Vaginal exams during labour - pros and cons?

meitaimama · #1 (**permalink**) 02-06-2008, 10:33 PM

I've noticed that people often stipulate 'no vaginal exams' on their birth plans - what are the problems with having VE's in labour? I know it's a bad idea with PROM (infection etc) but are there other reasons not to have them?

Thanks!

Marmee · #2 (**permalink**) 02-06-2008, 10:36 PM

I'm not sure .... but for me, it's the disruption of my space, my being and my concentration during labour. That's not to say that I didn't ask for one...but it was when *I* wanted it and was prepared for it, IYKWIM?

I don't want anything thrust on me that isn't necessary

lulutee · #3 (**permalink**) 03-06-2008, 10:30 AM

I agree with Marmee- it is very much up to the labouring woman if she is happy to have a VE or not. I had thought that I didn't really want any VEs at all, but then when it got to the time- I actually did want to know how many cms I was- just so I knew for myself. This could of course have completely backfired if I had only been not far along, but luckily I was 9cm dilated at this stage- so I knew that it wouldn't really be that much longer. It just helped me refocus and confirmed to myself that I was doing a great job. Next time, I probably won't need a VE as I'll know more about the whole birthing experience/ what it feels like etc.....

lulutee · #4 (**permalink**) 03-06-2008, 10:32 AM

But yes- they are NOT pleasant so trying to avoid unnecessary ones is the way to go......

emd · #5 (**permalink**) 03-06-2008, 10:56 AM

I don't want them if I'm having ctx. They hurt (especially when done by an ob - mw's are more gentle cos they know what it feels like). They break my focus on getting through the ctx. You can bet that my body will decide to have a ctx in the middle of the examination, which is worse because I have to be on my back for it. At a time when I feel very vulnerable, I do not want someone else's hand up my wotsit. If I'm having pre-term ctx, I don't want anyone poking my cervix in case it stimulates even more unwanted early activity or - worse still - accidentally breaks my waters. If I'm dilating slowly, I don't need anyone telling me how slowly or using the slowness of dilation to suggest interventions (I don't mind labour being slow). If I were dilating fast, there's still no need to stick fingers in my wotsit because the baby will be coming out soon enough anyway.

And I really don't like strangers doing internal exams while I'm blacked out on peth. The fact that I consent is meaningless if I'm so drugged that I don't remember it. And offering to do the internal with a condom over a large phallic-looking probe thing doesn't make it a pleasant experience either.

Yep, I have issues with internal exams. If there are women out there who don't mind having them, then great. But I will not have men in hospitals telling me I should have one just because it's hospital policy - there needs to be a medical reason specific to my current presentation at the hospital (and birth is not in itself a medical reason).

meitaimama · #6 (**permalink**) 03-06-2008, 09:06 PM

Thanks for the replies! I was glad to know how dilated I was during my first labour, and felt it helped me focus... but I think it would have been a different story if I was dilating slowly! I can't imagine having one done during a contraction

!

emd · #7 (**permalink**) 03-06-2008, 10:08 PM

Yep, that was my only experience with a male mw. When I refused, he whispered in my ear that he needed to do it NOW because if I was dilating, I would be flown to Sydney for an emergency caesarean as they had no NICU beds available (I was 30 weeks and planning to VBAC, my older child was 14 months old). I continued to refuse, so they got a resident ob who came in with a probe and a condom. After first calling my private ob at 4am on his home number, even though I'd just told them to call his back-up ob because he's supposed to be on holiday this week. By which time I'd stopped having ctx due to the surge of adrenalin at the thought of being several hours away from my older baby. So maybe it was good that someone was insisting on sticking their hand up my wotsit against my wishes. (that last bit was sarcasm)

marchbean · #8 (**permalink**) 03-06-2008, 11:13 PM

I wasnt planning on having one, but when the midwife asked, I agreed as I was curious and was very comfortable with her - I felt no discomfort at all, I actually don't recall feeling anything at all. I was 8cm, which was further along than I thought, so I was very pleased. But I agree, if it was less, it would have been very discouraging and I probably would have regretted it.
It definitely is a personal choice, and there should be no pressure to have one, which unfortunately is not the case I think.

justincredible · #9 (**permalink**) 05-06-2008, 02:37 PM

There's no NEED for them. Dilation happens. There's no reason to estimate where you are at unless you are on a timetable. They are a guess at best, and can be useless when assessing 'progress'.

Say a woman is offered after being in steady labour for 12 hours, and estimated to only be 5cm. Then what? It doesn't mean that in the next 20 minutes she can't go from 5-10cm, or it could take another 12 hours. So what?

And the same the other way, say a woman is assessed by vaginal examination after 2 hours of steady labour and assessed to be 5 cm dilated, it doesn't mean that she's any closer to birth than the woman who'd been labouring for 12 hours, as this woman might yet take another 12 hours to dilate that last 5 cm

Vaginal examination could *possibly* be beneficial when there is a question about the presentation of the baby (not breech vs cephalic), whether it's a brow or hand...etc.

We can labour effectively without vaginal examinations if we are supported by a care provider who has no 'time limit'. Any midwife worth her salt would be able to use a woman's labour sounds as a sign of progress, and even looking for more external indications of progress such as a Hobbs line (large purple line in the natal cleft) or the sounds she makes at the peak of a contraction.

Vaginal examinations can cause women more stress and/or harm than they can do to 'help' a woman.

As with anything, we look at the benefit, the risk, the alternative, and what happens if we do nothing... and doing nothing is far more favourable.

theycallmemum · #10 (**permalink**) 16-06-2008, 10:16 AM

I found that they were extremely uncomfortable and very painful if a contraction came along during one. When I'm in labor, I do what I can to get through it and if that means clenching legs, pushing against the bed with my legs, I'll do it. It can be difficult to remain focused with someone telling you to remain still or to relax!