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
Christine Fiscer, Birthkeeper at 9:38 AM