After membrane sweep on Monday, possible HB!! - Mothering Forums

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#1 of 66 Old 08-23-2010, 03:21 PM - Thread Starter
 
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We had our first weekly OB this morning. During our internal exam the doctor jerked upward and into me 3 times and when I got uncomfortable, he stopped, said something about babies head bounced... It was so unusual, and unexpected, both DP and I laughed. About two and a half hours after my cervical check this morning I noticed that I was spotting. The spotting, I assumed, was normal from irritation of the cervix during the internal exam. When I went to the bathroom it was a richer red, and I wiped 3x, but there was the same amount each time. I was still trying to justify this as normal irritation, but when I got up and looked in, there was a clot the size of a nickle. So I called L&D.

About an hour ago I got the call back. The nurse had talked to my doctor and told me that it was normal to bleed a little after the exam because the cervix is sensitive. I replied that I understood that, but was concerned with the clot and the fact that I was still spotting. "Oh that will happen because the doctor stripped you membranes during your exam."

Seriously?!? I kind of laid into her. Asking her what, in his opinion, justified stripping the membranes of a 36 week pregnant woman, during a NORMAL pregnancy with no apparent complications and without her knowledge or consent. She put me on hold. When she got back on the phone, she told me that she needed me to understand that he did not break my water (Which I sarcastically replied I am well aware of that!) and that what he had done was "manipulate" my membranes because I was almost 37 weeks along and it would soon be our time.

... Exccuse me! MY body is capable of deciding when our time is coming! I chose this ob because he has a good history of allowing the birthing process to complete as naturally as possible with few, if any, interventions. His induction and csection rates are unbelievably low. During the pregnancy he has given me no reason to not trust him, and last week I assigned him as our practitioner when I was approved for Medicaid. Today was a devastating blow! I am just... I don't even know. I have been crying, shaking and irate since I got off the phone with the lady.

He had no medical reason, and no ethical right, to make a decision like this without my knowledge, and consent. There was no reason for him to not take the time to explain why he thought I would benefit from this, and to explain that I may experience bleeding and at least one substantial clot. For the nurse to throw the word "normal" into my face was almost as insulting as the procedure I unknowingly went through. During a NORMAL pregnancy, the doctor you trust does not manipulate your membranes at 36 weeks! Does he? Maybe I missed something during my research, and the human reproductive course I just took a couple months ago... I feel extrememly violated.

"A baby will make love stronger, days shorter, nights longer, bank balance smaller, home happier, clothes dirty, the past forgotten, and the future worth living for." ~A.U.
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#2 of 66 Old 08-23-2010, 03:22 PM
 
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I'm so sorry! You're right, he had no right to do that. I don't understand WHY so many OBs and midwives, as natural minded as they may be, think that stripping membranes without consent or even NOTICE is okay! I'm furious on your behalf. What are you going to do - switch doctors, write a letter of complaint?

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#3 of 66 Old 08-23-2010, 03:24 PM - Thread Starter
 
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I don't know what to do! I think it may be too late to switch ob's and may be impossible with medicaid. At the very least I will tell him how I feel about his actions and inform him that he is not to provide me with ANY treatment, no matter what, without my prior consent. There will be no more internal exams... I just don't know what else to do right now.

Oh, and I am still spotting, but it is a light pink. Baby is moving around fine and I have only minimal cramping. Since stripping the membranes in any capacity is not always effective, I am hoping that my body can correct any damage the "good" doctor has done.

Before letting me go, the nurse told me that as long as I do not soak through a pad in an hour that I should not be concerned.

Thank you, if you took the time to read this rant...

"A baby will make love stronger, days shorter, nights longer, bank balance smaller, home happier, clothes dirty, the past forgotten, and the future worth living for." ~A.U.
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#4 of 66 Old 08-23-2010, 03:28 PM
 
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I am so so mad for you!!! I can't believe he did it at 36 weeks!!!!! Mine did it to me at 39weeks and I was 4cm already without permission as well - I called her on the carpet about it right as she was doing it and get this - it was because she was going on vacation and wanted to be there. #%&%^$&^%$

And the irony of it all is that she was in the hospital but not at my birth after all of that! Seriosuly, I am so glad you read them out - that is SUCH a violation!

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#5 of 66 Old 08-23-2010, 03:36 PM - Thread Starter
 
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Unbelievable that they can get away with it! My doctor was so... smooth! He made us comfortable, made us LAUGH and if I hadn't had the bloody show we would have NEVER known. It is such a scary feeling!

36+ 5 days today. At the time no dilation, no effacement and baby was only partially engaged, and when he was telling me this, after his "manipulation" he also told us that it was perfectly normal at this point for a first pregnancy for my body to not be showing signs. I asked him if he would want to do an internal exam every week, and he said that he usually does, but that if I wasn't comfortable with it we could skip it IF nothing had changed. I.E bleeding and/or contractions. Oh... there WILL.BE.NO more internal exams, especially since he instigated the change and I can no longer trust him.

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#6 of 66 Old 08-23-2010, 03:36 PM
 
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Stripping membranes wihout consent is not okay. I'd be seriously pissed.
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#7 of 66 Old 08-23-2010, 03:37 PM
 
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Wow, that's horrible!
But great for you for standing up for yourself and your baby. I think no more internals is definitely the way to go.

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#8 of 66 Old 08-23-2010, 03:37 PM
 
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Yeah, that is a ridiculous.
Out of curiosity, why did you consent to the vaginal exam in the first place? I think a lot of OBs want to do weekly VEs at the weekly apts past 36W, but the data they get on cervical dilation, effacement, & baby's position is utterly & totally meaningless (unless you're considering induction & want to get a Bishop's score.) Otherwise there is absolutely zip-zero-nada value to prenatal VEs.

Has he been truly accepting of everything else in your birth plan? Low rates of CS & induction are good, but is he cool with intermittent monitoring, you eating & drinking as desired (no prophylactic IV fluids), pushing in any position, not having hourly VEs in labor, etc.? & is he really truly fine with these things or just willing to accept them since you've requested them? (A crucial difference, IMO.)

IF you've gone over all that in your birth plan & he has been cool with it thus far, then perhaps he really did think the membrane stripping was "normal" and just a part of the 37W VE. I'm not trying to excuse his behavior because it's undoubtedly wrong - no question! But maybe he's just so used to doing it at the 37W apt that he kinda assumed you knew it was coming. (bearing in mind that the vast majority of women never QUESTION anything a doc recommends, let alone decline a suggested intervention!)

My point is that - *IF* you feel comfortable with him otherwise and you have enough other hard evidence that he really is a truly, good NCB-supportive OB, then maybe you don't have to walk away. This doesn't necessarily have to mean he's a UAV who habitually does stuff without consent, let alone notice. Switching docs at this point would certainly be a hassle. Unless you're open to HB - then i say go for it!
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#9 of 66 Old 08-23-2010, 03:43 PM
 
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That makes me so angry! It's wrong in so many ways! I'm sorry this happened to you. I had a homebirth mw that did a procedure without my consent also and I was so upset. It's such a violation of trust. I'm really sorry

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#10 of 66 Old 08-23-2010, 03:43 PM
 
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Originally Posted by Baby~Braatens~Mama View Post
I don't know what to do! I think it may be too late to switch ob's and may be impossible with medicaid. At the very least I will tell him how I feel about his actions and inform him that he is not to provide me with ANY treatment, no matter what, without my prior consent. There will be no more internal exams... I just don't know what else to do right now.

Oh, and I am still spotting, but it is a light pink. Baby is moving around fine and I have only minimal cramping. Since stripping the membranes in any capacity is not always effective, I am hoping that my body can correct any damage the "good" doctor has done.

Before letting me go, the nurse told me that as long as I do not soak through a pad in an hour that I should not be concerned.

Thank you, if you took the time to read this rant...
That is seriously messed up. I can't believe he wouldn't tell you. I would be just as furious.

And NO, that is NOT normal. I have a fairly standard OB, and he does NOT regularly strip my membranes when doing a pre-labor VE.

That he didn't give you a chance to consent would totally freak me out, too.

I definitely recognize that it's not a great time to change providers, but I would encourage you to have a very frank talk with him about how upset you are, and why. Hopefully if he listens to you and apologizes and reassures you, you can be able to still have some trust in him as a HCP. If he blows you off or doesn't seem to understand why you are upset, THEN I would think about doing whatever I could to find someone else, even this late in the game. You need to be able to have trust in your HCP.


As far as stripping the membranes, if your body isn't ready, it won't work. So, yes, your body can correct this. Stripping membranes as far as induction only works if you are on the edge of labor and just need a "push." So, as scary and sucky as it is, I wouldn't worry about the physical effects at this point-- just take it easy over the next day or so.

So sorry this happened.

Kelly (28), in love with husband Jason (38) and our awesome babies:  Emma 4/09, and Ozzy 8/10

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#11 of 66 Old 08-23-2010, 03:44 PM
 
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36+ 5 days today. At the time no dilation, no effacement and baby was only partially engaged,
How can that be? I actually requested to have my membranes stripped when I was 41W4D & my CNM said she'd try, but she can't do it unless I'm at least a little dilated already - like a 1 or 2 cm. Which makes sense. If there is literally no dilation, there's no way for him to reach through the cervix in order to lift the BOW off the mouth of the cervix.

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I asked him if he would want to do an internal exam every week, and he said that he usually does, but that if I wasn't comfortable with it we could skip it IF nothing had changed. I.E bleeding and/or contractions.
I hate to say, that seems a bit of another red flag to me. If you had some ctrx, why would it be necessary to do a VE? Until they were coming in a clear, continuous pattern, you don't consider yourself "in labor." So no need to come to the hospital. They tell you that themselves!

So if you have some extra BH ctrx or spotting, why would that necessitate a VE? I only see the VE becoming even remotely useful when the ctrx are long enough, close together enough, and continuing for a time to make you think your in labor- then they want to do one before admitting you to the L&D ward. But before that point, again, I see zip-zero-nada value to prenatal VEs.
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#12 of 66 Old 08-23-2010, 03:49 PM - Thread Starter
 
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Yeah, that is a ridiculous.
Out of curiosity, why did you consent to the vaginal exam in the first place? I think a lot of OBs want to do weekly VEs at the weekly apts past 36W, but the data they get on cervical dilation, effacement, & baby's position is utterly & totally meaningless (unless you're considering induction & want to get a Bishop's score.) Otherwise there is absolutely zip-zero-nada value to prenatal VEs.

Has he been truly accepting of everything else in your birth plan? Low rates of CS & induction are good, but is he cool with intermittent monitoring, you eating & drinking as desired (no prophylactic IV fluids), pushing in any position, not having hourly VEs in labor, etc.? & is he really truly fine with these things or just willing to accept them since you've requested them? (A crucial difference, IMO.)
I consented out of curiousity, and because he had to do the GBS. (It is hospital proticol and there is only 1 hospital here.) I am aware that the internals are not necessarily necessary, accurate or reliable, but this is my first baby and I really did want to know.

He has stated that he is ok with all of my wishes, (which are almost exactly as you described them!) and I have positive feedback from several women who have birthed with him. I will definitely be going over birth plan in more detail and have him sign it if I stay in his care. I have not been able to find a licensed mw here, and do not know if Medicaid would cover a hb.

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#13 of 66 Old 08-23-2010, 03:53 PM
 
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I would put IN WRITING (and notarized if you can afford it to make it that much more legal) that his hands come nowhere near your vagina without your explicit request. If he doesn't like it tell HIM to find you a new doctor.

Ugh, what he did is assault. I really really hope that you're busy writing a letter of complaint to send to everyone that will read it.

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#14 of 66 Old 08-23-2010, 03:53 PM - Thread Starter
 
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How can that be? I actually requested to have my membranes stripped when I was 41W4D & my CNM said she'd try, but she can't do it unless I'm at least a little dilated already - like a 1 or 2 cm. Which makes sense. If there is literally no dilation, there's no way for him to reach through the cervix in order to lift the BOW off the mouth of the cervix.
So if you have some extra BH ctrx or spotting, why would that necessitate a VE? I only see the VE becoming even remotely useful when the ctrx are long enough, close together enough, and continuing for a time to make you think your in labor- then they want to do one before admitting you to the L&D ward. But before that point, again, I see zip-zero-nada value to prenatal VEs.
I honestly don't know. I did not know that it was something EVER done unless necessary. None of it makes sense to me!

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#15 of 66 Old 08-23-2010, 04:02 PM
 
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I am sorry. I feel like he took advantage of you.
I don't take my bottoms off until the baby is crowning. LOL.
There really isn't reason for an internal this late in the game with you having a normal pregnancy. I am so sorry that he violated you like that, just awful.

That's the doctor I wouldn't trust at birth, to let's say NOT do an episiotomy...

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#16 of 66 Old 08-23-2010, 04:05 PM
 
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Ugh. It makes me crazy how common this is. Two people in our birth class had their membranes swept just before 40 weeks. In one case she said that's what she was going to do, but didn't really offer it as a choice. And in the other case she just did it, and the couple didn't realize what had happened until the other couple was telling about their membrane sweep earlier. And this was a midwife at a free standing birth center!

But, if it makes you feel any better about the effects of the sweep at 36 weeks- I had four (maybe five?) ROUGH sweeps between 39-40 weeks (we were trying to get me to go into labor instead of having to be induced due to cholestasis). I mean, rough. They hurt to the point that I had to have DH hold my hand, I was arching off the table a bit, and had tears in my eyes. And I *still* didn't go into labor- had to be induced!

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#17 of 66 Old 08-23-2010, 04:45 PM
 
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I understand that you feel violated, and according to your beliefs about how your prenatal care should go, that makes total sense.

BUT...some doctors view membrane stretching/stripping as routine. Did you know or ever ask if he does it regularly? Not that it's your place to pre-question everything he does, but you might find some comfort in looking at it from his viewpoint...he probably didn't do it maliciously, or out of disrespect for your feelings of birth. He probably didn't even realize it would clash with your wishes.

My guess is that, if next time you tell him you don't want membrane stripping, he'll totally respect that and go with the plan. This seems like an issue of miscommunication, not necessarily a bad OB.

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#18 of 66 Old 08-23-2010, 04:59 PM - Thread Starter
 
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I understand that you feel violated, and according to your beliefs about how your prenatal care should go, that makes total sense.

BUT...some doctors view membrane stretching/stripping as routine. Did you know or ever ask if he does it regularly? Not that it's your place to pre-question everything he does, but you might find some comfort in looking at it from his viewpoint...he probably didn't do it maliciously, or out of disrespect for your feelings of birth. He probably didn't even realize it would clash with your wishes.

My guess is that, if next time you tell him you don't want membrane stripping, he'll totally respect that and go with the plan. This seems like an issue of miscommunication, not necessarily a bad OB.
I have calmed down enough to come to pretty much this same conclusion. If, at any time during my research, I had come accross information that would have lead me to believe that todays actions were even a possibility, I would have been able to prepare myself to either accept the procedure or oppose it. IMO the OB has an obligation to inform his patients of any and all actions he is planning on performing, so that this type of misunderstanding does not occur. Unfortunately not all OBs feel that it is their responsibility to educate their patients, and unless we stumble upon this information or take the same obstetrics courses they did, we have no way of knowing what to expect until it happens to us.

Thank you all so much for your support! I have re-written my birth plan, hopefully filling in any holes that may allow for further miscommunication and frustration. I feel much better now. There are just so many things that can happen, and this is my first pregnancy.

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#19 of 66 Old 08-23-2010, 05:05 PM
 
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I have calmed down enough to come to pretty much this same conclusion. If, at any time during my research, I had come accross information that would have lead me to believe that todays actions were even a possibility, I would have been able to prepare myself to either accept the procedure or oppose it. IMO the OB has an obligation to inform his patients of any and all actions he is planning on performing, so that this type of misunderstanding does not occur. Unfortunately not all OBs feel that it is their responsibility to educate their patients, and unless we stumble upon this information or take the same obstetrics courses they did, we have no way of knowing what to expect until it happens to us.

Thank you all so much for your support! I have re-written my birth plan, hopefully filling in any holes that may allow for further miscommunication and frustration. I feel much better now. There are just so many things that can happen, and this is my first pregnancy.
Make sure that you AND YOUR OB physically sign your birth plan

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#20 of 66 Old 08-23-2010, 05:10 PM
 
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That is NOT ok.

File an official complaint with the state - for example, here's my state's site.

Even if the OB is not a "bad" doc, he is certainly not a good one. A good doc does not assume consent to any procedure is implied. Even if nothing comes of a formal complaint, the doc clearly needs to be reminded of rules and ethics.

I am sorry mama!

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#21 of 66 Old 08-23-2010, 05:11 PM
 
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Wow that is horrible. Since it is hard to switch providers, refuse any further internal exams. And for the record, the GBS is just a swab of your vaginal opening and rectal area, it doesn't even go as deep as you'd have to insert your finger to insert a tampon, so if he said an cervical check was necessary for a GBS test he was lying!

And yes, as pps stated, get that plan signed. Most of the time you will be alone at the hospital anyways, the docs/CNMs dont show up until you are pushing. So during that time, it's easier to stop interventions... During the birth process itself, have your partner be glued to what's going on down there... In case the doc decides on cutting you or God knows what.
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#22 of 66 Old 08-23-2010, 05:19 PM
 
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I am sorry that he did this to you. I would file a complaint with the state board of medical examiners/licensing.
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#23 of 66 Old 08-23-2010, 05:22 PM
 
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#24 of 66 Old 08-23-2010, 05:24 PM
 
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I's be so, so mad if this happened to me. Why does anyone think they can do what they like to your vagina, without your knowledge or consent? WTH?!
Anything performed to you should be explained and consent sought. It shouldn't matter how 'routine' this procedure is in his practise, it shouldn't be up to you to try to think of everything he could be possibly do before he does it.

I'm sorry this happened to you OP.

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#25 of 66 Old 08-23-2010, 05:30 PM - Thread Starter
 
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Wow that is horrible. Since it is hard to switch providers, refuse any further internal exams. And for the record, the GBS is just a swab of your vaginal opening and rectal area, it doesn't even go as deep as you'd have to insert your finger to insert a tampon, so if he said an cervical check was necessary for a GBS test he was lying!
I will be refusing any further internal exams. I was well aware of what entails a GBS swab and thought I understood the cervical exam procedure. Not because he has ever taken the time to explain what he is doing or will do, but because I have spent the last 8 months educating myself on all common procedures related to pregnancy.

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#26 of 66 Old 08-23-2010, 05:44 PM
 
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This is kinda unrelated- but I had an internal exam when my CNM did the GBS test too. I just asked her to check baby's position.
I know, any MW or OB with half a clue can map a belly from the outside, but I was soooo paranoid about a surprise breech! (had happened to a few people I knew.) And it seems that the belly-mapping skill is becoming a lost art too anyway.

So point being - yeah, cervical exam isn't part of GBS, but I can see having one with it since I personally did.
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#27 of 66 Old 08-23-2010, 05:55 PM
 
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I think that even if he thinks of it as a normal routine thing to do that he should have warned you because it can really freakin' HURT.

I think HCPs should warn you when they're about to do something that is well known to be painful to a lot of people.

Hippie sympathizer and mom to L, 4.8.10.
Pet-mom to Squirt with FLUTD & Maya the deaf wonder dog .
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#28 of 66 Old 08-23-2010, 05:56 PM
 
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How can that be? I actually requested to have my membranes stripped when I was 41W4D & my CNM said she'd try, but she can't do it unless I'm at least a little dilated already - like a 1 or 2 cm. Which makes sense. If there is literally no dilation, there's no way for him to reach through the cervix in order to lift the BOW off the mouth of the cervix.

.
Yeah, I don't get this, either. I don't understand how it could physically be done if you weren't already dilated. So maybe it was "just" more like a rough internal with his intentions of getting things started. I'd definitely have a good conversation with HIM, rather than the bitchy nurse, and get it spelled out.

I'm sorry

DD1 7/13/05 DD2 9/20/10
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#29 of 66 Old 08-23-2010, 06:04 PM
 
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Ugh BBM - I'm sorry this happened to you! It's so disturbing to think that the OB does not feel the need to adequately inform you of the actions he is taking inside of your body! That would really freak me out. Hope things get spelled out at your next appt and you are able to have a wonderful birth. And no more internal checks!

[QUOTE=MegBoz;15765958]
I know, any MW or OB with half a clue can map a belly from the outside, but I was soooo paranoid about a surprise breech! (had happened to a few people I knew.) And it seems that the belly-mapping skill is becoming a lost art too anyway.
QUOTE]

I was surprised to learn that a friend from water aerobics is having an US at her next appt to see if the baby is breech. I asked her if her OB has palpated the baby's position at all and talked to her about it and she said no. Her OB has not felt with her hands the baby's position and is instead scheduling an US to check if baby is head down. I find this ridiculous.
/hijack

SAHM to one precious 2 year old and wife to my loving DH. And here we go again!
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#30 of 66 Old 08-23-2010, 06:35 PM
 
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I's be so, so mad if this happened to me. Why does anyone think they can do what they like to your vagina, without your knowledge or consent? WTH?!
Anything performed to you should be explained and consent sought. It shouldn't matter how 'routine' this procedure is in his practise, it shouldn't be up to you to try to think of everything he could be possibly do before he does it.

I'm sorry this happened to you OP.
I agree with this. He should have gotten your consent since he performed a medical intervention. I'm so livid for you! I would definitely talk to him about it and if you're not satisfied with his response, file a complaint. And no more internal exams. From what I understand, they tell you nothing about when labor will begin and why risk introducing bacteria in there? My last OB was very conservative/traditional and she offered internal exams and stripping membranes but it was just an offer. She didn't try to push it on me and certainly never did anything without my consent.

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