Can't handle vaginal exams: what to do in labor?

[Mayrigah]

For reasons I won't go into except to say survivor and medical trauma, I am unable to undergo even a basic pelvic exam with instruments by a OB. I think I may be able to handle basic cervix checks by a *female* provider; hopefully my
Ob ( female) and a birth assistant I can trust.

Due to complications and not having been given the opportunity to labor during my last and first pgc y, I'm wondering what my options are to check my progress during labor. Any ideas?

I really wish I could join the survivor forum on here, but I have not posted enough. There are no support networks in my area of Austin for mothers like me, at my income level. I've literally been told by a therapist that she cannot help due to the interstices of my personal and cultural history, and have been looking for 2 years for a therapist in my area.

Stats: 36 w, gestational diabetes under control w/ glyburide & cinnamon/chromium supplement, GBS pos in urine, "survivor" by individuals as well as medical personnel. Risked out by hbmw,     medical  //XX  interferences . Planning to labor at home as long as possible for a VBAC ( ds, I had not even a chance to experience labor due to low amniotic fluid emergency c-sec w/ the natural CB obgyn here in Austin), putting in place "safety nets" just in case the baby is HBAC.

Wondering if there are other ways to check progress ?

[Alenushka]

I would dicuss your issues with your  OB provider. They can red flag your chart in the hospital and make sure only female check you and that you are checked the minimum number of times.

I think your therapist was a freaking jerk.

I have very complex cultural and childhood history.....not every therapist I had was a right one for me but I never met anyone who said things like this.  This is what competent therapist training is about, ability to help people who are not like them.

I am sorry you are having a hard time right now.

[onlyboys]

You should definitely discuss this at length with your provider.  When you mention that you cannot tolerate instruments, I suspect you mean a speculum, is this right?  If this is the case, there are very few times that you would be checked in hospital with a speculum.  Specula are not used to check dilation.  

When you do get to the hospital for the birth, tell the triage nurse that you are a survivor (have your partner or doula support you, and practice saying the words at home) and that you do not wish for a male practitioner in your room.  Ask to keep vaginal exams to a minimum and try to have them be a gentle and peaceful (lights dimmed, etc) as possible.  

There are some other ways to check progress, but none are as clinical as a cervical exam.  They can give your provider good information.  

Hope this helps a little.  

[womenswisdom]

You always have the right to decline cervical checks. In a normal labor, there is limited value to them, although if some information could be useful in the course of labor, you might feel that it's best. Babies do come out even when no one has checked the cervix!

[dogmom327]

Originally Posted by womenswisdom 

You always have the right to decline cervical checks. In a normal labor, there is limited value to them, although if some information could be useful in the course of labor, you might feel that it's best. Babies do come out even when no one has checked the cervix!

Agreed.  Having one isn't a requirement.  Short of an emergency, keeping yourself mentally healthy and safe should be the priority.

[channelofpeace]

I have it first thing in my birth plan, bolded, that I am a survivor and I prefer not to have VEs unless absolutely necessary, and in that case, they are to ask my permission and give me a bit to think about it.  My dh and my doula understand this also, should I be unable to advocate for myself very well at the time.  I hope you are able to find a way to express your wishes in no uncertain terms and that your birth is a good, respectful experience.

[LisaSedai]

I "just said no" to cervical checks by anyone but my OB and I only had 2 done, once about 5 hours after I was admitted to the hospital ( my water had broken)  and one 10 hours after admission - that one I was ready to push. I refused them because I was GBS+ and I didn't want fingers introducing bacteria up there if I could help it and I didn't want a repeat of what happened in my first birth (being discouraged from apparent lack of progress)

No one should hassle you about it if you tell them "no". Is your OB in private practice? Will she absolutely be attending you? If not, is her back up OB female?

Hope all goes well for you

[lizsky]

I'm so sorry about the therapist.  If you have health insurance of any sort, there have been recent policy changes at the federal level that have led many insurers finally cover mental health.  Not surprisingly, many insurers are not advertising this loudly and clearly for consumers so many folks don't realize that they now qualify for some benefits when they didn't just a year ago...if you have any type of coverage its worth at least checking.  

If you'd like to join the survivors forum here, I'd encourage you to keep posting...just a brief "congratulations" or "I'm sorry to hear that" will add up quickly, and people always feel encouraged when someone responds to their post with kindness.  

As far as VEs go, I also have a very hard time with them.  I requested a minimum in my birth plan, and had only 2- one when I arrived at the hospital (at 7cm) and one when I felt ready to push.  DH and my doula knew to help me refuse VEs by any male.  I was able to have them done only by my female MW who knew my history.  Best wishes to you for a peaceful birth.  

[justKate]

First of all, OP, I wanted to send you big hugs. 

I don't see any reason that you would NEED internal exams at all, unless there is an emergency.  Are you able to check your own cervix by any chance?  I posted about whether it was reasonable to do this here and got mixed responses, but in your situation it seems like it might be better than someone else doing it.  I don't know if I'll be able to reach my cervix by the time 40 weeks comes, but I'm going to give it a shot.

[Libelula]

I was worried about cervical checks with my VBAC too.  I have a gynecological condition that makes pelvic exams very painful.  I also had a traumatic first delivery. So I really wanted to avoid them as much as possible.  I ended up having a HBAC with a physician who felt that cervical exams were mostly unnecessary if labor appeared to be progressing well otherwise and the mom and baby were doing well.  So I actually did not have a single cervical exam during my VBAC.

I hope you can find a practitioner who avoids unnecessary exams and understands your situation.  Best of luck.

[Arete]

You have my very deepest sympathy.  I too am a medical trauma survivor, and I too was adamant about having only female drs., etc.  Unfortunately, the hospital where ds was born took no notice of this at all (I was a transfer from a birth center) and despite my heartfelt pleas and profound terror, gave me a male dr. and anesthesiologist.  I am not yet over that trauma.  I hope fervently that your experience will be different, but do NOT trust a hospital.  In my experience, they don't care at all.  Get backup, backup, and more backup.  Have you considered the asesthes. angle?  I don't know if there is a way to make sure a woman is available, but it might be worth checking out. 

[musikmama]

A friend of mine on FB just shared this link today...I hope this helps!!!!

http://www.natural-pregnancy-mentor.com/vaginal-exams.html