Why are you against internal exams?

[Vicitoria]

I'm just curious. Many people here are against internal exams during pregnancy. By that I mean, a vaginal exam besides maybe that first ultra sound for dating. Why?

[jessitron]

Because they don't tell you anything conclusive. From a birth story on another board yesterday: "Walking around 4 cm dilated for a week is very stressful." Well, she wouldn't be panicked about going into labor at any moment if she hadn't had the vaginal exam. Women get all excited about their progress, when it really doesn't say much about when you'll go into labor and when you won't.

Some doctors (and some midwives) will stretch your cervix or strip your membranes during a cervical exam without asking you. Avoiding the exams keeps that from happening.

There is a tiny increased risk of infection from them. Too small to bother me if there were any benefit to them at all, but their really isn't. Curiosity, maybe. I'm glad my doctor is happy to skip them.

[jessitron]

BTW, Vicitoria, I like the perspective you bring to this board. You're not biased against traditional medicine in the way many of us are, but you make educated decisions that we can all respect.

[Jenlaana]

I have a few reasons why I'm against internal exams. First, I have an emotional component and have zero trust in the obstetric community, other than a specific homebirth midwife (who cant be my care provider due to state midwifery guidelines) and have a LOT of trouble with them even touching my tummy let alone my insides.

Second, it has been well documented that there are situations where someone has done something against the wishes of the patient, or even worse, without even asking for that permission. anal probes during a GBS check, stripping membranes, breaking water, messing with the uterine opening in other ways, etc.

Third...because the more that you are messed with internally, the more chances there are for bacteria to come into contact with the utereus, which increases risk of infection to the baby.

And Forth... many doctors rely way too heavily on dialation as a way to judge how the pregnancy is going, and I believe that to be a falicy. I dont want anyone putting false expectations on when I am going to go into labor, and even worse, don't want a deadline or someone going on vacation because they are planning on my birth being before a certain date. In labor, I definitely would not allow checks because there is a rule of thumb about 1 cm dialation per hour, and there is just no way that I would set myself up for that kind of failure. My last pregnancy I was dialated a week prior to labor, and then I labored for 3 days before DD was born (and it was an incredibly easy birth). To have that spoiled because I labored too long would just not be acceptable to me.

and really.... I have never actually found a good reason TO do it. If I found a reason for it, I would do it, but there is no reason that I have found that justifies it.

[the_lissa]

Because they do not yield any useful information and are a risk for infections. It really bothers me when caregivers do things that do not have benefits and can hurt.

ETA: I thought this was in pregnant. Sorry for crashing the ddc.

[Hippiemommie]

Like the other people say, they are useless. I was 3cm dilated with DS for 3 weeks. It increases your risk for infection and some midwives/doctors will strip your membranes without your knowledge or consent trying to make the baby come before he or she is ready. Plus they make me feel like crap for the rest of the day. I can't really see why they do them at all.

[zak]

They don't "tell" you anything. They risk infection. They risk PROM.

[Devaya]

i haven't had any internal exams during my pregnancy, but I think where I live the midwifery model of care dominates much more than obstetrics, so i'm very fortunate in that. interesting to read about this debate... on another board I visit there's a lot of talk of 'numbers' which don't seem helpful other than to get people more anxious.
I was wondering though, what about internal exams during labour? I had read that a good midwife doesn't need to do them , to see how far you are progressing, and can judge by your behaviour, but when I mentioned this to my MW (as I'm planning a home waterbirth and internal exams would involve getting in and out the pool), she said no, they do need to do internal exams. There was a tone of 'no discussion'. (she's otherwise very pro-home birth and comfortable with water birth). what are people's thoughts?

[Jenlaana]

The midwife that I used (until her boss went psycho on me) told me that the information obtained from in labor exams is for their benefit, not mine. It helps them to gage their actions (i.e. when to set up the birth kit, when they can take a nap, how much longer they will have to be there etc) If they have any plans to transfer for lack of progress, then knowing the progress is very important as well. (some are not comfortable if someone stays in active labor for x amt of hours)

[Aeress]

I find them intrusive. Though my midwife is very gentle, I still find them painful.

I did consent to one yesterday as baby has been posterior and it has been hard to gauge where the head is lying.

I have also asked for one in the past when I had a concern with position.

[mittendrin]

Originally Posted by Devaya

I was wondering though, what about internal exams during labour?

I was wondering about that one myself. Partially because I am trying to make it to the hospital a bit sooner than last time. While I am all for laboring at home for the most part I did not like coming in there almost pushing. I would like some time to get settled (not harassed by the triage nurse tho ). With my ds 2 I came in very late in the game and getting checked and monitored was horribly uncomfortable to me. I will trust my instincts this time. If I feel lots and lots of pressure already with strong contrax and my body tells me it's almost time then I won't let anyone up my HooHa

[Devaya]

thanks for the info ladies interesting that labour internal exams can be seen as more for mw's information/benefit i.t.o. pacing the whole thing. I can't imagine going into hospital being in well advanced labour, though obv there are all those adv's to staying at home long as possible. i hope u can say what u want tho..i mean if u really don't want an internal exam !

[DoomaYula]

I don't want one while I'm pregnant because it doesn't really matter. Last pregnancy, I had one done at 39w and the CNM said, "You're about a half a cm dialated," and I flipped out, I said, "What do you mean HALF A CM?!?!? Women who aren't even pregnant are half a cm dialated!" :

I don't know about in labor, probably not. With every birth I've *known* when it was time to push, so it doesn't really matter to me.

My homebirth mw won't do an exam until 41w.

[Vicitoria]

Thanks for the answers.

I had my GBS test last week and my new OB was very easy with it. He did check for the head as well because the heartbeat is really up rather high.
He did another internal exam yesterday and was just checking for progress. I'm not against it, I'm interested actually but I felt like crud the rest of the day and I was wondering if that was the reason why. It could have been what I ate afterwards too but I just felt blah. So, coulda been the exam, maybe not.

My last birth was a birth center birth and the midwives did exams periodically to check when I could start pushing etc... That and all the doppler checks for the heart beat etc... I think I'd rather that then be hooked up to a monitor. We talked about low intervention birthing suites yesterday and he was all for it and said we could actually go low intervention in any of the suites with no problem.

[aylaanne]

I'm restricting vaginal exams because I don't want the pressure of the numbers, and there's a risk of infection. However, I will consent to them this birth for a couple of reasons. First, I've never been in labor before and I want to know what my body's doing when I feel certain ways. Basically, I want to get to know my body better. Second, my midwives have an apprentice and I want her to be able to practice. She's a fabulous midwife but she's not very confident, and vaginal exams are a hard skill to learn. A lot of women don't want to be a teaching tool, and I respect that, but I don't mind. I also reserve the right to change my mind later.

[Banana731]

Besides the evidence based stuff from PP. It's my vagina, I don't want random people's fingers in there. I wouldn't go around having vaginal exams all the time if I weren't pregnant, and no one else would either. I checked my cervix all the time with FAM before I got pregnant, funny right?

If I had an apprentice midwife I liked who needed experience I might let her check me before labor to get some with early dilation. You may change your tune on that one once you get going Aylaanne, internals during labor are NOT fun.

[Pumpkin_Blythe]

My dr had his hand in me every appointment from 35 weeks on last pregnancy. It was never an "option" for me as far as I know.

[ashleyhaugh]

ive only had 2 (well 3, if you count the pap at my first appt)- one when they did my gbs test, just to see, and one this week at my last appt cuz im nearing my edd. my doc never wanted/offered/mentioned giving them other than those 2 times.... i dont know what i'll do about them in labor yet.

[mama_daba]

I had my first internal exam done yesterday and it was my choice. in a way i wish i had not because the numbers are bugging me now but i didn't do it for the numbers i actually did it so that if my midwifes do any while i am in labor i am more used to that and feel safer trust them with what they are doing. it did not hurt at all and she was very gentle. i like knowing what my body is doing and that my body is getting ready and stuff it makes me trust myself more trust that my body knows what to do and how to do it. i have also do my own exams not because i want to know when the baby will be here but because i like that i can feel the head and i like that i can feel for myself that my body is doing all these changes and is working the way it should. i like tht my midwifes don't puch internal exams they offer them explain reasons to do them or not to do them and then let me decide what i want to do.

[Liam's Mum]

Originally Posted by Pumpkin_Blythe

My dr had his hand in me every appointment from 35 weeks on last pregnancy. It was never an "option" for me as far as I know.

See, that's what I don't get, some do them so early and/or all during pg -- but others don't, so what's the point? I am glad my OB didn't do one until 40 w, and the m/w won't do them until 41 unless there's a reason. I even got to do my own GBS swab this time.

I just agree with the others, what's the point of knowing you are a cm dilated if you can stay like that for weeks? Or knowing you aren't dilating at all when you could still go into labour the very next day? So I'm not completely "against" them, I just think they can be unnecessary.