I HAVE to get a vaginal check during labour?

[Tulafina]

Here's the story..

I had my 17w appt with my MW who I absolutely adore She is a very hands off MW which is one of the reasons I love having her with me during birth(my 2nd son was a homebirth with her attending).

Anyway, she had me write out my birth wishes and one thing that's important to me this time is to NOT be checked unless we feel there is something wrong...like heart decels, etc.

She told me that it wasn't possible for that to happen. I had to be checked. At least once maybe twice. Very minimally of course but she said that I had to be checked for cord prolapse, making sure babe was head down etc...

Now with both my previous births(DS1 nuchal arm and DS2 posterior/face) I have never pushed before I was ready. Both my babes have been head down and easily palpated to find that they were head down. They have engaged before and during labour but my water has broken at 9-10cm both times. I really don't feel worried about this...

(past experience- she checked me during my last birth(on my back with a posterior baby...it was pure Hell!!), once, and I was 9cm. My water broke during my vag check, which I still wonder about...did she break it or did it break when she checked by accident, or was it just time??? And when it broke she said it was all good, had me sit on the toilet for awhile and then literally minutes later I was pushing...But when he was crowning I noticed a funny lump with my hand. We discovered he was a face presentation and she had me push like mad to get his head delivered with the next push...which it did easily. So I still wonder if her breaking my waters...or checking me etc helped him move into an unfavorable position)

So what have your experiences been with vag checks...are they truly necessary?

Thanks for reading...

[Dese]

I think it's reassuring to midwifes to be able to check you initially in labour, to determine where you're starting from. You can check yourself for prolapsed cord as far as I'm aware, should be fairly easy to feel if you have something pulsing in the vagina.
I'm going to second you on the being checked on your back in labour being pure hell, I had to lie down after labouring standing up, for the check, and it was the worst pain of the whole labour. I want minimal checks this time and would love to refuse all, but I think I will allow at least the initial. Any person who is practiced at delivering babies should be able to tell by external signals that you're giving what stage you're at.

[xixstar]

I'd be a little riled if I was told I had to be checked, but I'd probably just let it go for now because things in labor kinda go their own way.

I had planned on no checks at all, but after not being able to tell what I was feeling myself and feeling like I was either somewhere or nowhere, I actually asked to be checked. So considering the labor can always be different, I'd probably just let things be and see whats going on in labor. If I didn't feel like being checked at the moment, I'd put it off -- but if it was a relationship that I wanted with my midwife I'd probably go along for now and just see what happens in labor.

as for do I think they're necessary, nope. you could check yourself for things like prolapse and position can be determined from the outside fairly well.

[Tizzy]

Even though we planned a UC, so my midwife was expecting to be hands off, I checked myself. So when I talked to her and she asked, I was able to tell her (4-5cm 75-80 eff). Mind you I had my waters leaking so that was a very good reason to decline any checks for the infection risk factor.

[Belle]

You don't need to be checked during labor. She can check if the baby is head down by palpation. Using a VE to check for cord prolapse is just silly. The cord could be compressed but it doesn't have to be in front of the baby's head to do it. A better way to check for prolapse would be to just listen to the baby's HR.

She probably didn't intend to break your water last time. But one of the risks of VEs are unintentional ROM.

[Mama~Love]

Your MW sounds a bit controlling. I never had a check during labor. I did what I wanted, and pushed when I felt like it. I never wanted to be checked, and she never asked. But baby showed up only 45 min. after she got there, so she was busy getting everything ready.

[MammaB21]

Hhmm. She doesn't sound like a very hands off midwife, especially if she did in fact break your waters. No offense. Not that she is a bad mw, just that from what I've heard it isn't necessary to do internal checks during labor.

She should be able to feel what position the baby is in externally. Also, listening to heart tones should be able to tell her what is going on with babe and the cord. And as far as where you are in labor, well it's pretty easy to tell that in an unmedicated birth strictly by observing.

[broodymama]

During my last two births (homebirths) I didn't have any vaginal exams. I pushed when my body was ready, no problems. I'm not planning on any vaginal exams during this pregnancy or birth either. (Everybody and their freaking brother had their hands up their during DS' hospital birth, that was more than enough for me.)

[loveneverfails]

I'll be the weird person out and say I would not have a problem with that, as it's one check. There may be a legal requirement there in terms of her practice to confirm that you're talking about a vertex presentation and that there is no cord prolapse. And she didn't say *when* that check needs to be. You may be able to wait until the urge to push, do a quick exam in whatever position you want to verify complete dilation, and that counts as your "one" exam during labor.

I don't think it's fair to the midwife to think she ruptured your bag at 9cm without any specific reason as to why you think that's possible or likely. If you were 4 and a bag broke during an exam, it'd be more suspicious. And I really don't think that AROM (if it was ruptured intentionally by her) at 9cm on a multipara would result in face presentation either.

I guess I'm not understanding why you "adore" this midwife but also don't seem to trust her judgment or her character to believe that she told you the truth that your water just broke during an exam at your last birth. That is the red flag for me, not that she feels like she needs to do one vaginal exam or may be legally required to do so. If you don't trust your caregiver and have a relationship of mutual respect, that is a bigger issue to me than anything else you raised.

[finn'smama]

I will probably get the same response from my mw when I let her know that I don't want VEs either. I'm in Ontario, where mws are heavily regulated, and they probably are required to do VEs. However, she can't force you to do it, right? You may just have to sign something...

[boheime]

You do not have to allow anything.

[Tulafina]

After reading my original post I realize I left out a few small things...

In Canada, midwifery is regulated by the government so there are rules that mw's must abide by...no breech or twins born at home(if known before labour), as well as doing certain procedures which I'm guessing would be checking heart tones, vag exams etc. I'm not 100% sure about vag exams so I wanted to see what other people's mw's did for them during labour.

Mama~Love... I guess after thinking about it she is a bit controlling but I wonder if it's to cover her butt because of the regulations they have to abide by...not sure...

MammaB21~ in comparison to other mw's in the area she is very hands-off and she's near retirement so she's had a ton of experience with breech, twins(before Midwifery was funded by the gov.) home/water birth etc. I do trust her but I wonder if she wasn't being funded by the gov...would she still require certain things at a birth(checks)

loverneverfails~ It wasn't until recently that I started thinking about this stuff(I gave birth 20 months ago) and when I asked her she doesn't really remember exactly how things progressed(she does do 6-7 births a month). I do really enjoy her as my caregiver. You may be right though. I don't feel a fantastic connection to her but after interviewing many mw's she was the one that had the same ideas as me about birth. And where I live it's almost impossible to find a mw unless you call the instant you find out you are preggo and even then many mw's here have a wait list of 30 people or more. I cannot change caregivers~I would never find another mw.
And about the rupture....I have been a doula at one of her births where she did intentionally rupture membranes at 8cm because of excess fluid and she wanted to make sure the cord didn't prolapse...I totally understand why it was done but I didn't like that she didn't ask the mother if it was ok for her to do that. Kinda made me think about my own birth....

Finn's mama~ You have to let me know what your mw says about your birth wishes...I'd be very interested to know!!

Thank you for all the replies!! Most of you didn't have to have one if everything was going smoothly which is what I figured.I think that if I feel that everything is fine I will not consent to be checked. If I have to sign something I will.
Take Care!

[SuzyLee]

Just an fyi, I was checked 2 or 3 times during my labor with DS and never on my back- once with me sitting on a rocking chair, and 1 or 2 times while I was laboring in the tub.

Flat on my back was not going to happen!

That said, you can absolutely refuse. I have no problem with checks myself (I like them! I like to know my progress!) but lots of women don't want to be checked.

[jeninejessica]

Tulafina-- I'm in MB, but you should be able to find a copy of the guidelines for your province. In them it literally does detail the standards of practice for licenced midwives. One of the things I took out of ours was that the midwife is not allowed to do (premature births, breech, twins, etc) UNLESS SHE FEELS NOT DOING SO would be compromising your care. It may be worth asking her about this (if it's the same in Alberta). I know I looked at that information in the air of 'if I were to be breech, and told MW that I would either deliver with her, or unassisted, she would likely stick around, due to being able to give the best care.

I would also ask her if she would consent to you doing your own exams? That way you could check for the cord yourself, without feeling violated.

[Nicole730]

I'm going to request that I don't be checked until I am ready to push. I'm not sure how my midwife feels about it yet, but I will bring it up at our home visit next week.

I wasn't checked with DS in a hospital birth, with a midwife, until I was in labor for quite awhile and I was 8.5, almost 9 cm. When it was time to push about 30 minutes later, they just assumed that I was at 10cm. My water did break 15 hours before contractions started and my midwife did not want to check because of risk of infection. I would assume if my hosptial birth didn't require multiple checks, a homebith wouldn't either...

[katelove]

Would you feel comfortable asking her what are the things *she* feels are really necessary and why and what are the things she does because they're "required"? Either way you can still refuse but it might help you feel more comfortable with her philosophies/motivation etc.

When I practice midwifery in a hospital there are certain things which we "have" to do to comply with hospital policy. However, the patient is not bound by hospital policy so if they choose to refuse then I just need to document in my notes that I fully explained the procedure, why I wanted to do it, what the implications of refusal could be and that the patient refused. I'm also obliged to offer alternatives if they exist. I'm sure your midwife could do that too and be protected even if you chose to refuse procedures that she was required to suggest.

[sattygirl99]

I'm planning not to be checked until I feel an urge to push... And only then because I felt the urge to push with DD VERY early (around 5 CM) and I don't want to push and swell my cervix.

I am also thinking about educating myself and DH to do self checks for the early part of labor, simply so we don't call the midwife too early... With DD, I got to the hospital (attempted VBAC) and was only 3CM and because I was a VBAC they insisted on admitting me. Of course it's different with a HB but I'd rather be 5 CM before I call the MW (I go from 7 to complete fairly quickly so 5 seems like a good number, lol).

[Dese]

Now that I've had my second baby a few days ago I can tell you what I did this time around! I only had the one internal right near the end to determine where exactly I was at because we didn't have the back-up midwife with us yet. My midwife needed to know when to call and make sure we had someone so she didn't have to call 911. I waited until a contraction passed and then lay on the bed. My doula sat next to me on the bed, my hubby stood next to me, both held my hands and talked to me and kept me calm while I was checked. My midwife asked to keep checking me during a contraction so she could see what my cervix did, and I was able to deal with that so much more calmly and with less pain than during my first labour because I had my doula there helping me through it. Later they told me that I was 5-6 cm initially, 10cm during contraction with the head descending so as you can imagine there was a bit of a hurry to get the back-up midwife there.

I think having had the two experiences, if you have to have the internal, if you can do it with someone supporting you and talking you through it it makes a world of difference.

[AustinMom]

I think if she is limiting it to only 2 exams that is a good thing. Most MW do more, and some never do any.

If it was uncomfortable to be examined because you were on your back, maybe she can check you when you are on your hands and knees or in a different position.

Also, to see if the head is down, you can do the Leopold's maneuver, which is all outer palpitations on the belly to find that out. Or do belly mapping to find out the true position, posterior, anterior, transverse, etc.

Every birth is different, even with the same woman, so there is still a chance you will have the pushy urge before 10 cm, and if you do, some see it best to wait till full dilation, if you do, then you will want to be examined then.

In the end, it is a procedure/intervention that has to have your consent. So there is always that.

Happy Birthing!