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!

I highly recommend downloading the Positive Birth Company digital pack which covers this and other matters of choice and consent in detail.

I'll be declining routine examinations in labour - there are large studies that show no benefit to the health of mother or baby from routine exams, and I have vulvodynia and therefore internal exams cause me extreme pain and distress. I have spoken to the birth team about this decision and have been reassured that they will use observation to assess how far I have progressed and whether my husband can join me. I do have a 'back up plan' for more urgently needed internal exams such as if the baby is in distress, so it's good to think of what you might do in this situation as well.

Reading your last post with regards to pain relief, I would definitely recommend hypnobirthing to you, as it works by helping you to remain calm and feel in control of your labour.

@ChristmasCarcass thanks for that link, very interesting reading even tho their clinic is closed atm! Yeah I'm pretty sure my midwife at booking didn't ask me anything about whether I could handle vaginal examinations - she did ask me if I'm currently in an abusive relationship (in those first 15 mins before my DH came in) and I'm not, my husband is ever so gentle and lovely. Hey ho! I'll definitely bring it up next appt.
@bluemoon2468 thanks for the recommendation and big hugs about vulvodynia. I had to look it up and it sounds so difficult. When are you due? Let us know how it goes when you've had your baby

I've had 4 children. The worst bit of my first birth was being examined. I was lying on my back so it was agony. I declined examination for subsequent births as I knew I was in active labour. My last baby the midwife kneeled down behind me for a look. I suspect she could see the head but I don't know for certain. I'm pregnant again now. If the baby was in distress or I wasn't progressing (and you can tell that yourself) I would allow examination but actually I found it unhelpful in my first pregnancy as my actual labour was much quicker than the exams indicated it would be.

My first born I was under the care of One to One midwives who took a very holistic approach to birth. I wasn't offered sweeps or exams prior to labour (and will be declining if I go down a VBAC route this time as I went naturally 2 days after my due date so I really don't think they're necessary).

Baby can be monitored by listening in with a doppler or in some instances through continuous fetal monitoring which I'll be having this time, and dilation only gives you a snapshot of where you are at that point and no indication of how much longer you've got to go

What I would say however is I did request an exam from my MW whilst in labour, I was meant to a home birth. She didn't do one because my waters had gone so this would increase the risk of infection, I'm not sure how common that policy is within the NHS because when I got to the hospital I had an examination and they discovered baby was actually breech. If I hadn't decided to take myself off to hospital, and hard even declined the examination, I could have ended up with a breech vaginal birth which can have complications based on what interventions etc have been used during birth.

You are completely within your right to decline however, and I will be noting this time minimal examinations because I don't believe he sole purpose of am exam should be because they're clock watching. I can't believe a previous poster was declined gas and air until she agreed to an exam! I hope she put in a complaint, that is taking advantage of you in a vulnerable position and pushing you into a decision you're not comfortable with!

Absolutely you can refuse them! I totally get it and I can’t have a smear without sedation. The worst part of my whole labour was the examinations. Far worse for me that pushing my baby out with no pain relief! Wish I’d known I could refuse. If there was an urgent medical need to baby in distress then it may be different but you do NOT need to be examined to check how dilated you are.
The problem is that if doctors get involved for any reason, most will have no time or patience for you saying no. They will treat you like you are absolutely crazy. That is why many women who are low risk choose to have their baby in a midwife only unit or at home- well away from that aspect!

I had it on my birth plan that I didn't want any internal examinations but surprised myself and actually asked for one on the day! I was just curious and they did one and told me I was 5cm which I loved knowing - felt like things were getting somewhere! After that I didn't want another and wasn't offered another so I only had the one but I'm pretty confident that had I not have asked for one then I'd have had an entirely examination-free labour.

It all depends on the labour though. Mine was very straightforward. I'm not in any way medical but I think sometimes in certain scenarios it does help the professionals to get an idea of what's going on. I'd advise discussing with your midwife.

The short answer to your question though is yes - you can ask to not have examinations.

Certainly can refuse them, best thing to do is speak to midwife if you can about the why so they can accommodate it, they want you to feel safe and not scared or stressed. I was honest with mine when I had my son, to say it stemmed from some stuff that happened to me and they were very understanding. Best thing to do is follow your instincts and what you feel comfortable with. As labour went on I found myself feeling more relaxed and open to do whatever was necessary, knowing the staff were keeping me and baby safe. I'm now having my 2nd baby and feel a lot more comfortable with things this time around knowing what to expect x

Thank you all so much for your comments!
@memberof5 and @time2change2 I'm sorry to hear that it was such a bad part of your labour experience 😟 and you've encouraged me to stay firm!
So I'm updating cos I've now chatted to one of my community midwife team... at first she was like, of course we won't do this without your consent, but then she couldn't really promise I could still get admitted to mlu/labour ward without them because covid regulations mean they'll only admit after 4cm dilation etc etc (she spent a long time justifying this policy but I didn't really want to know, I wanted to come up with a solution! Would they just send me back to give birth in the car/on living room floor?!) She seemed almost relieved when I said can I have a home birth then. She says she needs to talk to the team about it because I have a few minor niggles like GBS (humph, whole other story haha) and also covid might affect whether they can offer home birth... I've really got my hopes up now! But I'm so glad I brought it up now so they can go away and digest it, she did seem to react like it's quite an unusual requirement. (If I'd waited till the official 34/36 week birth chat appt they might have tried to fob me off as too much to organise at short notice?) The thing I was especially grateful for is that she didn't probe (sorry no pun intended) about my reasons because I wouldn't want to talk about it with them, I sort of feel like it's not really their business, consent is consent iyswim.
So yeah, basically thank you all so much for your stories and encouragement, you're all wonderful and as good as any hypnobirthing book for making me feel strong and empowered to stand up for myself 🥰💛

Ps my post didn't make entire sense - I don't have covid!! I meant the whole covid situation is affecting whether they can offer home birth 😅

During one of my labours they needed to check my baby's oxygen levels due to the umbilical chord being wrapped round the neck. I don't know how they would have done that without internal examination.

I would speak with your midwife about it. I am a midwife and we have a special book in work, containing women who will need extra special care, for example a woman like yourself, or a woman who's had a previous traumatic delivery or maybe has had a traumatic event like a partner passed away during pregnancy.
When that woman is admitted, the manager will be aware and will allocate the woman a senior midwife who's has the skills to deal with the situation.

Best of luck x

Also for these woman mentioned below, my manager will meet with the woman before labour and give them a tour of labour ward and go through the persons fears with them.

I had a sweep with ds from a very very old male co sultana and it absolutely repulsed me. Still shiver about it. I would decline sweeps now.

Actually in labour. It does feel a different process. The midwives were amazing. I actually had a student in and they asked if she could check for teaching purposes.

I think when you are in labour often these things cease to matter esp the further you go along. I am a large lady and was completely naked at one point and you just don't care as there is so much going on and no-one in that room is judging.

I think in 12 hours of induction I was only checked internally on 3 occasions so they don't do it all the time.

As people say above. Talk to them about it esp is it is linked to trauma or you just have really strong feelings about it. I am sure they could limit it to a need to basis. And may be able to have a look instead?

If this really is a problem for you and causing you a lot of distress, I imagine other parts of vaginal childbirth are going to cause you serious issues. Have you thought about asking for a planned section instead?

*consultant not co sultana 🙈

I have PTSD after sextant abuse and rape, which had previously been triggered by internal examinations.

Before my planned homebirth, I discussed this with my midwife. She reassured me that (all being well). It was perfectly safe to go through labour without any internal examinations. We agreed that I was happy for them to be offered as long as there was no pressure. This was included in my birth plan.

When I went into labour I actually felt very differently and was fine with being examined. But it was entirely my choice and there was no pressure. Please speak to your midwife and get your preferences included in your birth plan.

Sexual abuse, not sextant abuse. The latter sounds more fun!

Just saw your update about home birth. I can't tell you what a good decision I think that is!

Hoping for my second home birth in a few weeks. Hope your first and my second go as well as my first!

Hi OP, I work in maternity in service user representation and I have tokophobia myself due to past sexual assault so I very much understand where you are coming from.

Please please talk to your midwife so you can come up with a birth plan and write it down. They can also put an alert on your notes so that any professionals who open them are immediately aware of your circumstances.

If your midwife is not supportive, contact the head of Midwives at your local hospital - they usually have at least some Midwives who’ve had extra training or experience in these areas.

You can of course refuse anything. Without your consent they cannot do it, and there are other ways of monitoring your baby which do not involve internal exams. For most women internal exams tell you nothing more than how dilated you are.

However, it’s is important to talk to your midwife about situations where internal exams might be much more important than just checking dilation. I am not a HCP but these could include suspected cord prolapse or early rupture of membranes / leaking fluid. Personally I think it helps to understand what might happen and why, so I think it’s really important to have a frank discussion about it. You could talk about strategies that may help (gas and air, epidural, only female staff, staff being aware of your fears and taking things slowly, avoiding speculums whenever possible etc) if there is an emergency situation - you could of course still refuse but I think it’s important to talk about why they might be needed so you can make an informed choice.

I find speculums excruciating but did have to have one before my emcs - that was the only one I needed.

Whatever happens, it will all be much easier if the staff are aware in advance via your notes and birth plan so you’re not having to explain yourself when vulnerable and in pain.

There is also the issue of birth partners right now - if they know that you cannot tolerate internal exams then they may come up with a different plan for you.

If you’re struggling to be heard, google and see if there’s a local Maternity Voices partnership and contact them to advocate for you if needed, I’ve done similar before for women.

Sorry, missed the last page!