vaginal exam when ready to push REALLY necessary? - Page 2

[BlackSheepPDX]

AnneCordelia: Thanks for your description of breathing down. I'm getting ready to birth my second, and really wanting to let my body do the work this time, rather than the purple stuff I did the first time.

[luvmybaby333]

I'm not a midwife or OB, so I'm not sure if I'm qualified to answer this. But in my experience, it didn't appear to be necessary.

My first was born in a hospital and we had all the unnecessary trimmings (just short of a cesarean.) They checked me non-stop. It was painful and frustrating and didn't seem to help anything. I guess it was probably necessary, though, since I had been given an epidural and had no idea what my body was doing.

My second daughter was born at a free-standing birth center. My "real" labor was very short at just a few hours long. My midwife napped through most of it. The doula was the one attending me and guiding me through what I was feeling. When I started feeling "pushy" she made me get out of the bathtub (their birthing tub wasn't set up at the time.) I remember her guiding me to the bed and letting me assume the position I felt to be most comfortable. I remember her telling me to listen to my body and go with the urges I was feeling to push. But because if my prior birth experience, I started to panic. I kept asking if it was okay for me to be pushing-- she hadn't even checked me. Surely I couldn't have dilated that fast... from 4 to complete in like 1½ hours! She told me that it wasn't necessary. She said that obviously my body was ready to push my baby out, whether the midwife checked my dilation or not. And she was right. I pushed for awhile and out came my baby. Nobody had to get all up in my business or anything.

[MsBlack]

Originally Posted by Apricot

I've seen women spontaneously push a baby down with a cervical lip leading. That's probably damaging to the pelvic floor - the cervix is to supposed to be so low as to be seen. It certainly hurts like a mother.
I heard it in her voice, the painful shreik - but it took 20 minutes to convince her to let me check, and reduce the lip. 5 pushes later, a she birthed her baby into her own hands.
Posted via Mobile Device

Um, Apricot...is there a typo here?

I'm pretty sure I know what you meant to say, but thought you might want to look it over

Also--I agree about things like 'painful shriek', there are usually observable signs that pushing is not right somehow. With or without VE to determine the magic 10, I always watch/listen for those signs when mom starts to push.

Others who have sustained injury/swelling from pushing--first, I do try never to say never...all things are possible even if some are very unlikely when all things are as they 'should be' for that mom and baby.

So I wonder if all things were truly as they 'should be' for those of you who had swelling...immediately adding the disclaimer that of course, I speak ONLY from my own perspective about any/all 'shoulds' My perspective, then, is one of 'assisted but as much unhindered birth as we can get'--homebirth, yes, and also my being as much of a support, and as little of a manager as possible. Yeah, I do try 'never to say never' and know that someday I'll see a problem I've not yet seen...but I've not yet seen swollen cervices from pushing too soon, malpositioning, or anything else.

Your stories then make me wonder if you were getting as much support and as little management as possible. Were you well fed, hydrated and well rested, were you supported by care providers in moving/positioning yourself according to your own instincts--with no attachment (by wires/tube, by internalized 'customs' or external directions at the time) to a bed or to any position? I wonder because in my practice, those things do not apply. Sometimes I do have to address internalized customs of birth, if I see signs that she may be following those, with signs that this may be working against her.

I guess the answer to this question is about place of birth and type of provider used, not just the simple 'can cervical swelling occur if you push too soon'. It might well be a good idea for a hospital birthing mom, or a mom at home with a more 'directive' type of mw, to be sure with a VE that she's ready to push. Some of us who are more 'instinct-supportive' than 'process-directive' may well see little by way of these issues. Maybe this is something for moms to take into account when it comes to choices about VE about pushing. You have your good reasons to choose a place of birth and provider that suit most of your needs the best. But as with all else concerning birthplace and attendant, seems wise to take all factors into account when making choices and reviewing information from others.

[MegBoz]

Originally Posted by Twinklefae

I don't feel that anyone is listening to my story - it can happen. I would rather have 100 unnecessary VE's than have one c-section because I refused it.

I'm sorry you feel that no one is listening to your story. Do you feel that way because we're not automatically agreeing that VEs are always 100% necessary prior to pushing?

While I don't doubt your story, I do still doubt the fact that VEs are always necessary. In other words, just because pushing without being checked was damaging for you doesn't necessarily mean that everyone needs to be checked before pushing. That's the key to "evidence-based medicine" - we can't take individual stories & make practice decisions based upon them. That is "anecdotal" evidence. Large sample sizes & "statistically significant" data points are crucial.

However, I do still wonder about it. As I posted earlier, logic & other things I've read have led me to believe that, with a properly-positioned baby & in a labor that progresses 'normally' (exactly as mine did) that VE isn't necessary. I haven't discussed it with my new HB MW yet (only 10 weeks now), so I'm curious for her input. But, again, the signs were so clear for me & when I did finally let myself give in to the urge, I felt DS moving down. (I'm told I'm rare in that I WAS able to fight the urge to push while we drove to the hospital.)

Anyone know what Ina May says on this? It's been a while since I read the article on the "rule of 10" but I think it had something about a MW going to Africa & almost never seeing a swollen cervix. I believe she was theorizing all the 'interference' in the first place in American hospitals (such as regular VEs throughout labor) tend to mess things up. And, again, that theory is logical to me since we know disturbing the perineal tissue (vagina "wrenching") during pushing can cause swelling there - why wouldn't we think that regular VEs during labor might cause cervical swelling? Just a thought though - Ha - I probably ought to reread the article.

[Twinklefae]

Originally Posted by MsBlack

Your stories then make me wonder if you were getting as much support and as little management as possible. Were you well fed, hydrated and well rested, were you supported by care providers in moving/positioning yourself according to your own instincts--with no attachment (by wires/tube, by internalized 'customs' or external directions at the time) to a bed or to any position? I wonder because in my practice, those things do not apply. Sometimes I do have to address internalized customs of birth, if I see signs that she may be following those, with signs that this may be working against her.

My pushing started at home, well supported by my doula and my husband, who were doing everything in their power to follow my lead, and get me through each contraction in whatever way seemed best to me.

I feel that no one is listening to me because of things like what you posted here - it is the typical "well, you must have done something wrong" attitude I see in the Natural Birth Community, and it does not help your position.

I understand that some truly feel that they can just 'tell' by look or feel or sound that the pushing is 'right' or 'wrong' but I swear, I didn't look any different later, when I was fully dilated and pushing my son out then I did at 4cm pushing against my nearly closed cervix.

[GoBecGo]

I don't think they're necessary always, but sometimes they are.

With DD1 i was examined and found to be 2-3cm at 2.30pm. At 3.30pm i said i wanted to push and was told that i couldn't possibly be ready. By 4pm the urge was terrific and i said again and was pooh-pooh'ed again. I then fought that terrifyingly strong urge for the next two hours, clinging to the back of the chair i was astride and roaring my voice away (couldn't be heard for days afterwards) during contractions so i wouldn't push until finally at 6pm i was told to go try to pee and when i sat on the toilet her head crowned. Her body was born after i'd waddled back to bed for my next VE (which couldn't be done due to my V being full of baby by then). She was born at 6.15pm. I was at home.

10 weeks ago i had DD2, also at home but with an independent midwife who i trusted and knew (had never met my first midwife at DD1's birth). I felt pushy, and put my own fingers in but couldn't feel anything except an impossibly wide anterior vaginal wall stretching up into me. I asked the MW to check. I didn't know why at that point, but i needed to know. I NEEDED to. The MW did the VE with me on all-fours, and by the time she'd said to the student MW "can you write fully dilated, head at spines" i was pushing and the head was crowning. DD2 did not turn to deliver her shoulders and was out and screaming 6minutes after the VE. It turned out she had a knot in her cord and i think maybe some part of me knew that once she began to descend she'd need to be coming FAST.

So sometimes a VE creates a false picture of the labour, when too much focus is put on it, and sometimes it's a very reassuring thing. Ultimately it's something that the woman and (ideally) her trusted careprovider should be able to work through together.

[Youngfrankenstein]

I didn't have time to read the other replies but I'll say I had no VEs during my homebirth at all. When I told her I felt pushy she said to go ahead and try. I felt like I needed permission but she said to do what I felt. I must have been ready. I usually only push for 10-15 minutes anyway.

[MsBlack]

Originally Posted by Twinklefae

My pushing started at home, well supported by my doula and my husband, who were doing everything in their power to follow my lead, and get me through each contraction in whatever way seemed best to me.

I feel that no one is listening to me because of things like what you posted here - it is the typical "well, you must have done something wrong" attitude I see in the Natural Birth Community, and it does not help your position.

I understand that some truly feel that they can just 'tell' by look or feel or sound that the pushing is 'right' or 'wrong' but I swear, I didn't look any different later, when I was fully dilated and pushing my son out then I did at 4cm pushing against my nearly closed cervix.

Twinklefae--

I'm sorry that that is the way you hear me. I said that I 'never say never' for a reason--there are no rules that birth always follows! And no method or approach works for all, all the time. I know what has worked for me and my clients so far...and try to speak of what has worked for us...even knowing that 'never' and 'always' just don't apply. Still--is it ok to speak of what can work 'much of the time, for many people'?

I also was not saying that you, or anyone here who has posted of difficulties with a swollen cervix or pushing too soon on a closed cervix, did anything wrong at all. Not at all. I was suggesting or theorizing that different providers and birth places, in combination with each particular woman, can impact things that happen. I'm sorry about the way you read me, because what I was trying to say actually intended anything *but* 'blame'. For me, all that we experience occurs as a result of all people and various social and other factors (including outside things like the weather at the time) acting together. Everything and everyone plays a part...including random chance.

So I'm not judging...don't feel you did anything wrong...and I do believe that your voice is important here. To speak my own theories and experiences is not to dismiss yours...it is only speaking my own theories and experiences that are different from yours. All of our voices are important; to me that's the beauty of MDC--we share our stories and info we've gathered, and everyone gets to weigh it for themselves in trying to make their own best choices. By the way, I've certainly had clients who wanted me to check them before they pushed--and I do, it's not my decision to make for them, or to judge in any way.

[ErinMSB]

I'm right there with the PPers!

I had a very strong urge to push at about 8 cm with my daughter. My MW told me to go ahead and push when I wanted to. My cervix swelled and created some more difficult issues. This time, I've told my (different) MW that I'll ask her to check me to make sure I'm 10 cm before I start pushing!

[aramat]

I did NOT have a VE with my middle daughter. She was a homebirth, and when the urge hit me, I asked the midwife if I could push; she said I could try, and the baby was out in two pushes. But I felt that I needed to push--I knew it would feel good.

I'm not a big fan of VE's. I think if you want one, go for it; and if you don't want one, that's probably okay, too.

[donutmolly]

I've had 3 babies at home and have only had one VE during all my labors -- for my first, right when my mw arrived. I've never had a mw even offer to check when I was ready to push, I just did it. The mws could clearly tell that things had changed by the noises I made -- I can tell they were watching me go through transition, rest and get ready to push....

So really necessary? Not imo, I would have been as annoyed as all get out if someone had touched me at that point. But if my mw had seen/heard/felt something that made her think she ought to check, I wouldn't have argued with her, but I wouldn't be interested in a mw who just did them routinely.

[cileag]

No one has brought this up yet, but for me, there's often a big difference between a primip's (first time mom) cervix and a multip's (an experienced mom). In general, I feel that there's a lot more flexibility to a multip's cervix--if any of you mom's have ever heard of having a very stretchy cervix, this is what I'm talking about. I often check a mom and she's anywhere from 4-7 cm depending on if I stretch is out at all (and I mean this very non aggressively---I'm not deliberately doing it).

I do think that first time mom's often feel the urge to push sooner--like the Gloria LeMay article, I agree that there's often a feeling at about 8 cm--a different sort of pressure feeling that is a new sensation. I also distinguish between having a pushing sensation at the top of the contraction, throughout the whole contraction, or ALL the time, regardless of contractions.

And Twinklefae--was your baby posterior? I also think that there's a distinct premature pressure feeling with a posterior baby that is not usually the case with anterior babes. And that is not meant as a criticism---I've also seen it in women who have shorter perineums, where the rectum is very close to the vaginal opening---this I think applies more pressure to the bottom and gives woman that "pushy" feeling. For you, with your history, a VE would probably REDUCE anxiety, but for many women it does the opposite and like Meg said, isn't usually necessary. I agree with MsBlack and Megboz that for MOST women, external signs are enough and that for MOST women pushing on a stretchy, nearly dialated cervix does not cause harm--but I have seen some cervical swelling and again, nearly always due to malpositioning.