Refusing internal exams with preterm labor risks - Mothering Forums
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#1 of 17 Old 08-09-2011, 07:33 AM - Thread Starter
 
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I'm cross posting this from I'm Pregnant hoping some of you have some advice for me.  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 :(.  

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#2 of 17 Old 08-09-2011, 07:49 AM
 
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Wow. Yes, that sort of response does sound manipulative. Between the ffn and the ultrasound, I too would refuse an internal exam, especially every visit. It is my understanding that Any manipulation of the cervix is likely to cause some cramping and uterine irritability. It may not lead to "productive" contractions that cause cervical change, but then again it might. What makes you high risk for preterm labor? Is it just the BH you've been getting or do you have a previous history?

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#3 of 17 Old 08-09-2011, 08:11 AM
 
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I've managed to refuse internal exams pretty well so far- largely because I had pPROM with my now three year old following a LOT of cramping, constant BH, and so on. I had an exam, and an internal at about 10 am, and was back in the office that afternoon leaking fluid.  I was very lucky to develop a 'leak' instead of a true rupture as the membranes opened on top of the uterus, as opposed to on the bottom.  That happened at 28 weeks, and we induced at 37 when tests showed evidence of lung maturity (safer out than in thinking.) 

 

After that pregnancy- I learned to say 'no'.  OBs don't LIKE that I say no, but I have enough experience to know when there is something up that needs further testing.  The first thing I would do in your situation would be to ask what the internal exam would tell them that the other tests couldn't.  

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#4 of 17 Old 08-09-2011, 08:40 AM - Thread Starter
 
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Quote:
Originally Posted by Mayachel View Post

 What makes you high risk for preterm labor? Is it just the BH you've been getting or do you have a previous history?


Thanks to both of you for your replies.  I have a previous history and some shortening of my cervix as well.  I am cramping so much still I just want to cry :(. I am really worried she screwed things up.

 

 Insidevoice--that is awful that happened to you.  I just have had this strong feeling like she shouldn't be touching my cervix, especially so aggressively, and reasons like you describe are exactly why.  I don't normally have a hard time saying no, but she is just so manipulative that I am only successful like half the time :(.  I need a new OB but unfortunately it feels late in the game to find one and I have had such bad experiences with doctors in general that I don't have a lot of hope of finding someone I can be on the same page with.  I wish I could just have a MW and a homebirth but that is definitely not going to be an option. 
 

 

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#5 of 17 Old 08-09-2011, 09:10 AM
 
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"don't you trust me?"
Wow.

Maybe a response like "if I didn't trust you, I would find another provider. Trusting you has nothing to do with it. I have a brain and in order to make informed choices and give my informed consent to procedures performed on me as required by law, I need to know the risks and benefits in advance. Can you please explain to me what additional benefit an internal exam has when you're already doing these other things?"

If you're not comfortable with her answer, you can ask for research that supports her position.

In the end, it's your body and EVEN IF refusing to have an internal exam actually does pose a risk to you, she cannot MAKE you do it without a court order.
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#6 of 17 Old 08-09-2011, 09:29 AM
 
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OP, if I were you I'd spend the whole afternoon trying to find another provider. No way should you be made to feel this way. My CNM would have backed off and talked to me a lot about the quality of the contractions... repeated internal exams do more harm than good and can introduce germs.. even if she's wearing gloves.
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#7 of 17 Old 08-09-2011, 07:18 PM
 
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My apologies, I clearly missed the initial statement of a history, when I was being shocked by the brazen rudeness of your doctor. I agree with philomom that my biggest concern would be the combination of doubt and lack of respect of your wishes from your doctor. I'm sorry for the added stress.

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#8 of 17 Old 08-10-2011, 11:45 AM
 
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I agree, regardless of if the exams are necessary or not, your OB is being manipulative. "Don't you trust me" is a line used by abusers.  I'd much prefer a provider that calmly explained the pros and cons and why she felt that the pros outweighed the risks. And then respected MY decision.

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#9 of 17 Old 08-10-2011, 12:13 PM - Thread Starter
 
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Quote:
Originally Posted by Mayachel View Post

My apologies, I clearly missed the initial statement of a history, when I was being shocked by the brazen rudeness of your doctor. I agree with philomom that my biggest concern would be the combination of doubt and lack of respect of your wishes from your doctor. I'm sorry for the added stress.



No apology necessary at all. I didn't take it that way.  I am pretty shocked by her brazen rudeness myself.

 

Thank you everyone for your replies.  I guess I needed to hear that there wasn't some factor I wasn't thinking about making it necessary for her to do the cervical checks.  The other factor is that I have been through a billion OBs and doctors.  I am never pleased with my medical care and sometimes I start wondering if it is me or them.  I really think though that most doctors hate to be challenged by their patients in any way, and since I do it with regularity, I feel like I am always walking a fine line. I am not half as crunchy as most people on these boards in terms of medical care, but I still question and challenge a lot and it seems to typically be met with a lot of resistance.  I have already declined (with a big fight) a first trimester pap, continuing on aspirin despite my clotting tests coming back fine, progesterone shots, 12 week nuchal scan ultrasound, etc.   This OB is the best I have found so far with a lot of searching and switching already, so part of me just doesn't want to tick her off and end up with someone even worse which is why I have been a little cautious in what I say to her.  I do have an appointment for a different OB for a couple weeks from now.  I haven't ended care with the current OB because I am not that sure I will like the new one, but we'll see.  Thanks everyone for giving me the confidence though to tell her to keep her fingers away from my cervix.   

 

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#10 of 17 Old 08-10-2011, 01:16 PM
 
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Toddlermama - I run into the same thing with most doctors too.  I ask lots of questions and why's frequently and I feel I have confidence when I do it because I won't blindly follow what ANYone tells me (not just doctors).  I think they just don't get challenged very much and they start to feel that they know all the answers.  I have luckily found a doctor for my son and for me that is humble enough to admit when they might be wrong and respectful enough to explain and show research on what they are trying to tell me.  I don't know where you live, but those doctors HAVE to exist there!  :)  I used to be a clinical therapist and even though I am all about client empowerment, I found myself getting defensive when clients asked lots of questions (especially the ones I didn't have the answers to).  It usually took me a few sessions to adjust to the clients that asked so many questions without feeling like they were challenging me.  Once I let my ego go though, we were able to have wonderful dialogue.  

I think what your doctor said was pretty inappropriate and since you have liked her compared to others, I would suggest telling her your feelings.  I would mention how you felt it was a manipulative comment and ultimately it is your decision to make and this is how you make your decisions (by asking and researching).  If she can't respect that, then she is not a good doctor.  You are paying her to give you what is in your best interest.  


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#11 of 17 Old 08-11-2011, 01:10 AM
 
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Hi, I am kind of in the same boat, having constant contractions that (at least for now) don´t do anything to my cervix. My doctor does internal us everytime I am in, which is about once every two weeks, which does give me more contractions, and I do wonder sometimes, but: I am having an infection after infection after infection. It started around the 12th week with a bad UTI and never stopped since, I was on four courses of antibiotics since than because I have either a bug growing around the cervix or an UTI, and my doctor does swabs everytime the contraction gets worse. And clearing the infection does help - for about a week. 

 

So, my doctor does internals for swabs, which are really uncomfortable, and she tells me that it is wise to do as few internals as possible, just not always possible :( 

 

Hugs, hang in there!

 

 

 

 


Trin with DH , DD(7) dust.gif and DS(5) jumpers.gif,  DD(2) energy.gifdog2.gifbelly.gif(due 5/14)

I am not regularly online at the moment due to the above ...

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#12 of 17 Old 08-11-2011, 01:13 PM
 
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trinity - take garlic pills - garlic kills infections. (I'd be inclined to insert the softgels vaginally  also, no clue what an OB would say to it though ;)  i personally would also take tons of vitamin c , echinachea and zinc to up the immune system.

 

NOT medical advice, my own research as a self taught amateur herbalist.

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#13 of 17 Old 08-12-2011, 03:04 PM - Thread Starter
 
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Thank you Wendizbaby-- I think a small piece of the issue is that she comes from a culture in which you pretty much just listen to what your husband, older adults, or doctors tell you to do and don't question them.  Maybe that has been part of my hestitation with her is that I don't want to come off rude.  Thanks to all of you though, I am feeling confident enough to tell her she's not touching my cervix and share more of my feelings with her.  I do have a backup OB I'll be seeing so maybe she'll be more my style. 

 

Trinity--I definitely second the garlic pills.  I have had good luck with them for other things. 

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#14 of 17 Old 08-14-2011, 07:16 AM
 
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Thanks, I´ll try the garlic, having the next UTI at the moment ... :(


Trin with DH , DD(7) dust.gif and DS(5) jumpers.gif,  DD(2) energy.gifdog2.gifbelly.gif(due 5/14)

I am not regularly online at the moment due to the above ...

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#15 of 17 Old 08-15-2011, 09:40 AM
 
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Are there any CNMs practicing in your area?  You can look on midwife.org and go to 'Find a Midwife' to check.  I would think you might be happier, and it is absolutely NOT too late to change providers.  There are also some really nice family practice docs that do prenatal care and births--another option.

 

Hope you find someone who respects your choices and listens to you.  That's not too much to expect.

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#16 of 17 Old 08-15-2011, 10:18 AM
 
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Quote:
Originally Posted by APToddlerMama View Post

Thank you Wendizbaby-- I think a small piece of the issue is that she comes from a culture in which you pretty much just listen to what your husband, older adults, or doctors tell you to do and don't question them.  Maybe that has been part of my hestitation with her is that I don't want to come off rude. 


You are just doing your part to help her get accustomed to American culture. :-)

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#17 of 17 Old 08-15-2011, 10:27 AM - Thread Starter
 
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Quote:
Originally Posted by junebugmidwife View Post

Are there any CNMs practicing in your area?  You can look on midwife.org and go to 'Find a Midwife' to check.  I would think you might be happier, and it is absolutely NOT too late to change providers.  There are also some really nice family practice docs that do prenatal care and births--another option.

 

Hope you find someone who respects your choices and listens to you.  That's not too much to expect.


There are, but I am very seriously high risk :(.  Prior placental abruption and PTL with my son as well as "separation" of the placenta in this pregnancy with SCH.  My risk of having another abruption is very high.  Even family practice doctors aren't comfortable with me.  There is a really good one I'd probably use otherwise. 

Quote:
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You are just doing your part to help her get accustomed to American culture. :-)
 


Ha!  That is a good thought.  I'm actually helping her out ;). 
 

 

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