical and mental health problems and couldn’t cope with an internal examination. This was discussed with her midwife throughout the pregnancy and they said she would be able to avoid them. However after 24 h of active labour and a distressed baby they needed to do it to see if there had been any progression or go straight to an emergency c section. At that point even though she thought she would have been unable to cope with the examination the need to make sure the baby was ok overcame her fear of them and she was fine.

Yes you can decline, I didn't have one at all with my second. With my first I had one early on but when I got to hospital all they had to do was look to see my DS head right there and I was ready to push.
At the moment they're saying they will only allow partners in once in established labour hence the internal exams but I imagine if you speak to the midwife in charge they will be able to make allowances.
Is there a birth centre near you?
Have you considered home birth? I never had an internal at all with my HB and I know friends had the same, and partners can't be asked to leave their own home.

Thank you so much everyone for your responses and being understanding. It's really reassuring that, even if not many of you have declined them, it's not a completely crazy idea to you all. I guess I'm convinced that I can point-blank refuse, but like ppl say, what will the consequences be? @AliasGrape and others, yes I read Milli Hill's book and saw that she said you can decline, but I guess I'm just not sure how "realistic" her book is.
@LusciousV and @curtainsforme thank you for being so understanding :)
@ohwifey that's so reassuring... can I ask if your birth was recent?
@ChristmasCarcass yeah these are good suggestions thank you...but no a speculum is even worse, can't bear foreign objects etc either. I know I sound like a wimp! But in other ways I can be very brave haha honest, didn't bat an eyelid when I broke my arm once, it's just "down there" stuff.
A c-section would avoid some of these worries but I'm afraid that it has risks, recovery complications that just aren't worth it unless I actually need one.
@Sewingbea @StillWeRise thank you for your recommendations, I'll definitely read those.
I can't tag everyone but I'm so grateful to everyone's replies. I'll definitely raise this with the midwife next time, they keep fobbing me off saying they won't discuss the birth till week 34 but I'm getting the impression this is a pretty unique "need" that I've got...! Again, thank you all for the advice and understanding

I agree, you will need to discuss with your midwife next time you see her and talk about your concerns. They are super caring, helpful and kind.

While it’s your body, your choice can’t see a way round not having an internal at some point whilst in labour.

They won’t admit you to labour ward unless you are 4cm dilated which can only be checked by an internal examination.
Baby’s well being in the uterus might need to be checked through an internal examination. Keep that in mind.

I was still bleeding post labour and turns out I still had some piece of Placenta left so she had to manually scoop it out with an internal exam. I’m really thankful she did that as it’s dangerous to have any bit left inside.

Again another test for bottom rips and tears. Otherwise you would pooing through your vagina if you have a big tear not properly checked and sewn up. A close friend had that.

Of course you can refuse. I've had 3 children and my first two they did do an initial exam on admission but it was so painful to lie down if I had any contractions that they just left me alone.
They can check the baby's heart beat without an internal exam so you aren't affecting your or the baby's safety.
Third baby was so quick no one got near me to do one.

@ineedmoresleepnow and @raspberryk thank you for sharing your stories, I'll try and ask for a home birth and explain this is my reason. Gosh I'd much prefer a home birth. Yeah @raspberryk I'm provisionally signed up to be at the midwife led birthing centre in my hospital.
@zippy1510 that's good to know your friend's story... I guess if it came to that level of emergency then I'd have to go through with it...but I don't like how they do them routinely.
I guess I'm just not wholly convinced that the risk of infection etc (not to mention probably slowing down my labour by making me "clam up" in defense mode) are outweighed by the negligible benefit of "seeing how far along you are" as a routine thing. I feel there are other ways of monitoring the baby's well being like doppler ultrasound etc. Well I hope so anyway :(

@Umberta oh my gosh, some of the advice you have been given on this thread is horrendous. Of course you can decline any form if internal examination, it’s your body and your choice what happens to it when you are in labour. I have heard of many many women but wanting to be examined, and that has always been respected. It really saddens me to read that some women don’t know if they can be refused or not, of course they can! They are usually only used to check for dilation, which isn’t necessary, and there are other ways to tell how far along in labour a women is. My friend is a midwife, and she comes across this often and is not fazed at all by it, she says it’s not a problem. My advice would be to have a plan of what you would like to happen in all eventualities, so if they want to do one during labour you have a plan b

@Rhianna1980
They won’t admit you to labour ward unless you are 4cm dilated which can only be checked by an internal examination.
Yes this is what I'm afraid of. I'll guess if they were really stubborn about it I'd just hop back in the car and go home then...! I'm pretty sure I wouldn't want to be having an argumentative stand off in that moment haha
@Sickoffamilydrama thank you for your story :) I really hope mine is quick too

@TwinkleStars15 thank you for being so kind and reassuring. Does your midwife friend work in south london?? I hope I get someone like her!

No you are totally right, in normal low risk birth there is negligible/no benefit to having an internal exam. It is just not necessary.

@Umberta checking how dilated you are takes literally seconds. I was working up myself about it but it was very quick at the end.

I declined with my last baby because with my previous two, the initial, first examination (community midwife) hurt like a bitch. (The following ones in hospital during labour didn't hurt though.)
I think they were fine with me declining because a) I'd done it three times before so knew what was going on, b) I was telling THEM what was happening so didn't need them checking and c) the birth was going as fast as I had told them it was.

Just bear in mind that declining will make things slightly more difficult for your caregivers and they will have to take a stab at what they think is happening in terms of dilation etc. It can also add a tiny bit of unnecessary risk to baby but that's not a given. Checking is usually for confirmation and clarification of what's going on.

Gosh I'd much prefer a home birth. perhaps investigate this then?
DD2 was born at home. It was a very different experience from DD1's hospital birth. I loved her home birth, amazing experience and at the same time utterly ordinary. There's a lovely book of home birth stories by Abigail Cairns called "Home Birth, stories to inspire and inform" that's a lovely easy read, lots of different births but all normal and everyday in the best sense.

I declined them in my second labour. The reason was that I found them unpleasant in my first labour (the need to lie on my back for them, rather than the examination itself), plus I found it really dispiriting to be constantly told that I was 'only' xxx cm dilated. I preferred to just go with the flow.

The second time around, I discussed my plan with the midwife in advance. I had a home birth, and the midwife was more than happy for me to decline 'routine' examinations, but I did agree that I would allow an examination if she had any particular concerns about the progress of labour.

If you have a home birth, you will have your own midwife throughout, who will be focused on your labour. She will probably have a very good idea of how your labour is progressing, without needing to do an examination. This is very different to a midwife on a hospital ward, rushing around between several women, who only has 5 minutes to check on you, and may want to carry out a quick internal examination as the quickest way to monitor your progress.

My first baby was a hospital birth, and it seemed that the standard routine is to examine you at regular intervals, you need to be a certain number of cm dilated to be allowed onto the labour ward, and to be eligible for pain relief.

@sewingbea yes I've considered it but my hospital has issued a statement that they're not doing home births during covid 19 because of staffing issues. I can still beg and plead though...but it's unlikely I think especially as I'm a FTM :(

Yes I declined them as they really hurt (even with my epidural) so they hooked me up onto a monitor for me and the baby. If they want to monitor you / baby they will find a way.

@FeelinFagin @GrumpyHoonMain I'm sorry to hear about your painful experiences...I'm glad you were able to decline them after that.

Hi OP. I have no experience of this as I was induced and they had to break my waters, and also had to attach a clip to DDs head to monitor her as she kept wriggling away from the belt monitor. I have however heard of a lot of people who don't want internal exams and as far as I know you definitely can refuse.

Totally understand your reasons in a low risk birth but have you considered what circumstances you will allow this level of intervention (if the birth turns high risk) Ie will you let them attach a clip to monitor, will you allow waters to be broken if you're two weeks overdue and induced - at what point will you opt for an emergency section to avoid? (I ended up with one as the induction stressed DD) also with the induction I had loads of contractions and they had thought I was much further along until they did an examination and discovered I wasn't progressing fast enough (given DD distress and how long it had been since waters broke). If you are very clear at no exams at all then you need to consider what you would like to happen in these situations as at the time it's all a big blur and lots of people talk to you and make recommendations and it can be very overwhelming.
In my case there was no reason to expect a difficult labour and it was only at week 38 they decided to induce me as they expected DD to be much bigger than she was, so even then it was all a bit rushed to think about the different potential scenarios.

Also you will need to check whether home births are on offer as I understand a lot of trusts have stopped them. I really hope you find a resolution that works for you 1 I did find the midwives to be amazing and very good at hand holding once the slight flurry of panic had died down. Also have you considered what will happen if you need to be transferred from the MLU or home birth to hospital? I found the consultants to be wholly focused on baby and didn't really have much time for me and my emotional well being - that was left to the midwife who was assigned to me and the anesthesiologist who oversaw my section. You may need to ask for notes to be added to ensure they are aware of your feelings and are sympathetic.

Good luck OP - I hope it all goes smoothly for you

In both of my labours, no one wanted to examine me and with my first I had to ask even though I hated it (have ptsd and a few related issues) because they were convinced I wasn't in active labour. I was 5 cm. I did get admitted to the labour ward without any examinations with dc2. Have you spoken to your midwife? I found that getting everything in my notes made a huge difference. With my first I didn't tell anyone my issues, just tried to soldier on. It all went horribly wrong and ended up being very traumatic. For my second, I explained everything and found everyone was hugely sympathetic and understanding. Both my dc were both born by emcs (giant heads/rubbish pelvis) and with my 2nd, they asked if they could check position of DC's head but they did that after the spinal which helped a lot.

Does anybody know if they can carry out induction procedures without internals? This is one of the stages that I’m struggling to envisage without intervention.

I found the consultants to be wholly focused on baby and didn't really have much time for me and my emotional well being

My experience was the opposite. The midwife in theatre with dc1 never introduced herself. I didn't even know she was there until she tried to give me ds. The doctors were really chatty/friendly and caring. The midwife with dc2 was lovely but I'd spent over an hour with the consultant who delivered dd in labour because they had a staff shortage so she did most of the talking in theatre and hugging/stealing baby cuddles in recovery.

OP I have been pregnant five times and I have always declined digital internal examinations. I am now done with childbearing and I have never been examined in this way. It is your body and you get the only say on what happens to it, as simple as that. You choose. Nobody else chooses.

They are looking for signs of active labour. An experienced midwife can do this without any internal examinations.
There are midwives on mumsnet that you can ask and you can always ring your midwifery team or private midwife to confirm this.
You will not be the only woman during covid that declines this, you have the right to have support during the birth of your child.
If they said that the only way they can confirm you're in active labour is to do an internal and "allow" your dh to attend... you thank them for their lies and walk out.
You then phone a labour ward in a different hospital and go there instead, with your dh.
This is not the 1950s and you have human rights. Start as you mean to go on, stand up for your family and say no means no.