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!

@WeightGate

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.

No. The pessary needs to go in the posterior fornix and as part of the process this needs to be located with fingers. The pessary is then inserted with fingers and it can sometimes be a bit fiddly to get it in the right place (and leave it there). Not sure of some brands have a tampax type applicator but I’ve never seen or heard of that. The next step of a routine induction would be to have your waters broken, so a VE to see if you’ve dilated enough for that, then move you to labour ward, then another internal to have your waters broken.

You can decline these but it it would bring the induction to a halt. Sometimes after the pessary women start to contract well enough they might not need their waters breaking.

You could ask for gas and air if you think that might help?

You can absolutely decline- I have and it has always been honoured.

Rape survivor here and I've had very many babies with no internals during labour. Your body, your choice, and most midwives are fully supportive and can work around issues that arise. In the event of one emergency situation I had an epidural and as there was no sensation I could tolerate what needed to be done. I don't think anyone without PTSD can fully understand the sheer terror of internals. It's not as simple as gritting your teeth for the sake of your baby, it's an overpowering and overwhelming desperate terror and if this is your experience too OP then my heart goes out to you.

I'm sure they would honour your wishes OP but there are quite a few scenarios way it might become fairly vital to help get the baby out quickly. Are you not tempted to request an elective c-section?

Of course you can refuse but if it’s any comfort when I had them it wasn’t at all painful, I barely even felt it. It definitely didn’t feel like someone had stuck their fingers up there like it normally would. Midwives are well trained and you don’t really feel as much down there when in labour anyway. I didn’t feel myself tearing either to give you an idea of how little I felt. If an internal exam does become necessary for you it may be worth discussing using pain relief like gas and air (which is brilliant for dealing with stress - I used it while I was having stitches both times because the thought of someone stitching my vagina absolutely scares the shit out of me and I found it really helpful for keeping me calm).

You’ve got lots of helpful replies but just to add - you can absolutely decline, if everything is going normally then by all means you can get through labour without internal examinations.
Internals are used to check on labour progress, or to assist delivery where needed (eg for instrumental delivery). They’re not necessary to check baby’s wellbeing as long as all fine otherwise.
As people have mentioned there are other signs of labour progress - however, they are not always 100% reliable.

Couple of scenarios you should think about and discuss with your midwife so that you have a plan in advance -

• epidural - difficult but not impossible to get one of these without an internal first; but if you do have one in place it’s very difficult to know when you are then fully dilated and ready for pushing (as you most likely won’t be feeling any urge to push). There are strategies to get around this but definitely discuss.
• if baby is in distress during labour - it’s pretty much impossible for a doctor to decide what to do, without an internal exam. If baby is very distressed then knowing whether you are fully dilated, or less, is a main factor in deciding whether to do a C section, an instrumental delivery, or just ask you to push. If you decline examination there’s the option to transfer to theatre and prep for a CS, but CS can be very very difficult if baby is ready to be born vaginally (eg very low) - and even worse would be to end up with a cut when baby is basically already out, which I have heard of happening!
• instrumental delivery - can absolutely not be done without an internal. It sounds to me like you would perhaps not want a ventouse or forceps anyway but again, to think about and discuss. Occasionally if the baby is distressed or you are exhausted, a ventouse can get baby just the last 1/2 cm (it’s sort of around a corner!), takes about 1 minute, and avoids a very very difficult CS.

I think discuss with your midwife as soon as possible because it really does alter your birth plan/options if this is a non negotiable for you. As one PP said, it may be a reason to consider CS. It may also be a reason to consider some counselling sessions before baby is born, just to prepare for whatever possibilities.

Doctors and midwives working in Obstetrics are very familiar with women who decline or wish to avoid examinations for whatever reason, and you should find you’re treated with respect whichever decisions you make.

As mentioned, talk to your midwife. They are there to help you.

Just to add my experiences. In my 1st labour I knew I could decline but was bullied into believing what you've been told, that they have to check to admit you. And then told such lies as "we have to check at shift change" and "we've left you as long as we can and we'll get into trouble if we don't do an exam now".
So with my 2nd labour, on arrival I asked for no exams. The midwife agreed that I was in labour and was happy to use her skills and experience to assess suitability for admittal. We agreed between us that we would give it 2 hours and if it seemed like things were not progressing I would agree to an exam. In 2 hours there was no need and she let me listen to my body for when to push.
So my advice would be to discuss this immediately on admittal and make a plan with your midwife then (as it's unlikely to be the same one you see for appointments and they really don't read what's written on the notes). Have your preferences on your birth plan but keep an open mind.

@umberta youngest is 2

Absolutely decline. VE’s are not essential, I’d really encourage you to read “Give birth like a feminist”.
Your body, your choice.
Declining a VE will not impact your baby, they can monitor without going inside you.
Good luck with your birth, trust in your body and listen to what it is saying. You will know when you’re fully dilated xx

I declined in my second labour. It was a home birth and midwife went on behaviour and contractions.

I did mention it as soon as she turned up and she was fine about it- however with a Hb the power differential is quite different as you're on home turf- you may need to be more assertive in hospital.

@BeMorePacific yes! This is absolutely true. They are not essential and not having them will not impact your baby. So many people on here thinking by not having them your putting your baby at risk, that's just not true!. If they really need to do something 'assisted' that is different. But no one needs to stick their fingers in your during labour, it's a complete throwback from the old days, I've had many midwives and nurses tell me it's completely outdated and no longer needed to be done

Of course you can decline. It's your body, you're asked for consent in touching it every time and you don't have to give it

Please talk to your midwife about this, OP. If, reading between the lines, your difficulties are a result of rape/sexual assault, there may even be a specialist midwife/team who can take you on through labour, and make plans for different scenarios and options. Much better to get this out in the open and have a plan than just rock up in labour declining exams.

On top of what's already been mentioned, it's worth considering how you'd manage with things like suturing after birth, as this will also require an internal exam and probably a rectal exam too (to check the tear/stitches haven't gone through there). It may also be needed if your placenta doesn't deliver or if there's heavy bleeding - this can be done in theatre under spinal/epidural anaesthetic if needed, though usually they will at least check things in the room first. Please talk to people!

Another time they may need to do an internal is if you have a retained placenta. I had this. I had to have it removed manually. I was offered the option to have a spinal and have it removed in theatre. I was scared of the spinal injection and didn’t want to leave baby DS and DH. So a consultant came to the delivery room and I survived on gas and air. I would go for the spinal if this happens to you (or anyone else).

I did this having been reassured by my community midwife that it would be fine. In the event the midwives at delivery didn’t seem to be able to monitor me effectively without doing an internal and were outside the room when I gave birth. I think this is to do with a lack of experience in the other signs of progress in labour.

As others have said, yes you can decline. But it may affect things such as the pain meds they will give you. They didn’t believe I was in active labour until they checked me, and only then could I have pain meds. There’s also the chance of baby needing help getting out, be it needing an instrumental birth or physical help if baby gets stuck. And then if you tear, as I did, it’s a chunk of time getting stitched up down there. You may not have any of these and give birth with no intervention and no stitches, but better to consider them now than when you have no choice and no head space to make decisions. I would talk through all your concerns with your midwife, and in your position I would consider whether an elective c section is a better and safer alternative for you. And as a side note, I wasn’t warned after the stitches before the doc shoved a suppository up my butt. I’m sure it’s usual to be warned and asked permission, but it might be worth mentioning if that would be unacceptable for you. Good luck, you’ll do fine!

If I ever had another I would decline the examinations too. They tried to attach the clip to my sons head to monitor him as his heart rate was dropping. I wasn't dilated enough but they kept trying to reach him and when they couldn't they'd go and find someone else saying they have big hands etc so funny... It was one of the worst parts of my experience and I ended up with an emcs.

I'm sure if they required to do further monitoring you would make a decision based on the info you have about your labour and it's progress, it's impossible to say now that you absolutely will not as you may feel very differently during labour. For example if they are worried about your childs heart rate they will ask to monitor with the clip but you only know they can't reach when they've tried. It could save you having an emcs but it could also end with an emcs anyway.

Just came back as I thought of something doing an exam of how far you are dilated only gives them a snapshot of where you are at that time. With my first I went in and they said I wasn't in active labour and told me to go home (can't remember how dilated I was) anyway we lived a good 30 mins away from the hospital and I decided to stay in the grounds my husband and mum sat in the sunshine and I walked round and round this ornamental pond. Half an hour later I'm definitely in active labour so go back I'm up on the ward and waiting to go to delivery suite they examined me I think I was 4cm dilated they tell me oh it will be ages as I'm in the lift I'm sure I'm pushing, low and behold I get to delivery and I am pushing I think the only thing that stopped my DD popping out in the lift was her hand was up against her head, luckily for and her but not my pelvic floor I'm hypermobile so I stretched enough that she didn't get stuck.
2nd baby I don't think they did any internal, 3rd the community midwife made it for the final push so no chance, thank goodness I'm not having a baby now as I wouldn't make it to the hospital if they've banned home births.

I'm sure unless you are taking ages or showing signs of getting into difficulties most midwifes can tell when you are in active labour.

Request a c section. The. You will not need an internal examination, if this is due to previous truma/ abuse they will do it for that reason.
Unfortunately by going into labour you could potentially be risking your life and baby by not having examinations. Talk very honestly with your midwife about your issues and be prepared to see a consultant to discuss management.
Good luck

I’m not sure how helpful my experience is but will share just in case...

With DS, I did have examinations early on but once I got to 6cms I got into the birthing pool and so they couldn’t do any checks which suited me.

With DD, again, I had checks early on but as I progressed I declined them. That’s said, they weren’t able to give me any more pain relief until I’d be checked. I decided to decline the checks and pushed when I felt it was time. DD was small so I think I only got to 8cm before I started pushing but that was a guesstimate.

I’d speak to your midwife but would suggest being open minded and seeing how you feel once you go into labour. I’m not sure why your partner would need to leave while the examination is taking place - mine stayed through everything - but maybe things have changed given the current circumstances.

I had a homebirth and no one even suggested an internal examination. I think they could see and I was getting on fine and were happy for me to crack on.

I had the exact same issue so thought I would tell you my experience.
I had an epidural before being induced and because I couldn't feel any sensation of being examined I didn't find it distressing at all. The worst bit for me was stitches for a small tear after the birth but I asked my partner to talk and distract me and we had our brand new baby to cuddle and that helped immensely. Also as it wasn't actually internal, just a small outer tear I didn't find it to bad. I went home within a day or two after giving birth and was so glad I hadn't had to have surgery. Definitely worth asking if that could be an option as I was terrified and truly did not know how I was going to get through it.

Thank you all so much for your responses! I really really appreciate reading all your stories and advice. Everyone is so kind.
@ChanklyBore and @Savingshoes @anothernamereally that's so reassuring. I do feel kind of reassured/empowered after reading this.
@putastrawunderbaby big hugs. Thank you for sharing your story. Congratulations on your babies

OP if you are south London just talk to your midwife - I am assuming GSTT or KCH? Both hospitals have specialist midwife teams for patients who may have trauma responses to gynae interventions (whether that is due to previous rape, FGM, trafficking, CSA, cultural reasons, or psychiatric history). They will be completely unfazed by this, and tbh I'm surprised it didn't come up in your booking in appointment (I was asked about it in mine). The obstetricians are also entirely used to issues like this, and happy to work around it.

There's also this in Whitechapel:

www.mybodybackproject.com/our-maternity-clinics/