3 Questions from another overdue 1) dialtion/pain 2)cervical exam 3) not wanting specific doctor

[Mayrigah]

Hello all! I am a first timer, was due Fri. 11/13 and am now 4 days over. Was categorieed as low risk. My practice is the most sought after for natural childbirth (Dr. Sebestyen's North Austin Ob/Gyn in Austin) and am doing a midwife/pro-midwife doctor ( depending who is on call) in a hospital due to insurances covering it-and not homebirth. My partner,the biofather, and I took natural childbirth (Bradley) classes.

I've only had one vaginal exam at the beginning of pregnancy,and can't really do them easily due to extreme trauma, and partner can't take off til labor starts.
Before I was due last week, my doc discussed the date of induction ( the 25th; I can go til the 27th ( a holiday for us, eid al-adha) but she wanted to try on the 25th b/c of Thanksgiving weekend ( we don't really celebrate it, so I prefer 26-27). I was scheduled for a exam on Mon, but didn't go, and am scheduled this Friday for a NST, ultrasound and possible stri[[ing of my mebranes( which i am really scared of)

1) Is there any pain associated with cervical dilation? Or only at certain points of dilation? I have only had crampy menstrual lower back cramps for two weeks that fade, aren't super bad and have no rhythym at all. Nurse at the practice said pain in the back may mean baby's head is facing the wrong way. Any experience?

2) Anyone NOT had a cervical exam except right before pushing? Is it really all that important?

3) A doctor I detest, who wrote me a nasty ( half ALL IN CAPS) email regarding my weight that the head doctor had to smooth out may be on duty Wednesdays, (where my weight really wasn't an issue,btw). This practice told me I had no options, really; if she is on duty, I had to deliver with her. Would you deliver to a doctor that embarrassed you and you had been avoiding all your pregnancy ? I am seriously considering just busting out shoelaces and clean towels and having the baby here if he comes before 8 am on Thursday. What would y'all do at this stage? Other than begging on this Friday appointment if I make it that far..

Thanks for reading this and replying!!!

[Lily's_Mom]

Originally Posted by Mayrigah

1) Is there any pain associated with cervical dilation? Or only at certain points of dilation?

A woman's cervix can dilate without her being in any pain at all. For me, contractions that worked to dilate my cervix felt very similar to menstrual cramps, and I could feel the pain centered right in my cervix.

Back pain could be a sign that the baby is posterior (baby's back against your back). Try spending some time on your hands and knees so your belly is hanging down like a hammock, and baby can rotate so baby's back settles into your front (baby's back is heavier than its front, so gravity pulls it down).

Originally Posted by Mayrigah

2) Anyone NOT had a cervical exam except right before pushing? Is it really all that important?

If I have this baby at home, I will not have any exams. In the hospital, they like to know what your progress is so they can figure out which interventions they can do to make you have your baby faster. So, *they* think it is important. If I end up in the hospital this time I will be saying "No thanks!!" when they want to check me. I had enough people put their hand up my hoo-ha last time.

Originally Posted by Mayrigah

3)Would you deliver to a doctor that embarrassed you and you had been avoiding all your pregnancy ?

I had a horrible, creepy, disgusting resident do inappropriate things to me the day before dd was born (needing a big bright light and a speculum to check a pregnant woman because she has a cervidil in there? And he got in trouble for not having a second attendant with him while he was 'examining' me. No, my husband doesn't count as a medical attendant. ). Anyway, the next day he was on shift again and I told my nurse that I didn't want him anywhere near me. Never saw him again.

So just speak up and say you do not want that particular doctor to enter your room!

[akind1]

Not a BTDT (yet) but I feel you; I was due 11/7 and am still preggo. As far as I can tell, there *might* be some discomfort prior to being 4-5 cm; but you can have cramping, and small contractions without dilation. I've had all of that and false labor for 3 or 4 weeks, and am only 60% effaced and 1 cm dilated.

As for the exams hurting; if you have a good provider, it may be uncomfortable, but it shouldn't hurt. I have had only one (of 4) exams be at all painful, and unfortunately that is the midwife on call Friday, at which point I'll be 41+6 (they won't let me go farther than that). I have an appt Thursday and if everything looks good, I will ask to be induced then.

I will say that if you are facing possible induction, an exam may not be a bad thing, as without it they can't determine a Bishop score, which can help them determine 1) if you are a good candidate for induction at all, and 2) what sort of induction method to use. the score looks at your cervical ripeness, position, effacement, and dilation. If you score low, they would need to use ripeners to start out, like cervadil or some other prostaglandin. If you are good and ripe and score pretty high, then you can be induced with other methods, and are more likely to have a successful induction w/ vaginal delivery rather than c-section.

If your only choice is a provider you are very uncomfortable with, or a UC, I vote UC - mostly because I'd be ok with it myself and seriously considered it, until my blood pressure started being wacky. Otherwise I'd ask for a different day, even if it is a day or two before the 25th, so that you have a provider you are comfortable with.

HTH - and good luck!

[crunchy_mama]

On the pain and dialation that is really so variable.

I haven't had any vag exams and don't plan to have any at all, period.

I also would be strictly avoiding the nasty dr as well. I would be asking for another appt and then telling them whatever you have to make that happen OR if you are comfortable with it UC.

[notjustmamie]

1) It's not uncommon at all to dilate and not know it. Many women dilate to 3-4 without even realizing they've had contractions. In any case, how far dilated you are is completely irrelevant at this point (and, in fact, most of the time). I am due next week and have had zero cervical exams. I may ask for one when I feel like pushing, then again, I may not. Which leads us nicely to ...

2) No, there is no reason at all to consent to a vaginal exam unless YOU want to know the state of your cervix. Dilation prior to labor is no indication of how soon you will be in labor, or even how quickly it will go. Most hospitals tend to work on a 1-cm-per-hour expectation, but in reality, that's simply an average. Many women dilate several centimeters in one hour, then won't dilate at all for several hours (or vice-versa). The only time I would ask for a cervical check before labor is if I had to induce (for a medical complication--I would be VERY reluctant to induce simply for being past my EDD) and wanted to check out my Bishop's score.

3) From what I understand, a hospital cannot refuse to admit a woman in labor. They also can not force you to have a particular caregiver. If you end up going in the day this OB is on call, I would simply refuse to allow him access to your room or your person and insist on another HCP. Now, you may end up with a not-so-NCB-friendly OB, but it sounds like this guy isn't so friendly in the first place, so that might not be such a loss.

Finally, about the possibility of induction--they cannot force you to induce. It is quite likely that you will go into labor on your own before 42 weeks (as I recall, average natural gestation time for first-time mamas is 41 weeks). It seems as though the OB practice is at least being honest with you that they prefer to induce you before Thanksgiving so it doesn't mess up their holiday plans. However, quite frankly, their holiday plans aren't really your problem! Your holiday plans, on the other hand, should not have to be changed just because it's more convenient for your OBs to induce you earlier. If you are comfortable being induced at 42 weeks, go ahead and schedule it for Friday the 27th. If you're comfortable going later, don't bother to schedule, or simply cancel the appointment.

One last thing--I personally wouldn't have my membranes stripped. There isn't any clear evidence that it hastens labor and it can be very uncomfortable (especially if cervical exams are already difficult for you because of your history). Additionally, they run the risk of introducing bacteria (and the possibility of infection) and prematurely breaking your water, in which case, you'll likely be "on the clock" and given the choice of an immediate induction or c-section. I know many women do believe in membrane stripping, so don't just take my word for it, but please do your own research.