VE's in labour

[ndunn]

Just trying to find out some info on if VE's in labour are necessary (I don't want any....but I want to make sure there isn't a really good reason for one). Obviously this is barring any out of the norm circumstances, but with a normal labour is it necessary to do that when the mom says she wants to push, or at any other time? To me it just seems like it would be ok to let things progress naturally and I haven't found any research that suggests otherwise. Thanks for your opinions/info.

[charmander]

What's a VE?

[TurboClaudia]

you might consider asking your midwife what is normal for her with regards to vaginal exams during labor. some are more comfortable with not doing any, while some may not be as comfortable not doing them.

i didn't think i would want any while i was laboring. i didn't have any during pregnancy. but then i was in labor and i thought i felt grunty and wanting to push, i did want to know and i couldn't feel for myself. it was helpful information and i ended up having a swollen cervical lip for many hours that i then lay on my side to allow to subside. i had a long labor (about 36 hours) and my cervix remained at about 7-8cm dilated overnight while i lay on my side in my bed and slept intermittently. in retrospect, i suspect laying on my side may have helped our baby get into a slightly better position because after the sun came up, my cervix dilated the rest of the way and i was ready to push.

wishing you a peaceful pregnancy and a safe and beautiful birth...

~claudia

[violetbutterfly]

I think it really depends on what kind of birth you have. My "optimal" birth would have no vaginal exams whatsoever. I could have gotten away with that with my first and second birth. With my third birth I was getting pushing urges (and pushing) an hour before I was complete. It wasn't a problem necessarliy because I tried to tone it down with the pushing when I was only an 8. An hour later I had a massive contraction with huge pushing and my water broke. Then I was complete and I pushed her out within the next 3 contractions. I'm not sure if knowing how dialated I was would have made a difference. This time I'm definatetly going to say I prefer no exams till pushing urge though. Having that number in my head has never helped me. :

[JanetF]

I just posted this in another thread on a similar topic. VEs aren't necessary at all IMO unless you feel there's something wrong and getting information that way may help.

I think the focus on dilation is really more medicalised timeline stuff than anything else. If a woman is labouring you can see over time how her colour, mood, needs, introspection or otherwise, and so many other things change over time. With a known careprovider, your MW should know you well enough to see these changes occurring - or not - in you. The whole package is much more important than measuring dilation by VEs or other means. And a measurement of dilation tells us nothing other than how far you've dilated. It doesn't tell us about your emotional state, or how much longer you might be labouring. Some women take days to dilate fully others will make huge leaps in minutes. So measuring dilation doesn't help in either scenario really IMO. For me, measuring dilation or a VE to check on a baby's head position is an intervention best saved for maternal request, if she has a feeling something isn't right or it's agreed that it needs investigating. Otherwise I think the best way to judge dilation is that there's a baby coming out

The purple line which extends up between bum cheeks only happens in some women and there isn't any research into it that I've seen There are some articles I think. This is one:

Hobbs L (1998). `Assessing cervical dilatation without VEs Watching the purple line', The Practising Midwife, 1, 11, 34-35.

These are about VEs and other ways to judge labour progression instead of them. Hope they're helpful
http://www.radmid.demon.co.uk/suehanson.htm
http://www.radmid.demon.co.uk/guidelines.htm
In Midwifery Matters, Issue No. 81, Summer 1999
INVADERS OF PRIVACY Chris Warren

Checking your own dilation if you want to:
http://www.joyousbirth.info/articles...xlearning.html

[TurboClaudia]

your last link doesn't work, JanetF...

eta: found it... http://www.joyousbirth.info/articles...xlearning.html

[AnneCordelia]

If you are labouring normally, then VE's aren't necessary, IMO. If you are emotionally and physically well, then I can see how they are exposing unnecessary risk (PROM, infection, ect). However, I can also see how, after a long drawn out labour, a vag exam that shows you to be 9cm could also be rewarding emotionally. On the other hand, I can see how it would be depressing to know you are only 4cm after a long drawn out labour.

During my last birth I didn't have any vag exams throughout the pregnancy or delivery. When my daughter was crowning, we knew I must be 10cm.

~Emily

[charmander]

Duh...(slaps head).. VE = vaginal exam.

I didn't have a single vaginal exam when I had my homebirth,and for that matter, throughout my entire pregnancy. They are not necessary, and my midwife would only have done one if I had requested it.

[kerikadi]

:
Except I did have one during pregnancy because I'm a big dork and asked for one. You know when you get that feeling at 40ish weeks that you need to know if the almost daily petering out contractions were doing anything

I told my MW that I really didn't want to be checked but thought that I might want to once in labor to know that I was making progress.
Well, once I was in labor there was NO WAY anybody was coming near my cervix. Not long after my water broke I got pushy and asked her if she needed to check me and she told me "No - You can push if you are ready or wait - it's up to you" I had two previous hospital births which taught me that I needed permission to push

Anyway, my MW had complete trust in me and my body and didn't ask to check me once. With my second homebirth it was so fast she couldn't have checked me if she wanted too. I remember telling her that the baby was coming, almost inviting her and she said "I'm here" As it turns out 'here' was behind DH allowing him to catch our baby I caught the first one

Next time I will try to be strong and not ask for one towards the end of my pregnancy and certainly don't anticpate any during labor.

Keri

[girlsmamma2]

Also, they can not give you a true indication of where you are. With my first, I spend 16 hours at home laboring with broken waters. When I finally went to the hospital, they checked me of course and not only was it super super super uncomfortable, they said i was only 4 cm. After 16 hours and the contrax were getting really bad, that was very defeating. she ended up crowning only 1/2 hour after that, so it shows that either they were wrong or your body can do different things, regardless of you measure.

With my second my mw didn't even ask, she more or less read my reactions to the contractions and knew i was close. she was right and after she told me i could push if i felt like it, 20 minutes later out came dd.

i think in early labor they can really hurt you mentally, not to mention physically i can't stand them being done.

[Guest*]

Not necessary unless you want one or think your need to be checked.

I didn't have any and only had one in pregnancy because I thought my water may have been leaking. It wasn't, but since the midwife was already there, she check my cervix.

I won't have any this time either unless something seems to be wrong that needs checking.

[Hayes]

I had one. My Mw had a meeting, and wanted to check and see about how far Iw as dilated. I was still ok, but definitely in labor. I was 4 cm when she checked. Her check threw me into hard labor and transition, and Is tarted pushing about an hour after her exam. But that is how my labors have typically gone before.

[grace's voice]

I had 2 during my hb. One when my mw got there to see how far I was at that time, and one when I was ready to push. I could have done without the first one, but I would like to have one before I start pushing to make sure I'm not pushing against a cervical lip.

[littlest birds]

Not necessary. I did my own, though!

My midwife worked with quite a few Amish women who tended to request her not do them, and she actually asked us. She avoided them herself, I think usless there was some unusual reason for one. So for her, they really aren't routine.

[*guest]

I don't feel they are necessary for me. My mw practice does not do them unless specially requested. I will ask them about when they think it is truly indicated since I'm now curious too. But my understanding is that a typical labor with them does not involve a VE. They don't do the "OK, you are ready to push" business either. They watch how a woman is acting, sounds she is making, and the positions she is choosing and figure it out from that.

[ndunn]

I'm going to re-hash this topic because I'm my midwives say they are going to discharge me from their care because I"m asking for no VE's in labour. I think they are required by law to chart your cervical dilation or something...seems like a pretty stupid reason to me...ANYWAY, does anyone have anything else to say on the matter? i'm due today....(think that might be a bit of an early estimation of my date but...) and if they discharged me I don't know what I'd do then...

[onlyboys]

Well, I doubt that they will discharge you if you simply tell them no while you're laboring. They are not going to leave you, are they?

You may find you want one. If you wish to be left alone, then tell them so. They cannot force you to do anything, and the blackmail of "we'll drop you" would not fly with me."

They may be "required" to chart cervical dialation, but for those mamas who labor fast, then how could they chart? For those mamas who have abuse issues and cannot tolerate a VE, what do they do then? What about mamas who birth in water? It's not reasonable to check every woman every hour.

Good luck! Hope your birth is glorious!

[Mama2Xander]

Originally Posted by ndunn

ANYWAY, does anyone have anything else to say on the matter?

Yes - lose the midwives!! Seriously. I just read this thread and your other one (about vitamin K) and all of this sends off some serious warning bells for me...

I had RMs for my son's birth and we declined almost *everything*, and it was never an issue. I had no prenatal testing (other than blood type, rubella status, and hemoglobin), no ultrasound, no doppler (including in labour), no VEs, no vit K, no eye ointment, nothing. We didn't even do fetal heart tones in labour. The only "routine" thing we did was the newborn screening (PKU). They never batted an eye. (Well, they were somewhat uncomfortable about not doing FHTs in labour, but they didn't say anything about it until afterwards and even then it was not a big deal). I think it helped that I used to be a labour & delivery nurse, and used to work at the same hospital as one of my midwives, so we'd already known each other for awhile and they couldn't exactly say that I didn't know what I was talking about. But obviously I think anyone should be able to decline anything they aren't comfortable with. If you refuse something, they CANNOT do it. That would be assault. You may need to be very very specific and direct, as in "I do not consent to ____" and just keep repeating it. (That is, if you are keeping the midwives).

They are not required by law to do VEs. They also cannot abandon care in labour - I am not sure of the regulations about whether or not they can do this prenatally though. You could find out from the College of Midwives of BC. They have a website where you can go and read their guidelines: http://www.cmbc.bc.ca/

I would suggest that you *seriously* consider whether or not you want these people around you at your birth. You may be able to work out some kind of payment plan with a private birth attendant if the fee is too high. Where in BC are you? I'm in Vancouver...pm me if you want. I know a woman here who is a great private birth attendant, and she may have some contacts for you.

[provocativa]

As for VE's, for dd with the medwife in the hospital, she only did one because I wanted to know if I was complete, since transition was at that I'm going to lose it point and I was sick of the tub. Not necessary at all if labor is progressing in a way satisifactory to the parties involved.
Bullying and blackmail before birth is not the midwifery model of care. I would start calling any area birth attendant, or try to find an experienced someone to help you if you haven't mentally prepared for UC. But the kind of midwives you describe will inspire fear during your labor (what are they going to pull next?) and that fear will increase your pain, lengthen your labor etc. Which is part of what I'm having a homebirth to avoid.

[flapjack]

A couple of good reasons: if baby's head isn't engaged before the waters break you might want to rule out the possibility of a prolapse. Obviously, monitoring the heart rate can do this as well.
If labour is taking a while to get going, you may find that an internal gives more information about a malposition, which gives you more to work with on trying to straighten it out.
If you've spent 27 days straight in prodromal labour, you may find the information that your cervix is dilated more than 1cm welcome and want to hug and kiss your midwife.
This one won't apply to you, but if you have an unusual labour compared to previous ones, you may want to know what's going on because you can't read your own signposts.