Internal Vaginal Exams!
Ladies ladies ladies – lets sit down and have a chat about Vaginal Exams. Why do we need them? Why do we have them? Do we know what they are actually doing down there? It’s not like it feels good right? You know you have the right to say “HECK NO”?? Were you told that Internal Vaginal Exma’s can pose a risk? Probably not!
I wasn’t really that informed about Vaginal Exams with my first pregnancy, however I did ask for minimal exams throughout labour. Why? Back then I wasn’t really sure why, but now that I know more about them I wished I’d just said NO!
However what I do remember about them, was that I had to get on my back, spread my legs, and someone would go digging (sorry for the visual)……..THAT is not a fun time, let alone mid contraction when all I wanted to do was sway my hips and move as much as I could to get through the next surge.
Another MAJOR gripe I have about my experience is, I was NEVER once given the risks of a Vaginal Exam, just that they wanted to check how dilated I was. The fact they hadn’t informed me of the risks – really means that they didn’t get my full consent as I wasn’t correctly informed about them. TSK TSK TSK.
BRAN or BRAIN model
Going into pregnancy/labour and birth – BRAN or BRAIN should be your first thing that pops into your head if anyone requests/suggests anything.
A lot of birthing mums are very happy to get internals, and they thrive on knowing the numbers of their progress. That’s perfectly fine and I if that’s how you feel empowered then fantastic. Go into your birth with knowledge!
B – Benefits (what are the benefits to this intervention?)
R – Risks (what are the risks?)
A – Alternative (are there any alternative methods I could use)
(I) – Intuition (a mothers intuition is probably the most important – how do you feel?)
N – Nothing (what if we do nothing?)
WHY DO THEY DO VAGINAL EXAMS?
It is said that for a baby to make an entrance into this world, the mothers cervix needs to be fully dilated at 10cm and shortened / thinned so the baby can come through with the presenting part (Head preferably)
So most hospital policies ask for Vaginal Exams upon admission into hospital to see whether you are in active labour. They want to check whether your cervix has dilated, shortened, whether your cervix is “Ripe” yep – they can call your cervix RIPE.
In most cases VE’s aren’t accurate enough to “Guess” when this baby will come earthside, how quickly the progress of labour will be. So the indicative statement “you are so many cm dilated” means diddly squat. One Mother could be 2cm dilated at one check and progress to 8 cm in a matter of half an hour, yet you could have another Mother dilated at 8cm and won’t birth that baby earthside for another 4 hours.
Cochrane Review Specifically states there is not enough evidence to support VE’s
We identified no convincing evidence to support, or reject, the use of routine vaginal examinations in labour, yet this is common practice throughout the world.
CERVIX
So you can have a better understanding of the cervix and what it actually does when you are in labour. Imagine a tight thick elastic band! Imagine you stretching the elastic band! It doesn’t just open does it? The thickness also thins. The more open it is, the thinner it gets.
This happens because the uterus is pulling the cervix up to thin it through the contractions you are experiencing.
SO WHAT ARE THE RISKS?
Well if I’m going to be blunt and paint a picture for you, I feel one of the main risks is getting the wrong information.
- You may have one midwife come in, do a Vaginal Exam and tell you you’re 5cm. Then in a few hours another midwife comes in and does another exam, she has bigger hands, she also does her internal exams slightly different and her interpretation is completely different to that of the first midwife. Low and behold……….you’re still 5cm dilated, or even less. The interpretations of the 2 different midwives varies, their hand/finger sizes differ – and now all of a sudden it’s a panic because you haven’t progressed according to their guidelines and they start suggesting more interventions.
- There is also risk of infection being transferred from doing internal Vaginal exams. Yes your midwife or OB may be using sterile gloves, but what about the bacteria that is getting pushed up from your vagina through the cervix?
- There could be an accidental (or accidentally on purpose) membrane rupture. This is not only painful, but once your waters are ruptured, a lot of hospitals have you on the clock.
- The findings of a Vaginal Exam don’t indicate what the cervix WILL do. The cervix can dialate and retract. All mothers are different, we all birth different. What my cervix does from one pregnancy to the next is different to what your does/will do. Why are we all put into the same birthing box?
HOW ELSE CAN THEY KNOW YOU ARE PROGRESSING?
Midwives are trained in birth. They should be able to see a mother in labour, or in transition, and just know from the way they are acting, the noises they are making – the movements, the purple line.
Unfortunately for midwives they have to suggest and follow what their hospitals guidelines say. Which more often than not, is a VE upon admission and a VE every 4 hours (But not in all hospitals)
GUIDELINES ARE GUIDELINES………THEY ARE NOT THE LAW. THE LAW IS GETTING CONSENT – SO IF YOU DO NOT CONSENT, THEY CAN NOT PERFORM THE INTERNAL VAGINAL EXAMINATION!
Below is a statement given to Rachel Reed in her evidence based blogs on VE’s by a midwife.
“It’s like a performance… at this stage of this performance what is it saying? And… it’s not what she’s saying, it’s what she’s not saying. And it’s what she’s displaying, the way she’s moving, what her body is doing in a physiological sense.”
In transition – photo credit – Cat Fancote
MY EXPERIENCE.
In my experience, when I was told how dilated I was, it took me away from my little birth bubble. I would automatically be taken out of my zone and it would take me a while to get back into it.
In my second pregnancy, my first VE was done accompanied by a stretch and sweep……….I was not once told the risks nor was I told the SS was going to be done. Stretch and Sweep had been discussed as an alternative option to an induction, and I said I would be more open to this option. But wasn’t more open to it being done right away………………Nek minute, fingers performing an internal Vaginal Exam, and Stretch and Sweep………….”You could’ve bought me a coffee first” were my words to the DR.
The thing is, it is your choice. But you need to remember it is YOUR choice. If it is not what you want you don’t HAVE to do it.
It seems to be the complete normal approach to birth these days, and I really do wonder if it is just the normal approach because no one is really being informed about it? Food for thought right?
Knowledge is power. Be empowered and do your research!
I’ve dropped a few links to give you more info so you can go into your Birth with all the information you need.
Vaginal examinations: a symptom of a cervical-centric birth culture
https://www.cochrane.org/CD010088/routine-vaginal-examinations-in-labour
My name is Jackie O’Neill, I am a Doula who is inspired to help and support Women through their pregnancy, birth and postpartum period. I strive to keep myself informed with the most up to date evidence based information and resources.
“Live your life, Love your body, Birth your way”
If you want to know more, feel free to contact me here
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