Checking dilation during labor?

[Snowflake777]

Ok, forgive me if this is a really ignorant question...

I had a hospital birth with a midwife with DD1 (I'm in Europe, if it's relevant). During labor, the midwife did a couple of internal checks to see how dilated I was. I don't know how to put this more delicately, but she basically fisted me during some excruciatingly painful contractions. I'm not traumatised by it or anything, but it's something I'd prefer to avoid this time around unless it's really important.

So, how essential is it to manually check dilation during labor? Is it something you can reasonably avoid, or is it better to let them do it?

TIA!

[Tumble Bumbles]

Not ignorant at all!

It's not essential at all, it's not necessary, and it can even do more harm than good (entering bacteria into the cervix/uterus. Here's a great (opinion piece) article about it by a midwife: Cervical Exams, Who Needs Them? It won't let me hyperlink for some reason, so here's the link: http://www.nurturingheartsbirthservices.com/blog/?p=50&cpage=2

I avoid them 100% and 'standard' interventions such as those is in part what led me to consider (and ultimately, choose) unassisted birthing.

[Mamatoabunch]

Originally Posted by Tumble Bumbles 

Not ignorant at all!

It's not essential at all, it's not necessary, and it can even do more harm than good (entering bacteria into the cervix/uterus. Here's a great (opinion piece) article about it by a midwife: Cervical Exams, Who Needs Them? It won't let me hyperlink for some reason, so here's the link: http://www.nurturingheartsbirthservices.com/blog/?p=50&cpage=2

I avoid them 100% and 'standard' interventions such as those is in part what led me to consider (and ultimately, choose) unassisted birthing.

 

[lifeguard]

FWIW I think that it might have something to do with individual technique. I honestly didn't even feel it when my ob checked during labour.

[MegBoz]

Yikes! 

I had my MW check me when I felt the urge to push to make sure I was 10 cm& give me "permission" to push. It didn't hurt at all.

If it was excruciating, I'd guess she was manually trying to stretch your cervix, or at least sweep your membranes. I think just an exam to assess dilation & effacement shouldn't be that bad.

But for the record, yes, I agree exams are unnecessary. I've since read about "The rule of 10" - i.e. there really is no need to do an exam and "give permission" for a mama to push when she feels the urge. (I hadn't know that before.)

[SGVaughn]

I've actually never felt pain for a dilation check..but they are completely unnecessary and can lead to a cascade of events if things don't fit the "correct" curve

[Beccadoula]

She was likely trying to "help" the cervix stretch a bit - QUITE painful.  I know that you don't absolutely have to have your "progress" checked at all...but you can even check your own if you want...here's a link for info. on that:  http://prepforlabor.tripod.com/id14.html

If you choose to allow someone to check - I suggest you limit the number of times and talk to them before labor about how unpleasant your last experience was.  I've seen nurses get really agressive about it, but never a midwife. 

[Twinklefae]

On the other hand - I started feeling the urge to push in my last labour at 4cm.  By 5cm, I was starting to swell my cervix, and that was with frequent checks and knowing that I shouldn't be pushing.  I personally would never be comfortable pushing without knowing that all was clear.

[SGVaughn]

yeah...I always ask for a check before pushing myself...last time I had a little lip and I was asked if I wanted the dr to push the lip back through a contraction...I did..I was worried about pushing against a lip and causing swelling

and dilation updates help me keep focused and know where Im at (Im weird like that)

[Italiamom]

Originally Posted by SGVaughn 

yeah...I always ask for a check before pushing myself...last time I had a little lip and I was asked if I wanted the dr to push the lip back through a contraction...I did..I was worried about pushing against a lip and causing swelling

and dilation updates help me keep focused and know where Im at (Im weird like that)

I *asked* for my midwife to check me twice, and then I believe she checked me when I started pushing for a cervical lip.  That last cervical check, despite not asking for it then, was something I had requested a few weeks prior when we went over my birthing preferences.  I had a friend who pushed against a swollen cervix for over an hour, and I did NOT want the same fate.  NO thank you.  None of the three checks hurt though...
 

[MegBoz]

Originally Posted by SGVaughn 

yeah...I always ask for a check before pushing myself...last time I had a little lip and I was asked if I wanted the dr to push the lip back through a contraction...I did..I was worried about pushing against a lip and causing swelling

and dilation updates help me keep focused and know where Im at (Im weird like that)

Regarding cervical checks throughout labor - I had this fear I'd do "labor math" in my head.. ya know, like if it took 10 hours to get to 6 cm, I'd be thinking, "Noo! I have another 8 hours to go!" & then start doubting myself that I can do it that much longer... but it doesn't work that way. Intellectually, I know it doesn't work that way, but I'd be worried that emotionally, I'd feel discouraged that I wasn't as far along as I felt I "should" be - or worried if I focused on how much more I had to go.

I had heard stories of pushing before being 10cm causing cervical swelling & problems before, which is why I wanted the check myself. But for me, in hindsight, the urge-to-push was so overwhelming and it followed what was so clearly transition. Plus I read the below article on "The rule of 10" and thought I probably could have easily just trusted my body. I told my MW this time that if it doesn't feel the same as last time, I'd want the check to confirm, but I think if it DOES feel the same, I'm confident in listening to my body.

http://www.midwiferytoday.com/articles/RuleOf10.asp

[Snowflake777]

Thanks so much for all the info guys! I really appreciate it. :)

I'm not sure why it hurt me so much. Maybe she was stretching it as well? I honestly can't remember - it was all kind of a blur at that point.

[Smokering]

I find cervical checks really painful too - both during labour and not. I had a REALLY painful cervical smear last year - an incompetent nurse and a too-big speculum - that was just freaking horrible. I can't use Diva cups either - apparently I'm just sensitive or something.

That said, despite the fact that they hurt like the blazes, I actually requested a few cervical checks during my last labour. The insatiable desire to know if it's nearly over might override your pain issues! As it turned out I did have a cervical lip for awhile, so panted through/fought the pushing urge for as long as it was possible, until the midwife said "Just go for it" (without checking again). It worked, so... I dunno! Not sure whether I'll request them this time. But it's definitely not abnormal not to have one. Or you could always tell your MW "Don't check until you think I've been through transition and I show signs of wanting to push", if you want to check for the cervical lip thing, but avoid periodic "4 cm", "7 cm" progress checks.

[kythe]

Most hospitals has regulations such as cervical checks every hour as a part of monitoring labor's progression. They try to have the same nurse consistently since cervical checks are somewhat subjective, but they do interventions if you haven't "progressed" enough for their timetable.

I gave birth in a free standing birth center with more lenient midwives. Their policy was once upon admission, and once when you feel ready to push. Additional checks could be done at the discretion of the midwife and mother, but were not routine.

I couldn't lie down due to back labor, but my first midwife was experienced and willing to check while I was on all fours, even though that isn't an ideal position for feeling the cervix. I ended up not having any cervical checks at all with my second born since he came too fast. I definately didn't like the cervical checks, but it was more because I didn't like feeling "handled" during labor. It didn't really "hurt" any more than internal exams at the end of pregnancy. It just disturbed my "rhythm" and interrupted my concentration through contractions by creating another distraction to work through.

[HRJ]

You are right.  They can be uncomfortable.  And discouraging if you are having a long labor (mine was 30 hrs).  In my birth plan this time around, we state "Keep internal checks to a minimum (preferably once in triage and when mom feels an urge to push).  If dilation isn't rapid and internal checks become discouraging, we would prefer to take a break from checks."  I put the 2nd sentence in just in case we get my OB's backup who might not work the way he does.  My OB was fine w/ not checking all the time, but he said he likes to check about 4-5 hrs after you've been admitted.

[HRJ]

Just had to post about my lack of faith in internal checks.  Just had baby #2.  Water broke at 8 pm and when I got to the hospital (after only having a few contractions) at 11 pm (per my dr's request b/c I'd had no internal checks in his office yet), I was only 1 cm, 50% effaced, and -3 station.  The resident was like "you aren't very favorable."  and my OB said if I wasn't close to having the baby by 8 am, they'd start pitocin and antibiotics bc of infection risk.  So they weren't going to check me again until 8 am.  My contractions never got more than 2-3 min apart even in the end.  Things got intense around 7 am and I felt a need to push.  I was complete.  So much for 'not favorable'.  That said it might have been good to check before 8 am had I labored at home b/c I would have never dreamed that I was in transition w/ contractions 3 min apart.

[Marissamom]

with my first I really wanted to push and was told I still had a cervical lip. as soon as I was alone in the room I pushed with the next contraction. broke my water and went to complete with that push. I'm really leaning toward just listening to my body rather than waiting to be told I am ready this time.

[Banana731]

I think they are at best unnecessary, and often harmful (in the long run).

Maybe, if I had a posterior baby and was getting an urge to push earlier than I thought was right, I might asked to be checked. That's the only reason I can think of off the top of my head for me.

Most women with a "lip" that I have talked to who have had natural, non interventive births (including me) get a slight urge to push and when those natural instincts are followed the lip goes away and the urge to push grows more intense and baby is born. Most women in the "you can't push with a lip!" situations have either an awful early second stage where they are scared into trying not to push (which their body does anyway) or they have a cp who does that crazy manual reduction. Having actually heard a woman go through that, I can not imagine that it could possibly be less traumatic on that tissue than what happens most of the time when a mom follows her own pushing instincts. That kind of thing so smacks of the whole "inability to give birth without the help of the medical profession" thing women have shoved down their throats, I find it pretty obnoxious.

For all we know something like a manually reducing a lip just because there is one might be detrimental in other ways too. If a woman has a lip because the baby is not in the most ideal position and the baby's head hasn't been evenly applied to the cervix then wouldn't that sort of slight pushing you see with a lip be good? Wouldn't giving that baby more time to navigate the birth canal be better than pushing that lip out of the way in one ctx with mom pushing as hard she can? Should a baby in a less than ideal position really be barreling out like that? It certainly affects moms perineum and may affect the baby's muscles too, right?

Yeah, not a fan of the routine cervical check here.

[allisonrose]

With my first son, I had just one cervical check by a nurse before I got an epidural and it was quite painful. With my second son, my midwife did several cervical checks to try to figure out what was going on - long labor - and many of them were painful. If I have another baby, I'm going to aim to restrain my curiousity about my dialation!

[Spiralshell]

Glad to find this thread!

I'm not currently pregnant, but am thinking about having a second child. I ended up with an induction due to very high blood pressure which led to c-section with my first, and it was a long and drawn out horrible experience. It was a hospital birth with two CNM. I felt like my midwives and everyone and his brother had a hand up in me at some point trying to turn the baby's asynclitic head and posterior position. No surprise, I ended up with a 100.5F temperature, which was over the hospital's "line" for infection risk. My baby was taken from me after birth. I saw him again for 30 minutes 5 hours later, and then they made me wait FOURTEEN HOURS before I got to see him again. Yes, FOURTEEN HOURS in his first 24 hours of life. He was in the NICU, and I was recovering from c-sec, and they would NOT let me see him. Mind you, he was 100% healthy, but my elevated temperature meant that he had to be treated as a possibly infected baby, which I believe was total overkill.  He's 16 months old now, and the memory of that still makes me shake. The next time after his birth day that  I was away from him for 14 hours was when he was 13 months old!

Anyway, I really believe that all those internal checks after my water broke were the reason why my temperature went up. I'm hoping for better positioning next time, but I'm also hoping to avoid internal checks completely, or as much as humanly possible.

So what I'm wondering is: how do you refuse? What do you say? When they come at you with a gloved hand and insist that you have to be checked, what's your response?

My thought is that NOBODY gets to put their hand in my vagina without my permission, so they're just not going in there, period. But I'm fearing that this will lead to some really adverse interactions with the staff. I know I need them on my side, but I also need to protect myself. I tend to cave and just "go along" when I'm stressed and overwhelmed.

In labor, when your mind is really elsewhere, how do you stay firm on this? Anybody been there with any ideas about how to handle it? Good techniques? Snappy comebacks? (lol!)

It's crazy, but I'm not afraid of having a second pregnancy, or managing to be a full time working mom to two children. But I am TERRIFIED of having another birth like my first. And alas homebirth is not an option -- my DP truly believes that our son and I were near death. There's absolutely no way I could convince him that birthing at home would be healthy and best for me (physically and mentally) as well as baby.