VEs in Late Pregnancy- Their Emotional Value? - Page 2

[Turquesa]

Originally Posted by Addie

but they offer them because some moms just want to know, and some moms come in and say that their friend/mom/sister is demanding to know.

Oh good grief.

[Twinklefae]

I did one, on a Friday appt, when I was 41 weeks. We were discussing membrane sweeping. She couldn't even FIND it it was so high and tight.

I went into labour on Monday.

[Quinalla]

I was pretty "meh" on this issue, so since my OBs standard practice was VEs starting week 37 IIRC I didn't push it because it didn't really matter to me. But yeah, when people asked, I would tell them and then immediately follow up with "...But it doesn't mean anything..." and go on to explain why. Granted, since I gave birth at 38 weeks, I only had one, so maybe I might have started pushing back if I felt it was too much at some point. And my birth was so fast, I only had two VEs, one when admitted to triage and one I asked for because I felt I was complete and was, so I guess for me, VEs were never an issue really

[Smokering]

...They DO routine VEs before labour??? My midwife didn't do any until I was in labour. I absolutely hate VEs... there's no way I'd have up to 6 of them for no good reason! Yikes!

Also, in New Zealand people ask about a baby's weight, but not length. I'd always thought knowing the length was an American thing?

[CEG]

I am a CNM and I try to talk people out of routine VEs and very very rarely succeed, even after I explain that it means nothing. Granted, I work in a practice where people are not trying to avoidintervention but the discomfort along would be enhough for me to say no, even if I had no philosophical objection.

[Pirogi]

I had one VE when I was around 20 weeks with my first baby, because I had a history of HPV, LEEP, and I was worried about incompetent cervix. It was all for naught; my cervix was long and firm and high. I went into labor on my own at 37+4. I had 2 or 3 (?) VEs during labor, without the backup midwife asking or getting consent. Annoying.

I won't be having any this time.


This may not be a popular opinion, but I really think that our and our care providers' (some of them) fascination with VEs (and other interventions) has to do with gender roles. Poor, helpless, miserable pregnant women who need to be saved. Strong, smart, typically masculine, white coat care provider whose job is saving. It wasn't so long ago that one of the most respected obstetricians of the time, Dr. Bradley, was paternalistically addressing women in childbirth education books and classes. Immensely helpful to many of the women giving birth at that time and now? Yes. But his tone and some of his message grates on some of my more feminist nerves. Nevertheless, most women then and many today still carry those cultural/societal expectations of distressed damsel/gallant doctor. VEs (and other interventions) are an illusion reinforcing the whole concept.

ETA: I am not trying to make anyone feel bad for getting or wanting VEs. I am having a hard time all of the sudden getting the right words and tone to come across the way I want, and not just online. I think I am going through some weird pregnancy hormonal things right now.
(Save me! )

[MegBoz]

Pirogi,

Really interesting post. I could see how that could play a part.

[Turquesa]

Originally Posted by Pirogi

This may not be a popular opinion, but I really think that our and our care providers' (some of them) fascination with VEs (and other interventions) has to do with gender roles. Poor, helpless, miserable pregnant women who need to be saved. Strong, smart, typically masculine, white coat care provider whose job is saving. It wasn't so long ago that one of the most respected obstetricians of the time, Dr. Bradley, was paternalistically addressing women in childbirth education books and classes.

Love your post! FWIW, it's popular with me.

My mother has always prefaced her opinions with "I'm not a feminist but . . . " (Translation: "I am a feminist and . . . " ) Anyway, I won't say much more out of UAV concerns, but she knew Dr. Bradley and can validate the content in your post.

Because obstetrics is a male-dominated profession (not just in number of OBs, but also in its overarching philosophies), I think that in terms of what you've described, there's no guarantee that a female OB will be any better.

[Sudonk]

Originally Posted by nia82

@ Megboz: wow that is creepy... I'm starting to think obgyns do the exams to push inductions....

It's not your imagination, that is becoming routine. It used to be that OBs would do a cervical exam and say, "Well, there's nothing happening. Obviously, your body needs help getting this birth going, so we need to schedule an induction." But now I've known several women in the last year who were told, "Wow, you're (X) cm dilated! We need to induce you right away!" And I've even known a woman who was told that since she was "so far along" it was illegal for them to "let her leave"! It's ridiculous. And the ironic thing is that the women I know who dilate significantly before their birth begins don't even have particularly fast births. Two women I know who have a history of dilating to 8 prior to the start of their birth still have 5-8 hour births once things begin. Hardly an emergency! I recently discussed this topic with a midwife who observed that women who have truly precipitous births aren't going to be walking around largely dilated for weeks. When they're 8 cm, they're probably minutes from meeting their baby, not weeks!

[VillageMom6]

I thought of this thread and you lovely ladies yesterday at my midwife visit.

She is definitely not paternalistic and does not suggest/encourage/require VEs but I asked for one. (I'm 37 weeks)

I know it tells me nothing valuable but I liked hearing that last week I was 1cm and the baby's head was "floating" while this week I am 2cm and the baby's head is at -1.

Since when is pregnancy an entirely logical experience??

[MegBoz]

Originally Posted by VillageMom6

I know it tells me nothing valuable but I liked hearing that last week I was 1cm and the baby's head was "floating" while this week I am 2cm and the baby's head is at -1.

Since when is pregnancy an entirely logical experience??

, well you, and others, seem to have confirmed my theory in the original post - that although we intellectually realize that the data means nothing (with regards to precisely when we'll meet our baby) we still want to know anyway because emotionally, we FEEL better knowing.

But let me ask you this, you said you LIKED hearing that you'd made "progress." A key question, I think, is Would you have been disappointed, upset, or frustrated if you had made zero progress?

I felt that intellectually I WOULD have been upset if, at 40W, I was still hard, high & closed. I just felt that that was stress I didn't need. Likewise, if I was like 3 cm, 80% effaced, etc. I might have become even MORE anxious - making the next 11 days I waited all that much harder.

So, , point being, I too am guilty of not being logical. But I made the decision that I'd rather not know because it could cause me stress. So rarely in our lives can we "opt out" of stressful things. It's so rare that we have an opportunity to utterly remove or otherwise avoid a source of stress (Well, not without any negative consequences). When I do have that opportunity, I take it.

[billikengirl]

Originally Posted by MegBoz

So it is as though there is a disconnect between

• The intellectual realization that this data means nothing (without labor, of course)
• & The emotional desire to view it as “progress” & a good thing (a sign that birth is coming soon)

This is exactly what I experienced. I knew (and preached to others!!!) that there's no crystal ball up in there, but I *STILL* requested VEs at 39/40 week appointments. I just couldn't help myself, I wanted to know, even though I knew knowing meant nothing. And then when I was 40w+2d and measuring big and baby was still high it started to get in my head that there was something wrong with my body. So I still preach that it's a bad idea. I had the baby the next day, and I was 1cm/30%/baby nowhere near dropped 12ish hours before going into labor.

[VillageMom6]

Originally Posted by MegBoz

But let me ask you this, you said you LIKED hearing that you'd made "progress." A key question, I think, is Would you have been disappointed, upset, or frustrated if you had made zero progress?

Oh, haha, YES! I would have been totally bummed!

But in my defense, I am only 37 weeks. I have always gone to at least 39.5. So if I had made no progress between 36 and 37 weeks, I would have been bummed, but gotten over it quickly. It's just too early to worry about it.

Now if I was 39 weeks and still high and tight? That would send me into a funk that would last until baby arrived, whether that was 14 days or 14 hours later. You are so wise to avoid that source of potential stress.

I completely intended to take the same patient, non-stress-adding approach. I was going to decline any checks until I felt the urge to push.

I had also considered not finding out the baby's sex at the 20 week ultrasound and I was going to wait to pee on a stick until AF was officially late.

Sooo... I'm at a 2, it's a boy and I got a BFP at 10 days post ovulation.

[BlackSheepPDX]

Originally Posted by billikengirl

I knew (and preached to others!!!) that there's no crystal ball up in there

This cracked me up. So....that bowling ball between the legs feeling isn't the crystal ball?

As for exams, last pregnancy, I had one at 41+ weeks just because I didn't know WHAT to think at that point and probably didn't really make the connection about it not mattering anyway. I then was checked once during labor, when I just wanted to know "if it was working" (lo and behold, my "crimeny, is this working, because I'm getting really tired of it" was my version of transition, and I was 9cm).

I won't be checked this time prior to labor, and then, only if I am feeling a strong need for reassurance when I'm well into it. Otherwise, I believe that my body is going to do its job, and I don't need anyone poking around up there.

[MsBlack]

To my way of thinking, prenatal VE is primarily if not entirely a ritual with various underlying meanings and purposes. I agree with Pirogi that it's a paternalistic thing, one of numerous acts and words used by OBs (and sometimes hb mws too) designed more than anything else to serve the creation of a power structure in the mother-doctor relationship. Well, not just ' doctor control over patients', and the corresponding participation by patients to essentially 'submit' to the doc's power--but also feeding both parties' sense of 'power over birth'.

As some have pointed out, VE has no true value as a measure, or predictor; even within minutes of birth, VE can be misleading as a source of info (thinking now of the mama whose baby was posterior, cervix was high and very posterior, no more than 3-4 cms--hard to tell because hard to reach--and having contrax every 4min but only 45 seconds long--who had a sudden, VERY intense shift in labor and was pushing her baby out 15 min later). The informational/predictive value of VE is even LESS reliable prior to labor's onset. It has NO predictive value, at any time! But it has come to be so important, one way or another in the course of care, and a woman's experience of, and relationship with, her care provider (and the provider's relationship w/her of course).

We have been taught, over the course of one short generation, to accept and even 'believe in' the power of prenatal VE (and I'm so glad to be older than that...never had ONE VE during pregnancy, never had it offered even, never missed it!). We were taught by OBs in the last 20 or so years...whether directly by our own OB, or indirectly by our friends/relatives who went before us in babyhaving...not just to 'allow' prenatal VE, but to WANT them, to VALUE them, to feel that something is 'missing' if they don't occur!

As a feminist, as a 'rhetorical critic' (an analyzer of words, images and actions under the assumption that they all have symbolic significance to people along with any 'material', literal significance), as a mom and 'Trust Birth' mw, I've had some 30 yrs to consider all matters 'pregnancy and birth'. And I will tell you that the great majority of VE is done as a ritual with almost NO real value as an assessment tool (occasionally it can be--at least for those of us with insufficient knowledge of 'non-VE methods' of determining some issues w/labor). Actually, a great deal of what happens in our care has far more symbolic significance than of actual value. Not to say that there should never be anything 'ritual in nature' in our lives or prenatal care...that would be impossible, for one thing--ritual and symbol are enormously important to us, are an intimate part of how we communicate and form our selves and relationships, our lives and societies, religions, all of it. It's just the things we don't KNOW are ritually based, the things we believe have 'real', material value, that have so much power over us.

But, with or without 'actual assessment value', VE can sure be of great value in the establishment of power relations between doc/mw and 'patient', and in the securing of our sense of control over birth! So, anyway--I won't say that a woman should or shouldn't have VEs in pregnancy, and I won't tell anyone how to feel about their prelabor VEs, should they choose some...I just hope to prompt further thought about all this, so that women can make truly informed (informed and aware on all levels) and FREE decisions about it.

So--maybe, knowing (well, agreeing to some extent anyway?) that VE is so primarily a symbol, a ritual with 'hidden agendas' and not so obvious impact on us, a woman might even choose to allow them so that her doc/mw won't feel threatened by her, will have some notion of her 'adequate compliance with protocol' and not get buttons pushed that don't warrant pushing. By the same token, a woman who really wants, say, a normal birth with no/few 'interventions', might begin during pregnancy by refusing VE as a way to show that she is already taking charge of things.

People have different ways of establishing their power in relationships, and getting what they want, however--I'm not saying that 'refusing VE/other testing' is THE way to demonstrate your will to take charge of things. Still--when you know what's going on beneath the surface, are aware of the symbolic force of particular words/actions, you give yourself more power to choose, and more understanding of why one might make this choice or that one!

To wind it up...VE is a ritual, and has little to no material value. Use it accordingly or don't, all for your own good, and nothing else!

[Pirogi]

Originally Posted by BlackSheepPDX

(lo and behold, my "crimeny, is this working, because I'm getting really tired of it" was my version of transition, and I was 9cm).

That was exactly my experience of transition too! I never had "I can't do this anymore/I don't want to do this/take me to the hospital/kill me NOW!" thoughts. The only thing I said to my husband the entire labor (except like, "Water," or "Trashcan - puke!") was to look at him in the eyes and say, "What if it's not working??" Bless him, he said, "Oh, it's working, honey," and that satisfied me at the time. Of course it was working, why wouldn't it be working? His good response/my openness to his suggestions at that point in the labor probably kept me from requesting anything like a VE from the midwife.

[autumnfairy76]

I do find very much that the "wanting to know" is very much an american thing as well as the fact that in other countries, like in my experiences France and Italy, we are given much much less information on our pregnancies and test results. For example, with my last birth in France I was only told after a vaginal exam that resulted in enough concern to put me on a partial house rest with home midwife visits, that I was "shortened". There was no percentage effaced information given, no dialation info, there was no info on stage (-1, 0) etc of baby there was just a vague "shortened". The only numbers I was given in labor was how many cms. I was. In fact, in Italy, I had to ask the ultrasound tech many questions about the baby (length, heart rate) because NONE of this info was given. It was one of MANY incidences where the health provider was irritated for my asking too many questions for things they felt I didn't need to worry about. I think part of it is there is a much greater tendency to trust drs. opinions as the word of God and that one should never question authority. I find it very very annoying, but on the other hand, with this pregnancy since I am so much more comfortable with it, I have a better trust that my body is doing great, and I don't crave that information as much. I am still amazed at how much information women are given on their pregnancies in the states. I think in a lot of ways not knowing leads to less interventions too. Which with socialized medicine, you don't have as much of a push for interventions for more money...

[MsBlack]

Originally Posted by autumnfairy76

I do find very much that the "wanting to know" is very much an american thing as well as the fact that in other countries, like in my experiences France and Italy, we are given much much less information on our pregnancies and test results. For example, with my last birth in France I was only told after a vaginal exam that resulted in enough concern to put me on a partial house rest with home midwife visits, that I was "shortened". There was no percentage effaced information given, no dialation info, there was no info on stage (-1, 0) etc of baby there was just a vague "shortened". The only numbers I was given in labor was how many cms. I was. In fact, in Italy, I had to ask the ultrasound tech many questions about the baby (length, heart rate) because NONE of this info was given. It was one of MANY incidences where the health provider was irritated for my asking too many questions for things they felt I didn't need to worry about. I think part of it is there is a much greater tendency to trust drs. opinions as the word of God and that one should never question authority. I find it very very annoying, but on the other hand, with this pregnancy since I am so much more comfortable with it, I have a better trust that my body is doing great, and I don't crave that information as much. I am still amazed at how much information women are given on their pregnancies in the states. I think in a lot of ways not knowing leads to less interventions too. Which with socialized medicine, you don't have as much of a push for interventions for more money...

Thanks for sharing your perspective, which I find so interesting. Can you say how 'not konwing leads to less interventions, too' ?

I can see how, if a woman just doesn't have the info from her doc and the technicians, then PARENTS are less likely to push for inteventions themselves. And I have thought (from the perspective 'across the pond' where we DON'T have socialized med) that socialized medicine, with no profit-concern for docs but a greater eye for saving $$ on the part of the administration, might be less likely to push for costly interventions of the sort that are not strongly evidence-based. And I would really like to hear more from you on this idea that 'not knowing leads to less inteventions'. I find your thought on this makes me very curious to hear more

[autumnfairy76]

First, just to clarify, I am an american. So I myself struggle with this wanting to know and feeling like I should know exactly what is going on, but at the same time, I see in previous posts on this thread, the information causing an unneccessary increase in anxiousness by the parents which could lead to requests or like you said, agreeing to more interventions. I also see perfectly healthy babies of my friends being born at home, UC and with midwives, who have had much less exams and information given to them through ultrasounds, tests etc and then go on to have natural births with no interventions. It's not that they are un informed, or under informed, they are just not over informed, over tested, over examined. If that makes sense?
I felt under informed in Italy, but it was really a cultural thing. Everything was fine with the pregnancy, and in retrospect they *were* giving me a proper amount of prenatal care. I just felt that culturally I was being dumbed down. That they felt I was not intelligent enough to handle knowing more about my body. That I didn't need to worry my little head about it.
I'm ok with knowing less now in with this pregnancy, but only because I trust my body more, not the doctors. At least in Italy I was encouraged to put this faith in my body whereas, when I came to France at 6mo preg with DD I was told to put faith instead in the Drs who would "take care of everything" Sorry to get a little OT here...

[WifeofAnt]

Originally Posted by Addie

some moms come in and say that their friend/mom/sister is demanding to know.

You know pregnant women are stripped of all their dignity as human beings when people ask how things are going in their vaginas.