Internal Exams During Labor - Mothering Forums

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Old 05-24-2010, 05:52 PM - Thread Starter
 
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Are there legitimate reasons to consent to internal vaginal exams during labor? And if so, do they apply across the board or only in special circumstances?

I consented to two last time and had no issue with them, but I'm feeling a little more paranoid about the chance of a hospital acquired infection this time. I know the drawbacks of cervical checks, but I'd like to know the benefits (if any) before broaching the subject with my doctor. I'd particularly love to hear the perspective of birth professionals.

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Old 05-24-2010, 07:19 PM
 
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They'll probably tell you that they want to make sure you're 10 cm dilated before you start pushing. Some women start feeling pushy before 10 cm, which usually leads to a general freak out and advice like "don't push, blow."
I feel that in many cases, it's actually not evidence-based to refuse to let a woman push along with her natural pushing urges.
If I have another baby (which I guess would be predicated on me ever actually having sex again, but I digress) then I would plan to tell the midwife that I'd be refusing cervical checks.

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Old 05-25-2010, 02:58 PM - Thread Starter
 
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The hospital I'm delivering at is apparently taking part in a study/initiative (I heard this secondhand so I'm unclear on the exact details) where the goal is to ONLY have women push when they feel the urge... whether that's before 10 cm or after they've been at 10 for longer than most hospitals would "allow." I'm going to ask my doctor about this at my appointment next week, but if I'm "allowed" to push at any time then there's really no point in the nurses knowing when I'm at 10. (Even if it turns out they aren't in the "push when the mom wants to" camp I'm still pushing whenever I feel like it.)

My husband thinks the reason they'll give for justifying cervical checks is so that they "know when to to call the doctor." This doesn't seem like a really medically necessary reason to me. Last time I was at 10 cm, feeling the urge to push, and being coached by the nurses not to because the doctor hadn't arrived yet

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Old 05-25-2010, 03:42 PM
 
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Originally Posted by rparker View Post
The hospital I'm delivering at is apparently taking part in a study/initiative (I heard this secondhand so I'm unclear on the exact details) where the goal is to ONLY have women push when they feel the urge...
The study sounds interested. I'd love to hear more when you find out.

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My husband thinks the reason they'll give for justifying cervical checks is so that they "know when to to call the doctor." This doesn't seem like a really medically necessary reason to me. Last time I was at 10 cm, feeling the urge to push, and being coached by the nurses not to because the doctor hadn't arrived yet
That was my experience with my first born. He was crowning (the nurse could see his hair), and they prevented me from delivering because the doctor wasn't there. Pretty painful experience.

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Old 05-25-2010, 09:28 PM
 
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I personally would not allow them to do cervical checks even for the reason that I feel pushy. I allowed it with dd #2 and it turned out to be a mistake. I told the nurse that ds #1 was born 20 min's after I felt pushy and that baby #2 was on her way. She did a check and said 'no hunny that can't be your only 6 (or 7 I can't remember atm) cm's dilated'. I told her I was sure the baby was on the way and then she said something to the order of 'sure she is sweaty' in a condescending way. Needless to say it hurt way too bad to not push so I started pushing. I was incredibly scared because this was my first delivery with no pain meds (and sad to say that wasn't by choice) I felt so alone since noone besides me knew dd was on her way even DH went back to watching tv thinking he had lots more time to kill. When she started to crown DH literally had to scream down the hall for assistance. The doc was only there for the last 1/2, maybe less of her delivery (which in hindsight was probably a good thing but that's neither here nor there). In the end dd was born 13 min's after I talked to the nurse. I think those last cervical checks can be particularly damaging to Mom.
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Old 05-26-2010, 12:34 PM
 
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We just had a pretty good thread going about that:
http://www.mothering.com/discussions...ight=premature

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Old 05-26-2010, 01:38 PM - Thread Starter
 
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We just had a pretty good thread going about that:
http://www.mothering.com/discussions...ight=premature
I remember that thread!

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I think those last cervical checks can be particularly damaging to Mom.
I agree. For me, having someone else confirm that I'm fully dilated and "ok to push" is definitely not a compelling reason to consent to cervical checks.

I guess the reason I posted this is to see if anyone will chime in with a completely different reason for doctors/nurses/midwives wanting to do cervical checks other than to determine how dilated someone is and/or if they're "ready to push." Like maybe there's some totally unrelated justification that I'm not thinking of since I'm in no way a birth professional? Because internal exams during labor happen during a lot of home births too so it seems like this might not just be a matter of yet another annoying hospital policy if that makes any sense.

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Old 05-26-2010, 02:42 PM
 
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In my experience they measures "progress" with internal checks. I didn't know any better at that time, they didn't do too many (I have heard of hourly checks), but enough (4 or 5 I think)...

I wouldn't allow it again, especially since my water had broken at the beginning of labor. I never felt pushy, I was instructed to do so at 10cm, and I think my body wasn't there yet. That's why I pushed for 2:36h - I had a 3h limit set by the obgyn, so I was getting scared, but his midwife stayed cool luckily.
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Old 05-26-2010, 03:06 PM
 
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I didn't have any cervical checks during my last two births and am not planning on any this time either. For me it's just a personal preference, I labor much better that way (my midwife got to my house 15 and then 20 minutes before the baby was born the last 2 times) and my body simply ejected the babe when it was ready.

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Old 05-26-2010, 07:51 PM
 
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I had an internal check when I got to the hospital. Then another when I wanted to get into the birthing tub. And when I felt the urge to push they checked me again and I was at 9cm, but they didn't stop me from pushing.

I try to limit the internal exams especially since my water broke before started labor.

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Old 05-26-2010, 09:44 PM
 
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Once we got to the hospital last time I swear there was a pair of hands in there constantly.

I ended up with nasty uterine infection afterwards so I too want to avoid them this time around. I don't think there's much reason for them.
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Old 05-26-2010, 11:52 PM
 
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I had 2 checks with my vba2c and I was fine with that. The ob checked me when I arrived, then asked a nurse a few hours later to have him come check me again (I could feel my bag of waters bulging and it was really uncomfortable, I ended up being 9cm so I asked him to break it). I was okay with the way that went. IDK about cervical checks from a professional standpoint, though. I think it's just a way to monitor "progress."
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Old 05-27-2010, 12:50 AM
 
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I know that the many checks are pretty unnecessary but I have to say I found the occasional check kind of reassuring. It was nice to have some measure of progress 'cause labour was just hard & painful for me & sure didn't feel like anything was progressing.

At the same time I do think I started pushing because I was at 10cm & not because I felt like pushing & that is something I will try to change for next time. Pushing was terrible for me & I think if I'd waited this would have been more productive.

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Old 05-27-2010, 02:46 AM
 
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I had several when I gave birth to my first son but they didn't really tell me much besides a number. I knew when it was time to push, they checked me, i was at ten and so I started pushing. Textbook. Took a little less than two hours to get him out though because he was OP.

With my second, I went in saying no checks but consented to one when I started hurting pretty badly and just wanted to know I was making progress. Was at a "tight 5cm". DS2 was born 3 minutes later after one push which could have been mistaken for a sneeze. Not so accurate that time.

If I have another, I would deny them again though. They didn't prove to be so much help with either baby.

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Old 05-27-2010, 11:28 AM
 
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I remember that thread!

I guess the reason I posted this is to see if anyone will chime in with a completely different reason for doctors/nurses/midwives wanting to do cervical checks other than to determine how dilated someone is and/or if they're "ready to push." Like maybe there's some totally unrelated justification that I'm not thinking of since I'm in no way a birth professional? Because internal exams during labor happen during a lot of home births too so it seems like this might not just be a matter of yet another annoying hospital policy if that makes any sense.
There are occasions when doing a vaginal exam provides useful information. If you are having a long difficult labor, they can check and see which way the babies head is turned and from there, suggest specific positions to help get the baby in a better position. Of course, sometimes you can tell just based on the labor pattern, but a vaginal exam will tell you exactly which way the baby needs to rotate. A vaginal exam can also be useful if there is some kind of complication and you need to see how close birth is. Or if they want any kind of pain meds.

Many homebirths that I've been to haven't had any vaginal exams, but that's pretty hard to obtain at the hospital unless you come in pushing.

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