Monday, January 24, 2011

Vaginal Exams - Why They are UNnecessary in Normal Labors



Most women anymore believe that vaginal exams just simply come with labor. It's a package deal. Go into labor, hand in vagina. Often repeatedly, in fact, especially in the hospital. Though it is definitely not limited to hospital births. Some Midwives believe that vaginal exams are necessary for a safe home birth, even though the only women birthing at home are (should be) women with low risk pregnancies. However, evidence just doesn't back up the idea that vaginal exams in low risk labors are life-saving.

For the majority of women who are low risk, vaginal exams are very much pointless and do have the possibility of causing harm. And not only physical harm, but mental/emotional harm as well. Is the risk of physical harm low with a care provider who knows what they're doing? Sure. Extremely low. But it's still there, and it's added unnecessarily. Each and every vaginal exam done pushes bacteria up toward the cervix. Doesn't matter if the care provider has on sterile gloves. Bacteria is pushed from the vulva and vaginal opening, up into the birth canal and into the cervix. The risk is dramatically increased once the waters have released. There is also a risk of "accidentally" breaking the amniotic sac. I saw this happen when I was a Doula. Now, the Midwife could have broken it on purpose (which is what I believe happened due to other reasons), but that particular area of the sac could have been weakened by the repeated exams that had been done up to that point.

Some women will say, "How will I know when I'm 10cm and I need to push though?". Not all women are at a full 10cm when they get the unbearable urge, and their body takes over. At the same time, some women can be 10cm for quite a while before they get that unbearable urge. The point is, women should follow her body (never instructed on when to push!), and unless she is pushing for an abnormal length of time there is no reason to know where the cervix is at. Most Midwives are pretty good about interpreting external signs, without the need of checking internally. Most are good at gauging when a mom is in the early stages of labor, or when she is very close to birthing her baby. Most are also good at gauging when things are not normal, and a more hands-on approach may be needed.

Don't get me wrong. I am not saying that vaginal exams are NEVER necessary. But, in normal labors with women who have had low-risk pregnancies, it is rare. There is absolutely no need to know what a woman's cervix is doing in labor, when things are moving along normally. Knowing how open the cervix is does NOT tell us how soon a woman will have her baby. A woman can be a few centimeters dilated for days or even weeks without progressing to active labor, and a woman can be fully closed and have her baby within hours.

In my experience, it the emotionally detrimental risk to vaginal exams is the worst. Especially if you are serving a VBAC mom. Think about it this way. Mama is laboring beautifully, handling contractions well and in a labor groove. Midwife interrupts this groove to have her lie on her back, open her legs wide and insert her hand into mama's vagina. She announces that she is 5cm dilated and 75% effaced. Mama thought she was much further along. Now begins, "Is this taking longer than it should? Am I supposed to be further dilated? Can I do this?". OR, Midwife announces that there "has been no change" since the last check. This discourages mama. "Why no change? Is something wrong? Shouldn't something be happening?" Especially if you happen to have a VBAC mama who was diagnosed with "Failure to Progress". Mama is now doubting whether or not she can do it. Mama is now out of her groove. The laboring process was disrupted by an unnecessary, irrelevant cervical check. Does either of the above scenarios tell of how much longer this mama will have in labor? Not at all.

Women do not need to be rescued from labor and birth. Women do not need to be managed during labor and birth. Quite the opposite. Women should be left to labor in the most respectful of environments, and not interfered with. Vaginal exams ARE invasive by very definition of the word, even when necessary. To claim otherwise is a disregard of what it literally is. Even when I feel that a vaginal exam is necessary, I always ask permission, and I always apologize for the intrusion. I would NEVER want someone to feel that it is their very right to insert a hand inside of my body.

I personally believe that only because women have been trained to view vaginal exams as normal in labor, that it is accepted as a "package deal". If more women understood that they are widely unnecessary in normal labors, maybe more would come to a point of understanding that they have absolute right to refuse, and that it's probably a good idea to avoid them over all.

Women: If you have a care provider who wants to do a vaginal exam, ask WHY. What will it tell you? Is there a valid medical reason for checking? Will the benefit of checking outweigh any risks in doing so?

My heart wishes that women would come to KNOW that they can birth without any interference. We have a society full of women who believe that they cannot possibly birth without help, instruction, or someone controlling it. And more sadly, a society full of women who believe that they are broken.

"We have a secret in our culture. And it's not that birth is painful. It's that women are STRONG." ~ Laura Stavoe Harm

14 comments:

Joy Johnston said...

I agree!
Vaginal exams are an intervention / interruption / intrusion in physiological birth.

bluebirdjohnson7 said...

I absolutely love this article! Thank you. You have put my feelings into words so wonderfully. I did not like how the medical 'professionals' would treat women in labor, myself included. So I decided to have a home birth with baby #4. All went well and I have since had #'s 5-7 (soon to be 8) at home as well. My husband catches the babiess, so it is unassisted by any medical 'professionals' at all. I love home birthing. Thank you.

Abigail said...

Great post! My midwife told me as well that there was no reason for vaginal exams during labor, as she could usually tell how far I was by how I was acting. I decided I didn't want to be checked so that I wouldn't be disappointed if the number she said wasn't as high as I thought I was. The only time she checked me was when I told her I was feeling "a lot of pressure"- I was a first time mama so I didn't realize that was the "urge to push." Turns out I was further than we all thought, and I was already a 10. I think not knowing put me at ease and actually made it easier for me to progress faster. :)Thanks for posting!
http://www.thebirthbug.wordpress.com

Christine Fiscer, Birthkeeper said...

Abigail, that is awesome! Though vaginal exams are not necessary, even when mom feels pressure. The baby will come down, and the body will go into the ejection reflex when the timing is perfect. ;)

Aurelas said...

I've always been a big proponent of birth as a natural event that women are built to handle, but now that it's my turn to try it I have been a little concerned because our midwife doesn't see pelvic exams as necessary and I know it's considered normal practice nowadays with doctors...this makes me feel a lot better--thanks :)

Christine Fiscer, Birthkeeper said...

Aurelas - rest assured that your body knows what to do without someone needing to stick their hand inside of your vagina. ;) The ONLY time I will check a mom is if there is a really abnormal labor pattern. And only because it can signal that baby has gotten his/her head into a wonky position in the pelvis, and doing an internal will allow me to assess this more clearly.

Hope for us yet said...

Yes!
My birth was going along well, I presented to the hospital already fully dialated. My OB wanted to to an internal, I told her that I didn't want one if possible. Her response "How do you think you're going to have a baby without one?"

My Doula and husband already knew where I was, without having to touch me.

I am definately not going with that OB again, and are currently researching for a homebirth for no 2

Katherine Wright said...

Gynos have left me severely traumatized and permanently damaged emotionally/psychologically. I feel that I have been legally, medically raped and I will not ever go again for any reason whatsoever. I have seen no compassion or understanding for the horror and torture inflicted daily on women in the name of medicine. Gynecology is legal, medical rape to me. I wanted to find a place to share my feelings and encourage other women to protect themselves. Just experienced for the second time the worst gyno "event" of my life and I will never, ever return, not even if pregnant. Let the body naturally take care of itself!

Christine Fiscer, Birthkeeper said...

I'm so sorry, Katherine! :( You're right - though it's not just isolated to the OB/GYN world. I wrote this post with home birth Midwifery in mind, and in particular, the other Midwives in my area. They have actually warned women about me because they say *not* doing vaginal exams in labor is "dangerous". ;)

Medical/birth rape occurs all the time. It's a horrible shame that needs to stop. Now.

Sageonkel said...

I was never given a choice and had many vaginal ultrasounds and pelvic exams....I lost my beautiful baby girl 5days after a pelvic at 22weeks. Never again! The doctors told me that a hard fall or sex would cause per term labor but no possibility that a pelvic exam would. Now I know better.

Sageonkel said...

I was never given an option and had many pelvic exams and transvaginal ultrasounds. I lost my beautiful baby girl at 22weeks just 5days after a pelvic exam. I was told by doctors that having sex or a hard fall could cause preterm labor but not a pelvic exam...now I know better...just wish my baby girl would not have been lost due to my ignorance. Doctors also never mentioned even when asked the risk of infection by a pelvic exam. Never again!

Virginia Maddock said...

I would love to pin this to my pinterest board but it doesnt have a picture. can you please add one so i can save it for future reference? TIA.

Christine Fiscer, Birthkeeper said...

Virginia - please let me know if that doesn't work.

Carolina Corthorn said...

Hi! I had a home birth with my second baby without any vaginal exam at all. It was the most spiritual and beautiful experience. It would have been too much pain to have that kind of examination without anestesia. I know because i had that experience with my first child and it was the most painful thing i've experienced in life. Labour contractions are nothing compared to vaginal exams... It made me feel violated. Totally unnecesary! Our bodies know how to birth a baby!