Risk of preterm labor and refusing internal exams? Please help!

[APToddlerMama]

I'm 23 weeks and have been having BH contractions for over a month already.  Lots of them, like 10 an hour for hours on end pretty much every day.  My OB  just started doing fetal fibronectin (sp?) and is insisting upon doing internal exams every time to make sure I'm not dilating even though she is also doing an ultrasound to check cervical length.  I'm high risk for a variety of reasons including one preterm birth.  Every time she does the internal exam, I end up cramping and very uncomfortable.  I am still cramping from the one she did yesterday.

I know typically MWs don't do internals until the very end, if at all, but I am wondering what you wise mamas think about doing them in my situation given the contractions and high risk of preterm labor.  Isn't fFN and an ultrasound enough?  Should I demand she stop doing them?  Every time I express concern (like when I refused pap), she asks if I trust her which I find incredibly manipulative.  Anyhow, some advice would be very much appreciated.  I am literally in pain still from yesterday and terrified of getting an infection :(. 

[KaliShanti]

Wow esp with your history I would NOT be doing exams! I have BH contrax since 14 weeks, sometimes several an hour. It can be really normal.

[Autumn Breeze]

I would suggest, considering getting a second opinion.

Also, braxton hicks contractions are normal, and begin the moment the pregnancy begins. When we feel them will be different for everyone.

For example, with my first, I noticed them starting around 23 weeks, some days they were frequent like yours 5-10 an hour all day. Other days, I would only notice them if I put off urinating for too long.

With my second they started at 12 weeks when I didn't urinate when I needed to, and by the 18/20 week time they were something that went on daily.

Checking your cervix only puts you at risk for infection, and irritation. It sounds like she's not treating you as an individual, and perhaps you need to do a little shopping around for a provider that will actually listen.


ETA: Bottom line is that this is YOUR BODY. If you don't want her fingers in it, say NO.

[dashley111]

I get routine cervical ultrasounds for monitoring my cervix after a preterm birth also.  How are your cervical lengths?

I just had my first manual exam last week (24 weeks).  Sometimes they can give a lot more info than the ultrasounds- like whether the cervix is starting to open, position, and if its softer than it should be.  Now with those things in mind I see a preterm prevention clinic at a local university, and have never had manual exams EVERY time I go in, but I have had them about every 2 weeks after a certain point.  Manual exams become pretty important if your cervical lengths are lower, your showing cervix funneling on the ultrasound, or if your dilated at all.

[APToddlerMama]

Originally Posted by dashley111 

I get routine cervical ultrasounds for monitoring my cervix after a preterm birth also.  How are your cervical lengths?

I just had my first manual exam last week (24 weeks).  Sometimes they can give a lot more info than the ultrasounds- like whether the cervix is starting to open, position, and if its softer than it should be.  Now with those things in mind I see a preterm prevention clinic at a local university, and have never had manual exams EVERY time I go in, but I have had them about every 2 weeks after a certain point.  Manual exams become pretty important if your cervical lengths are lower, your showing cervix funneling on the ultrasound, or if your dilated at all.

Thank you everyone.  Good to know Kali and Autumnbreeze that others are having as many BH too without other issues. 
 

Dashley-- My cervical lengths have been pretty good.  Some mild shortening.  Most likely my last PTL was caused by having a placental abruption.  I haven't have any funneling or dilating.  I think the thing that changes things a little is that I was able to get almost to transition without any serious pain with the contractions beyond the discomfort I've had with the BH contractions.  When I went into the hospital to have DS, I was 7cm dilated and really didn't know I was in labor...thought I might have a UTI causing the BH contractions because they weren't very much out of the ordinary and they weren't at regular intervals.  When I went into the hospital this time with contractions at 21 weeks, they looked at my cervix but didn't touch which was fine.  Do you end up cramping after your checks?  We are due about two weeks apart. 

[1love4ever]

You have every right to say no.  you have a legal right to refuse any medical procedure, intervention, action, etc that you choose.   If your Dr does not like it or causes you problems than I would get a diff Dr.

[dashley111]

Originally Posted by APToddlerMama 

Thank you everyone.  Good to know Kali and Autumnbreeze that others are having as many BH too without other issues. 
 

Dashley-- My cervical lengths have been pretty good.  Some mild shortening.  Most likely my last PTL was caused by having a placental abruption.  I haven't have any funneling or dilating.  I think the thing that changes things a little is that I was able to get almost to transition without any serious pain with the contractions beyond the discomfort I've had with the BH contractions.  When I went into the hospital to have DS, I was 7cm dilated and really didn't know I was in labor...thought I might have a UTI causing the BH contractions because they weren't very much out of the ordinary and they weren't at regular intervals.  When I went into the hospital this time with contractions at 21 weeks, they looked at my cervix but didn't touch which was fine.  Do you end up cramping after your checks?  We are due about two weeks apart. 

Yes, I always cramp after my exams.  I usually just drink water and take it easy on the couch for the rest of the day.  Have you talked to your doc about only doing ultrasound lengths and not actually poking around at the cervix?  They might be open to it, and if they aren't at least it will open a dialogue for you to ask the reason why they are doing internals.

[APToddlerMama]

Originally Posted by 1love4ever 

You have every right to say no.  you have a legal right to refuse any medical procedure, intervention, action, etc that you choose.   If your Dr does not like it or causes you problems than I would get a diff Dr.

I know I have the right to say no, etc.  I guess I didn't make it totally clear but what I am really wondering is if given my history if there is some reason that there would be a benefit to allowing this.  Unfortunately this pregnancy isn't straight forward given the issues I've had in the past and am having now. 
 

Originally Posted by dashley111 

Yes, I always cramp after my exams.  I usually just drink water and take it easy on the couch for the rest of the day.  Have you talked to your doc about only doing ultrasound lengths and not actually poking around at the cervix?  They might be open to it, and if they aren't at least it will open a dialogue for you to ask the reason why they are doing internals.

I guess I am wondering how cramping after exams is a good thing for either of us given our histories, ykwim?  I have talked to her about just doing ultrasounds and not poking but she says she needs the information from both...  I wish I could find some actual research about how necessary it is to have internal exams with my history but haven't been able to find anything.  I guess my gut though is really telling me that I don't think my cervix being poked and prodded to the point that I am in pain and cramping for 24 hours is really going to accomplish anything more than the fFN.  I'm concerned about her accidentally rupturing the membranes or getting an infection.  I wish I could go into my next apt with hard evidence of that.  If anyone has any, please link it for me!  I'd be forever grateful.   

[sarah_bella1050]

You need to be able to make your own decisions for your prenatal care even if it isn't what your OB wants.  Yes you trust her, but you know your body and what is best for you and your baby.  Just say no, it's a good time to start standing up for yourself now, you will need to do it a ton in labor if you want a natural birth.

[Autumn Breeze]

If they are being so insistent on 'needing that information' that they feel they have to pressure you, I would seriously start looking for a second, third, or fourth opinion. ANd don't settle until someone starts treating you like an individual.

[APToddlerMama]

Originally Posted by Autumn Breeze 

If they are being so insistent on 'needing that information' that they feel they have to pressure you, I would seriously start looking for a second, third, or fourth opinion. ANd don't settle until someone starts treating you like an individual.

I ended up seeing her earlier this week and she kept her fingers out!  She was actually fairly reasonable about it, but I think she could tell I was more confident about it than I had been in the past, so thank you all for that :).  I am still trying someone new just go find out if I like her better, but it does seem like with PTL most OBs are really into checking the cervix, so I might just have to be very insistent with whoever I end up using. 

[waluso]

Hugs, you are in such a difficult position! Although BH contractions can be normal, they can also lead to PTL. I had a ton of BH contractions with my daughter that eventually started opening my cervix around 29-30 weeks. I was on medication and they stopped it, but who knows what would have happened if I did nothing. May have been fine. I still wonder if the drugs were really necessary. My sister started having BH contractions around 21-22 weeks and ended up in full labor at 25 weeks and they couldn't stop it. I'm 22 weeks now and having a ton of
BH contractions and the dr wants to put me on meds again. I haven't decided yet whether to take them. My cervix is ok right now so I don't think it's necessary. On the other hand, I wouldn't be able to forgive myself if I went into labor early. The frustrating thing is they don't really know what causes PTL or what stops it, so I guess frequest exams/ultrasounds are the only thing they have to go by. With your history I can understand why the drs are cautious but you just have to follow your gut. Try to be in tune with your body, know what other signs to look for, etc. If the exams are causing cramping, I wouldn't want to do them either. At the end of the day it's your decision and it's just a matter of whether you think the intervention is worth it. No one is going to be able to guarantee what will happen either way because they just don't know. Good luck!

[Autumn Breeze]

Originally Posted by APToddlerMama 

I ended up seeing her earlier this week and she kept her fingers out!  She was actually fairly reasonable about it, but I think she could tell I was more confident about it than I had been in the past, so thank you all for that :).  I am still trying someone new just go find out if I like her better, but it does seem like with PTL most OBs are really into checking the cervix, so I might just have to be very insistent with whoever I end up using.