I want a VBAC but don’t want internal examinations - bad idea?

[dreamerkr]

Hey guys, I had a c-section with DS1 in 2022, and this time around I’m leaning towards VBAC. I actually have my VBAC appointment later today, but I’m terrified of any kind of internal examinations. I had a miscarriage in 2020 and had to have an internal exam then, and it was so uncomfortable and so painful that I don’t want anything like that again. I mean, I guess I don’t mind having an internal exam when I’m in active labor but not before that if that makes sense? They’re going to push me for another c-section, right? Would a c-section be the better option in my case? Every time they try to do an internal exam on me I tense up and get scared and it doesn’t work. Any advice?

I would ask why we they want to do vaginal exams in the first place. What is the benefit to you? Under what, if any, circumstances would you be willing to accept a vaginal exam?
I accepted vaginal exams in my first labour- it gave me information I didn't need that only made me feel bad. There was no benefit and there often isn't any benefit to the woman from routine exams.
It's your body and it's your choice.

They will probably only do a vaginal examination when you're in labour to check how dilated you are. Or if you need an induction they might offer you a sweep/balloon etc. My cousin also finds these really painful and uncomfortable x

You have absolutely every right to deny a pelvic exam. Even when in labour.
If you are uncomfortable doing one, don't do one. X

You might be offered an ultrasound measurement of your cesarean scan in the third trimester to assess the risk of a VBAC but there is no medical reason that an internal examination would provide and useful information about the risks.

You’re within your rights to consent or not consent to any exam OP. Certainly any time an examination is suggested it should be clearly explained why it’s needed and your consent sought. Routine exam pre labour or frequent exam in labour shouldn’t be needed. But I think a blanket approach of no examinations at all might not be in your best interest so it will be good to talk it through in advance with your midwife/consultant. Internal exams can be really important in labour, particularly if progress is slow (obstructed labour can be more dangerous in VBAC because of putting more strain through the scar), or if there is a concern about baby and your midwife/doctor needs to know how best to get baby out quickly. Standard exams in labour would be generally recommended also if you’re wanting more pain relief (to see eg whether early labour and best to give morphine type pain relief, or to make sure there is time for an epidural for example). There are ways to get around the painful nature of exams if needed, and some women plan early epidural in anticipation of this. Making sure you have a really trusted support person with you who can help making sure you’re comfortable is also so helpful.

Your right that there are some situations when an exam will give useful information but be aware that they are treated as routine. Even if you decline they may be offered "just to see what's happening" even though it doesn't seem anything is wrong.
I declined but then my contractions slowed down a bit so they offered a VE. I'd only been in labour a few hours and it's totally normal to have physiological pauses. There was no need to do an exam and I shouldn't have accepted, everything would have been so much better if I'd declined. I was in labour, I was suggestible.
If you want to decline routine exams but would be okay with it in certain situations, really think about which situations specifically you would be willing to accept in.

I changed my mind 3 weeks before due date and managed to book a c section for 39weeks.

but up until that point I was going to go for vbac - never once got an internal exam or got asked about having one

Talk to them. I had a VBAC (against my consultants advice!). I only had one VE, I was in active labour and it was before I got into the birthing pool and I was asked if I wanted it.

My experience was they mostly did internal exams when there was a need. My waters went early and they did discuss an exam and a sweep to see if that would help labour start and reduce need for induction 24h later. When they got me on the monitor they could see I was having contractions that I couldn't feel so they didn't do the internal

I went back in when I was having 3 contractions in 10 minutes and they were 1 minute long. I had an internal then and was happy to have but if I had concerns about internals I would have skipped this exam. I was 2cm and sent home.
Not long after I started to struggle at home and asked to go back in. They weren't initially going or let me back as if barely been home an hour but the woman on the midwife led unit has a room for me. She did another exam and I was fully dilated and she got me in the pool and I was ready to start pushing within half an hour of getting to the hospital.

The question I would be asking each time would be is this exam going to influence your recommendations. For me I think the first exam wouldn't have changed the recommendation of paracetamol go home see how you get on and give us a call if things get too much. The second exam would have influenced what I was going to do next. If I had only been a few cm I would have been asking to talk through pain relief options to help me cope with the labour. As it was it highlighted that I had advanced through labour very quickly and baby was imminently due. The midwife was completely surprised that i was fully dilated and said had she not done both exams she wouldn't have believed I'd progressed as quickly as I did.

Whether a vbac without any internals is feasible I don't know but I think it would be absolutely possible to have very minimal exams and it's within your right to question the necessity of each exam and the timing of the exams.

It’s worth remembering that internal exams only benefit the MW or doctor. You can say no to all and every examination as it’s your body and you decide who touches it.

With my VBAC, I had no internal exams until I went into hospital in labour then they did one to check how dilated I was and another one about 10 hours later (by which point I had gas and air as I was in the delivery room but labour had massively stalled). The second one informed the decision to put me on the pitocin drip. The gas and air makes a huge difference to how internal exams feel.

The thing is, though, I had to go back and have an internal exam and swab a few days after my CS to check for infection due to fishy-smelling blood coming out very heavily and severe abdominal pain, so whatever route you take, you can't completely guarantee that you won't have to have one at all.

I had internal exams mainly during the few days I was in hospital being induced. I found them very painful and asked for gas and air after the first ones which made them not too bad.

I tried for a vbac but ended up with another emcs - a key reason for this was that they discovered I was bleeding during an internal exam.

People here are all say they dont benefit you, just the doctor/MW but I think they forget that with a vbac there's the real risk that your scar can rupture and any bleeding is taken very seriously.