Painful dilation checks?

[ByFirmHiker]

I gave birth to a son about two years ago, and I'm currently seven months pregnant.

My question is about dilation checks.

During my first delivery my midwife told me my cervix was sitting high and due to this, my dilation checks were super painful (even more painful than my contractions). I literally cried while she was poking around inside with her fingers.

I'm curious to hear if others in this group also have the same experience? Is there anything I can do to make these checks less painful in a few months?

They are optional. I only had one, at 8cm, and even then only because I wanted to know.

Did they give you gas and air while they checked you. I had some for 2 of the checks with DD2 x

@ByFirmHiker I experienced this, mine were so painful! I ended up having about 6/7. Turns out I had “bulging membranes” - the baby was pressing down on my waters basically and no one could figure out what it was at the time.

I requested gas and air for the last few checks, however I plan to limit/decline checks this time around.

Mine were excruciating too, as was the fitting of the Foley catheter when I was induced.

My mum says that she was found to have a tilted cervix and her examinations were verging on unbearable, so I do wonder if I had this too.

Firstly, you dont need to have them. They tell us limited information about what has happened, little about what is happening next. I would never agree to them on an arbitrary time schedule like every 4 hours. What for?

You can always use gas and air if you want to. Sometimes midwives wont go and get it for someone merely being assessed for admission, make them. They should have a mobile one in the initial assessment area.

Sweeps do very little to start labour in someone who wasnt well on their way, anyway. If your cervix was high and closed at a sweep, but you go into labour that night, it is coincidence.

Mine were so so painful. Second time round I used gas and air and was tripping the whole time. Much better!

It's a long time since I gave birth, but is it still OK to refuse checks like this unless they can give you a good reason? My births were both straightforward, so I might just have been lucky, but I said in advance that I wanted to avoid any internal examinations if possible, and I didn't have any. I think it was considered quite a normal request back then....

It is absolutely your right to refuse and not to consent to vaginal examinations, or anything else they offer for that matter! This will always be the case. Just posting this for anyone reading this who might not know this x

Here are some reasons they might say you need a vaginal examination (VE), and the pros and cons of consenting or declining.

The disadvantages of VEs

They increase the risk of infection
They can be painful
They are subjective
They do not give accurate predictions about future progress overall
The information provided can influence morale of everyone present
They can lead to unnecessary intervention

To assess whether you are in spontaneous labour because we cant give a room to someone who may not give birth imminently

Active labour is typically defined as having 3-4 regular, strong contractions in 10 minutes, with 4cm dilation of a soft, central cervix . However, this is an arbitrary definition and vaginal examinations are notoriously subjective. They also tell you more what has happened, rather than what will happen and when.

You may need and are entitled to support before this, but the issue with rooms/staff is a real one. If you are contracting, need support, but dont seem to be in active labour (whether you had a VE or not), you could be admitted to the antenatal ward and have an opiate or gas and air plus some support from staff. You needing support is separate from you being in active labour.

Sometimes people want to use the pool early on in labour, this can be known to prolong the early stages of labour. However, we also recommend a bath and paracetemol in early labour to people on the phone, both of which have been known to delay progress. I recommend doing what you want because we dont know which person you will be unless we try and see something like a reduction in contraction intensity.

The plus side is that hearing that "the books" agree you are indeed in active labour as you suspected can be validating. You know you know your body.

To assess whether your labour is progressing

There are some increased risks when a labour goes on "too long" but we dont actually know what "too long" is. We dont really know how quickly someone should dilate. Plus, dilation isnt the only sign of progression.

If you ask someone in labour if they think things are moving along, they will say yes, no, or I dont know. If they say they dont know, you could ask them if they want you to feel their tummy or do a VE to check the babies position and descent as well as their dilation. We dont need to do all of these things, we can use some of them along with behaviour and the length and strength of contractioms to build a picture.

However, where there are already risks such as compromised baby or a mother at risk of haemorrhage, it can help us continually gauge the risk and recommend interventions that will minimise the chance of it occurring before it happens.

You want an intervention like an epidural or opiate

Sometimes, a sudden request for something like this might mean there is progress and the second stage of labour is rapidly approaching.

Research is patchy, but there are definitely cases where I feel like a "late" epidural led to intervention like forceps because of a lack of feeling, but it is never too late to have an epidural and labour could go on for 3 hours from 10cm dilated. This is where informed choice comes in. Pretty sure the latest reviews say epidurals do not impede labour.

Opiates are a bit different in that the baby can be affected after birth. The vast majority of affected babies are only sleepy and lazy feeders. However, if someone specifically wanted opiates AND it appeared labour might have progressed significantly, there is more clinical justification for a VE than there would be with someone wanting an epidural.

Its equally valuable to step up conservative support, recommend position changes, massage, warm or cold compresses, etc.

There has been a change in the baby's heart rate

Sometimes this can signify that there has been progress and the baby is just responding normally to being on its way out. Other times, it can indicate fetal distress. While other behaviours like an urge to push can make it obvious that progress has occurred, it is often a time where knowing the exact position of the baby can help make the safest decision for all.

This is a time where there is total clinical justification for strongly recommending a VE because it will give vital potentially life saving information.

You are being induced

Despite there being oral method of induction avaliable, a VE can tell you what methods are clinically indicated (some people are dilated enough to just have their waters broken). This can help you avoid unneccessary drugs and procedures and even stay in a low risk birth setting.

To check if an intervention has worked/if we need to do more

If you are being induced, or your spontanous labour stalled, staff often do something, like break your waters, and then check a couple of hours later to see if there has been progress.

Sometimes it is obvious there has been (see above) and the need to check with a VE (especially with no waters) becomes less clinically justifiable. Other times, it is not obvious and a hormone drip is the next line of action. If someone has had very few contractions and/or reports limited change in sensation, then you may as well just start the drip without the discomfort and infection risk of a VE.

While on the drip, having progress checks will give you information about whether it is likely to work. This is clinically valuable because the drip increases the risk of haemorrhage at the point of birth. You have to balance the risk of its long term use with that risk of bleeding.