Declining vaginal exams during covid?

[AnimalCrossingHere]

I understand my partner can't join me on labour ward till I'm 4cm dilated.

I don't want routine vaginal exams. I'll consent if there is an indication baby is distressed but otherwise no. How will they determine if I'm 4cm dilated?

Very worried about being left alone for a ling-time because the vaginal is used as gate keeping.

Will this just mean I

It's not always obvious how far along you are I had 2 3h apart by the same midwife at 2cm and 10 cm. The midwife was as surprised as I was and said she wouldn't have believed it had she not done both exams herself.

You can absolutely decline VEs - please speak to your midwife openly and honestly about the reasons why, and make sure that all the information is in your birth plan. I find VEs agonising - I had them in my first birth and even with gas and air I couldn't bear them. I was dilating very slowly and was refused an epidural until 4cm, which took hours for me to get to. Once I'd had the epidural, I could have examinations without even knowing they were happening. When I went for my birth reflections session, the midwife explained that there is actually no medical reason to wait until 4cm for an epidural, it is simply the process. I'm pregnant with my second now and this time round I will either be having an epidural as soon as I request it, without any prior examinations, or I will be having a c section. I'm yet to decide. But my midwife is being very supportive.

@AnimalCrossingHere

I'm so sorry I posted on the wrong thread it wasn't meant for you or this thread.

Can anyone tell me what the issue is with midwifes checking? Obviously I’ve never given birth before and I just assumed that was part and parcel of giving birth. Why are some women so uncomfortable with getting it done?

I don't understand this at all (apart from those who have suffered sexual abuse). You won't have a VE in labour, but presumably you go for a cervical smear? I was being sent home as the midwife said I wasn't in labour. I asked to be checked before being discharged and I was 5cm. DC born two hours later. Baby distressed and covered in poo and I had a PPH. That would have happened at home if it hadn't been for the VE.

I don't understand this at all (apart from those who have suffered sexual abuse).

Ah, but that's the beauty of patient autonomy and informed consent. You don't need to understand their choices.

You absolutely have the right to decline vaginal examinations.

Some information for you:

Do I have to have a vaginal examination to assess whether I am in established labour?

No. You always have the right to decline any intervention, including vaginal examinations (VEs). If you have given your consent to a vaginal examination under pressure, for example, because you have been told your partner cannot join you until you are in established labour, your consent may not be valid and the healthcare professional could be legally liable if they proceed with the VE.

There are other ways for an experienced midwife to tell if you are in established labour (around 3-4cm dilated) and therefore ready to be admitted to the unit if that is your plan. If you are still in early labour, you should have the option of returning home with your partner. If there is any doubt about whether you are in established labour or not, you should be admitted to the birth centre or labour ward if there is room.

From www.birthrights.org.uk/2020/03/12/coronovirus-how-will-it-affect-my-rights-to-maternity-care/

And

It is important to know that while VEs are offered to almost every woman, and they are often seen as an essential part of labour, there is actually a lot of evidence to support women considering not having them at all - this will be discussed below.
www.aims.org.uk/information/item/vaginal-examinations-in-labour

When I gave birth to DC1, the midwife did very frequent vaginal examinations (which I don't even remember consenting to), even after my waters had broken, and after the birth I developed a uterine infection, which I don't think was a coincidence.
When planning my second birth, I decided that I didn't want any vaginal examinations unless I requested them... as it is, everything happened so fast that the midwife arrived when I was pushing, the closest she got to an examination was checking the baby's heartbeat on her way out (I didn't know they could do that!)

There are a number of medical conditions, both physical and psychological, such as vulvodynia and vaginismus, that can cause VEs (and yes, this includes smear tests) to be extremely painful and very distressing. I think that if there are ways for this to be managed and a women's wishes respected, whilst obviously also ensuring the safety of the baby, then that is really important.

Just to say I obviously have no idea why the original poster wants to avoid VEs during birth, and it may be none of the above - but I don't think it really matters why, more that women are able to have some element of control over their birth, feel listened to and have their wishes respected (with the exception of situations when this has to be overridden due to medical need)

I don't think it really matters why, more that women are able to have some element of control over their birth, feel listened to and have their wishes respected (with the exception of situations when this has to be overridden due to medical need)

See, I'd disagree with the above. Provided that the woman is judged as competent to make her own medical decisions, there should be absolutely no circumstance under which her wishes about medical treatment on her own body can be overridden. None. No means no in medicine as elsewhere.

For me it was repeated sexual abuse by several different people as a young-mid teenager, but I (and anyone else) shouldn't have to tell those experiences to midwives when I'm in the middle of labour and vulnerable. That's not what I want to be focusing on in that moment! Other women may have other issues around easily picking up infections, previous negative experiences with VE/labour (waters broken early by VE/stillbirth etc), have sensory issues or simply feel they wish to focus on progressing in their own time and not be told they're hugely less dilated than they thought etc. Sexual abuse is not the be all and end all of this choice. Women should simply have the right to refuse.

In regards to the smear, it took me years to get the courage to have one and caused a trauma response afterwards.There are a large amount of women who have had abusive experiences who do not attend the smear. I would not want to risk a trauma response during labour as it would bring the risk of foetal distress (I also avoid gas and air during labour as it feels like a dissociative experience and doesn't help) and also increase my own risk of postpartum MH issues. No one would pick up on these things by meeting me or looking at me or knowing me day to day now. Choice is really important in health care, because otherwise it can devalue people's own life experiences, physical needs, emotions and beliefs while also putting people at risk of having to divulge upsetting information at a vulnerable time or start trying to explain their beliefs, needs or emotions at a time when their mind is not able to do so (try explaining faith in a medical emergency! Could you have answered the big philosophical questions during labour? Or give a clear account of a disability you've got?). Choice is really necessary.