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Cervical Examinations

post #1 of 20
Thread Starter 

Hi Mommas,

 

I am choosing to refuse cervical examinations this pregnancy unless I show signs of pre-term labor. Was wondering if you have any advice on how to say "no" to my doctor. (Who just gave me a long spiel today on how cervical exams prevent stillbirth, premature birth, and inductions?!!) I talked to my wonderful, supportive doula, but just had to vent/share in another "safe place." :)

 

Thanks!

 

Melissa

 

P.S. I really, really miss midwifery care. I'm learning I'm going to have to grow some thick skin to survive all of these prenatal visits.

post #2 of 20

I find this really hard too, but I think just try to politely say "I understand what you are saying, but no."  Is he wanting to do cervical exams now?  My--often much too interventionist for my taste--OB doesn't do any between your first visit and 36 weeks, and I assumed this was standard of care. You might want to do some research on this so that you feel more confident saying no.

 

In general, I have have found where you don't need to affirmative say no to something, it is easiest just to listen to what they have to say, without commenting at all and just let it sort of role off of you. I have reasons for wanting to stay with my doctor, who in some ways is absolutely amazing, so I've really had to get good at this, and at in general finding other ways to get the support I need. I also tend not to bring up things that might be controversial with her until they actually need to be addressed.  And for things that I'm pretty sure I'll get an answer I don't like (like, can I eat during labor?), I just never ask at all, and do want I want in the hospital.

 

Another approach of course is trying to find an OB whose approach is more in line with yours.  Not sure if that is an option for you.  But if it is it might be worth considering. I know a few people in this group have switched providers over similar concerns and been thrilled with their new docs.  I will say that the reason my OB works for me is that in the end, although her prefered approach is often different than mine, she absolutely respects my wishes and goes along with what I say. In some ways the cervical exam issue is a good way to test this with your doc.  If he really won't accept your position even once clearly voiced, it might be particularly a sign that it is time to start looking for another provider.

 

Good luck!!

post #3 of 20
Thread Starter 

Thanks so much for the great advice and support Rebecca. I really appreciate it.

post #4 of 20

My OB doesn't do them until after 36 weeks and I've always just said "no thank you" and they say "yep, it doesn't really mean much anyway...you'll have the baby when you have the baby".  After 40 weeks I let them check with both pregnancies because they seemed a little more pushy about it and I didn't really care at that point :).  I suppose they do see my cervix on the u/s's that I've always had to have, so the checks would've only been for dilation and effacement??  I really think it's not standard to do internal checks until 36-37 weeks though.  Very strange if they want to feel up in there at this point???

post #5 of 20

I second that it's weird for them to want to do that so early. I had them do some aggressive checks at the end of my pregnancy because I had pre-eclampsia (in order to try and get me to dilate faster), but I wouldn't have done anything if my blood pressure and urine were fine. My doctor is pretty hands off, so I'm not worried about doing them this time around...unless I have blood pressure and protein issues again. Then I'll definitely ask them to check me out.

 

If the situation makes you feel uncomfortable at all, find a new doctor. You don't want to have a weird relationship with the person you are trusting to deliver your baby!

post #6 of 20

sallyrae, are you worried about the pre e again?  I still worry even though I have gone on to have another pregnancy without it.  Would love to hear your story.  Don't mean to hijack the thread though.

melissa, I feel just like you.  I am totally hands off the cervix.  But something happens to me right around 39 weeks, when I think I should be in labor, even though I've had two right on their due dates.  LOL.  I let my husband check me.  I would do it myself if I could check.  

When I went ot the hosptial for pre e, I tried to get by without them checking but they wouldnt admit me till they did.  LOL.  But every time they asked, I declined.  I did a LOT of declining during that hospital stay.  

You could also, "miss" some appointments and not have to fight it every time.

post #7 of 20

I'll give you a quick rundown:

 

I'm actually not worried about pre-e again this time. I know that it's common for a lot of first time moms. I didn't have symptoms until 33-34 weeks, so it was pretty late in the pregnancy. I DID end up with HELLP syndrome, though, but that was after laboring for 16 hours. I don't know...I'm doing acupuncture, going to the chiropractor and exercising (yoga and pilates) every week, so I feel much healthier this time around. I'm definitely more active chasing my toddler around. My midwives weren't worried about the protein or my blood pressure until about week 39 (my bp was high for me, not really for a normal pregnancy), so it didn't seem like that big of a deal. The pitting edema sucked, though. That was the worst part, really.

 

I'll have to start a thread sometime about pre-e. I'm sure some moms on this board either have a history of it or might have it during this pregnancy.

post #8 of 20

I totally agree that you don't have to explain yourself. Simply, just say, no thank you. And have NO guilt. I say this in retrospect, as I had a lot of anxiety about it with my OB.  No apologies, because ultimately your body.

Internal exams are not necessary in a healthy pregnancy by any means.

 

Hugs, I know going "against" the doc can bring on a lot of anxiety.

Best wishes.

post #9 of 20

You've gotten great advice... not much to add other than just politely stick to your guns.  I don't believe I've ever had a cervical check with any of my pregnancies.  And I can't remember refusing either... that is probably because I've given birth at 37 1/2 weeks with both of mine - so no one ever pushed it.  But I've had OB care with both pregnancies, and have had to refuse things already with this pregnancy - I will say it does get easier as I have more children - I've developed a thicker skin as well as a greater confidence.  I just do what I know is best for me and politely talk it over as little as necessary with the doc.  

post #10 of 20

I never refused cervical exams (I sort of liked knowing where I was, because I knew that there were other factors involved with labor and knew that dilation was only a part of it, so I liked to hear where I was dilation-wise and weigh it against the other stuff going on. Plus my OB was super gentle and never pushed stripping membranes or anything), but I have refused other things. I agree, you just sort of have to be firm about it.

In Bradley class, we learned about a method that uses an acronym that I can't remember (preggo brain! lol.gif) for evaluating if an intervention was something you wanted or not. I wish I could tell you more details off the top of my head, but I just woke up and I really can't remember. However, it was totally helpful for us during labor at the hospital. It was like, "ask for details, ask what the outcome expected is, ask what happens if we don't do it," and so on. Basically you're asking the doctor or nurse to explain exactly WHY they need to do whatever the intervention is and implications therein. Then you (and your partner) ask for some time to discuss/think, and make your decision.

post #11 of 20

I think you're thinking of BRAN - what are the Benefits, what are the Risks, are there any Alternatives, and what happens if you do Nothing.

post #12 of 20

Yup, that sounds right. orngbiggrin.gif

post #13 of 20

I like that!  BRAN.  

Yeah, Aimee, it's like one small piece of the puzzle.  It's why I have my husband do it when we get towards teh end.  It's not the determining factor, not even close, but I still like to know.  In fact, every time I say....it's too weird when he checks me, we arent doing it again.  LOL>  And every time I ask him to check me.  When I had to go to the hospital for my son's birth, he told the doctor that I was dilated to a 3 and however far effaced I was.  The doctor gave him a look of stupidity like there was no possible way he could know that. But sure enough...LOL

post #14 of 20

OH - I thought you all were talking about cervical checks during pregnancy - not during labor - I've had cervical checks during labor from my midwife.  Although it was fairly disheartening because I dilated so darn slowly.  So with my second labor, I didn't check until the very end (UC), because I didn't want to be discouraged.  And... please don't think I'm a weirdo, but I just checked myself.  It was pretty clear that I was at a 10, and then I just pushed that bambina out! ;) 

 

So, yes, it's nice (but not totally necessary) to have that piece of the puzzle during labor.  I just dislike it when docs get so attached to the 'progress' (or lack thereof) of dilation - because it's not a steady process.  

post #15 of 20

I was referring to both, personally. I think I was 36 weeks when my OB first checked, and I was at a 2-3. When I went into active labor with Cecilia at 38 weeks, I was at a 5-6.

post #16 of 20

Yeah, I'm the same way, I dilate really really slowly.  

There are MUCH better queues on where you are in labor than dilation.  

I was referring to both.  Both before, so they can "tell you" when they think labor will start, and during, so they can tell you how far you are along in labor.  Which again, could mean nothing.  you could sit at 5 for HOURS, or boom, give birth in minutes. 

post #17 of 20

I'm very much against them before labor for sure.  I don't feel like it tells anyone anything - it makes people feel like they are being proactive but I know people who are told they won't go for a week and then have a baby 24 hours later, or told they are 3 cm and will go anytime, and stay at 3 cm for two weeks.

 

During labor, particularly if waters haven't broken, I am not as adamant about it if I know my labor is moving.  It gives me some encouragement.  If it's going slowly then it does the opposite, so I will probably see how I feel.

 

I don't see any reason for them to even want to do them before term.

post #18 of 20
Thread Starter 

Thank you so much for all of the wonderful advice and support. This has been terrific. :) Thank you!

 

 

post #19 of 20

A friend just sent me a really great article, and I thought of this thread and wanted to share:

 

http://www.bellybelly.com.au/pregnancy/vaginal-exams

 

There's a great section toward the end called "What if I don't want an exam" and some examples of how to deal with hospital staff. Also was a great anecdote in the article about one woman who said she avoided exams by saying "I just didn't DO vaginal exams" just like some people just "do DO needles". I'm a very non-confrontational person, and I can easily see that phrase working for me. "Sorry, I just don't DO [fill in the blank]" Very simple and to the point. 

post #20 of 20
Thread Starter 

Thank you so much for sharing that article. Very encouraging. :)

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