VEs in Late Pregnancy- Their Emotional Value? - Mothering Forums

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#1 of 76 Old 07-23-2010, 01:23 PM - Thread Starter
 
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It seems it’s common to have vaginal exams at the weekly appointments post 36W of pregnancy. I had co-workers I didn’t even know well and friends-of-friends ask if I was dilated!

When they asked, of course they all got a lecture about how it doesn’t really mean anything – you can be firm, high & closed & have the baby that night, likewise you could be 3cm and walk around that way for 2 more weeks. Besides I was GBS+ & the VEs just increase the risk of infection.

The strange thing was, they all replied, “Oh yeah, I know that. But I still wanted to know if anything was happening down there.” I’ve heard this repeatedly.

So it is as though there is a disconnect between
  • The intellectual realization that this data means nothing (without labor, of course)
  • & The emotional desire to view it as “progress” & a good thing (a sign that birth is coming soon)

As we know, of course birth is “imminent” – you’re pregnant!

Ya know, I think I realized I too might have been tempted to be disappointed if I was still hard & closed at 41W. Again, the intellectual realization might not be adequate to stop the emotional disappointment. (Likewise, if I were 3cm, I’d probably get even MORE anxious for things to start.)

So what was your choice- did you have VEs in late PG? & why do you think people consent to them even if they know the are worthless? Are we all just so desperate for insight into WHEN because the NOT KNOWING is too tough to handle? (My DS went to 41W4D and I did find the issue of not knowing when to be really difficult.)
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#2 of 76 Old 07-23-2010, 02:02 PM
 
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I'm not sure if I'm going to allow them but I heard of a woman who walked around for three weeks at 6 cm!!!

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#3 of 76 Old 07-23-2010, 02:17 PM
 
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Funny things about humans, we let emotional thought trump rational thought. My DH and I were just talking about this last night. It's kind of like all the old wives tales we have about whether we are carrying a boy or a girl. So many times over it has been proven that there is no correlation between heart rate and sex. Same goes with the shape of a womans belly. Round and out: boy, high and wide: girl. The only thing it depends on is the the shape of the womans body pre birth and the way the uterus and baby are lying.
Deciding to get checked is an emotional choice woman make with the hopes that the doctor will say something exciting. Unfortunately, it usually only leads to more anxiety and disappointment. We got so close to end and want to hear that we are almost there. We know that it doesn't mean anything, but for some reason we still do it. I learned this the hard way with my first. My MW told me a week before my due date that I was 2 cm and effaced and baby was way engaged and that she thought I'd have my baby within a week. Well, that sure did make the next 3 weeks feel like an eternity. I was 10 days past my due date.

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#4 of 76 Old 07-23-2010, 02:53 PM - Thread Starter
 
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I'm not sure if I'm going to allow them but I heard of a woman who walked around for three weeks at 6 cm!!!
Oh yeah, that reminds me, one mama I know got induced simply because she had been 4 cm for weeks! No other reason! She said her OB said she'd never heard of a woman walking around at 4cm for so long. WTH?! That's a reason to induce?!
I remember thinking "OK, so that's reason # 8 million to decline the VEs - so we don't have to have that discussion!"
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#5 of 76 Old 07-23-2010, 06:49 PM
 
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Originally Posted by MegBoz View Post
The strange thing was, they all replied, “Oh yeah, I know that. But I still wanted to know if anything was happening down there.” I’ve heard this repeatedly.
Hmm, do you think they really knew that, or maybe just didn't want to seem ignorant?

I pity the person who asks me about what's happening in my vagina - they're gonna get an earful!
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#6 of 76 Old 07-23-2010, 07:03 PM
 
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I think most women don't know they can refuse the exams! I sure didn't know with DS... I was with an obgyn and it just was normal... Now I know better and won't allow them at all with this pregnancy. It's horribly painful, potentially dangerous (infections or unwanted membrane sweeping!) and just no reliable information...

@ Megboz: wow that is creepy... I'm starting to think obgyns do the exams to push inductions....
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#7 of 76 Old 07-23-2010, 07:43 PM
 
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We know that it doesn't mean anything, but for some reason we still do it.
So true, so true, so true!

I've spent the last eight months explaining to my family and friends how checks mean nothing... it's just to satisfy curiosity... usually it leads to disappointment... this time I'm refusing all checks until I feel the urge to push.

Well, guess what? I just turned 36 weeks and I caved. Completely caved. One week ago I was all "No checks!". Yesterday? "Could you check me, please?"

Gah, it's going to be a long month!

(I was 1 cm. dialated, by the way. When do you think I'll go into labor??)

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#8 of 76 Old 07-23-2010, 08:19 PM
 
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I just got them last pregnancy because my Dr. said "Now I will check your cervix." Of course she didn't mention that it was a really useless piece of information. And honestly I didn't really know what any of it meant...even if there was a point.

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#9 of 76 Old 07-23-2010, 10:20 PM
 
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I really think that most people don't realize they mean nothing at all. Heck I don't think most OBGYN's realize they mean nothing, at least not the ones I've dealt with.

I actually just had a 'discussion' with my MIL about this today. My sister was due yesterday and MIL was asking how far along she has progressed. I told her that my sis hasn't had any VE. MIL seemed shocked and was asking 'well how are they going to know around when she will deliver?'. I told her the VE's don't tell you that anyway and that you can reverse dilate or even be like me who was 3-4 cm's dilated for months on end. She proceeded to strongly INSIST that a good doctor can tell around when you will deliver by looking at the thinning of the cervix and how much you are dilated. She does that all the time, where I will explain something and she will INSIST that I'm wrong and she is right. I just politely smile and nod and wait for my eye to start twitching in frustration.

MIL is also HIGHLY against midwives telling me how I will kill my baby (not preg. yet) if I go to one. Guess she's in for a surprise huh?
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#10 of 76 Old 07-23-2010, 10:43 PM
 
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You know, I really didn't mind them. And even though I knew they didn't predict anything, they helped me feel like the end was near, even if it was 1-4 weeks away. I knew my doctor wouldn't sweep my membranes (he doesn't believe in it) and wouldn't push an induction (doesn't induce prior to 42 weeks), and after going through fertility treatments, I guess I was used to people being all up in there

At my 36 week appointment, I was 1 cm, 80% effaced, and baby was at 0 station.

At my 37 week appointment, I was 2 cm, 100% effaced, and baby was still at 0 station.

At my 38 week appointment (38w3d), I was a little over 2 cm, 100% effaced, and baby was at +1 station (and boy was that uncomfortable with a head between my legs).

My daughter was born at 39 weeks exactly. In retrospect, my appointments did show a progression towards my body prepping itself, week by week.

I think the thing is, even with factual information in front of us, by the end of your pregnancy, most women are looking for a sign, any sign, that labor is close, that the time to meet your baby is near.
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#11 of 76 Old 07-24-2010, 11:14 AM
 
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Originally Posted by nia82 View Post
@ Megboz: wow that is creepy... I'm starting to think obgyns do the exams to push inductions....
Oh, that's not the only rea$on, unfortunately.

With that factor, unwanted membrane sweeping, and fishing for induction excuses, they can then push VEs by playing on the emotional aspect that MegBoz has described. "But don't you want to know...?"

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#12 of 76 Old 07-24-2010, 11:20 AM
 
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I think the thing is, even with factual information in front of us, by the end of your pregnancy, most women are looking for a sign, any sign, that labor is close, that the time to meet your baby is near.
Oh, don't worry. There are plenty of signs--abs swollen out to kingdom-come, extreme fatigue, peeing every 5 minutes, losing your mucous plug, pushy relatives wondering "when," pushy OBs pushing induction . . . these indicators are no more mathematically accurate at predicting labor than VEs and constant ultrasounds. I do agree that the psychology is complex, and women and their doctors are willing to convince themselves to believe in the pseudoscience of frequent VEs. There's nothing like believing that you can control the uncontrollable and predict the unpredictable.

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#13 of 76 Old 07-24-2010, 01:20 PM
 
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With Ds, I didn't know it meant nothing. Had I known that at the time I would not have done them as they were really uncomfortable. My midwives acted as though they meant something, and I trusted their judgment on it. After all, they were midwives practicing in what I thought was a natural birth friendly hospital. At my last prenatal, the midwife then stripped my membranes without my knowledge or consent. That is when I realized it was something I should have been refusing in later pregnancy, but it was too late by that point. This time I have had no exams at all, and my homebirth midwives haven't offered any. I don't plan to have any in labor either.
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#14 of 76 Old 07-24-2010, 02:25 PM
 
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Originally Posted by vanislandmama View Post
deciding to get checked is an emotional choice woman make with the hopes that the doctor will say something exciting. Unfortunately, it usually only leads to more anxiety and disappointment. We got so close to end and want to hear that we are almost there. We know that it doesn't mean anything, but for some reason we still do it. I learned this the hard way with my first. My mw told me a week before my due date that i was 2 cm and effaced and baby was way engaged and that she thought i'd have my baby within a week. Well, that sure did make the next 3 weeks feel like an eternity. I was 10 days past my due date.
yup.

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#15 of 76 Old 07-26-2010, 12:36 PM - Thread Starter
 
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Hmm, do you think they really knew that, or maybe just didn't want to seem ignorant?
Hm, good point. I suppose that's possible, but at least with one woman, I can picture her face & the tone of her voice when she replied, "Oh I know [it means nothing] I just wanted to hear that something was going on down there!" It did seem like she was sincere that she knew. So it sounds like the classic case of disconnect between the intellectual realization of fact & emotional desire to view it as "progress."

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@ Megboz: wow that is creepy... I'm starting to think obgyns do the exams to push inductions....
Oh, absolutely! I read about the "Sneak-Attack Induction" before. Basically, go for the weekly check up, have the VE, told you are dilated -- then told, "Oh, you're in labor! Head on down to L&D right now! Congrats! You're going to meet your baby today."

Then when you arrive at L&D, and -surprise, you're not progressing! So they "speed things up a lil' bit" with pit, AROM, etc.

Basically... they induced you when you really thought you were in labor & then once you arrived they needed to just "speed up." Scary thought.
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#16 of 76 Old 07-26-2010, 01:24 PM
 
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With DS1 I was 4 cm dilated for 8 weeks (preterm labor), then 6 cm at 39 weeks when he was finally evicted. (AROM induction before a hurricane evacuation.)

With my others I had no VEs during pregnancy or labor and it was much more peaceful.

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#17 of 76 Old 07-26-2010, 02:51 PM
 
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I had 1 VE during this pregnancy (when I was in labor: I was 5 cm dilated). The baby came out fine without more! Not even when it was time to push.

My midwife did say that having a VE late in pregnancy increased your chances of birthing before 41 weeks. Anyone know about that? I still declined.

Also, does anyone else think it's weird how being pregnant gives everyone license to ask about the state of your cervix? I had all sorts of acquaintances ask me how dilated I was...I didn't mind, but it was still odd/funny.
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#18 of 76 Old 07-26-2010, 03:13 PM - Thread Starter
 
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My midwife did say that having a VE late in pregnancy increased your chances of birthing before 41 weeks. Anyone know about that? I still declined.
Never heard that. Now there is some research that sweeping membranes can make you birth faster (i.e. decrease the risk of going beyond 41W) but some research shows it makes no diff. But, of course VE & membrane sweep aren't synonymous.

Of course, maybe it's a correlation vs. causation issue - the HCPs doing lots of VEs are clearly not practicing evidence-based medicine. So maybe they're the same HCPs who push induction on due-date. So that would lead to that "correlation" that mamas having regular VEs in late PG don't go beyond 41W.

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Also, does anyone else think it's weird how being pregnant gives everyone license to ask about the state of your cervix? I had all sorts of acquaintances ask me how dilated I was...I didn't mind, but it was still odd/funny.
I do think it's weird! I wonder if it's an American thing to be so bold to ask about that. For example, we're apparently the only ones who want to know a baby's weight. I was on a con call at work with a guy from the UK & his team based in The Netherlands (people from India, Israel, Sweden, etc.) & he announced the birth of his 2nd child & said, "oh, and for the Americans who like to know, the baby's weight was..." it hadn't occurred to me that this was not a universal tradition. When you think about it, it is weird.

Anyway, overall, being PG seems to make people think your body is not your own & the universe has license to butt in - touching your belly (I never had strangers do it, but I've heard others have.)
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#19 of 76 Old 07-27-2010, 11:11 AM
 
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I delivered with a hospital-based midwife practice, and their policy was no VEs unless the mom requested one. I didn't have one until my 40 week appointment, and even then it was more of a "well, sure, why not" type thing than a "we need to know what your cervix is doing." I asked the midwife about the policy once, and she reiterated that the information gleaned by doing VEs beginning at 36 weeks doesn't really do anyone any good, but they offer them because some moms just want to know, and some moms come in and say that their friend/mom/sister is demanding to know.

At my 40 week appointment, the midwife could barely even find my cervix because it was still so high up (and, I'm tall ). This confirmed my suspicions that nothing was going on because I'd had nothing even resembling a contraction yet. She checked again at my 41 week appointment, after days of increasingly persistent contractions, and lo and behold I was 6 cms! Baby was born the next morning.
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#20 of 76 Old 07-27-2010, 11:58 AM
 
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OT: People ask about baby size and how long your labor was back home too (Germany). Nobody ever asked me if I was dilated or effaced though.
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#21 of 76 Old 07-27-2010, 12:44 PM
 
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but they offer them because some moms just want to know, and some moms come in and say that their friend/mom/sister is demanding to know.
Oh good grief.

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#22 of 76 Old 07-27-2010, 01:50 PM
 
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I did one, on a Friday appt, when I was 41 weeks. We were discussing membrane sweeping. She couldn't even FIND it it was so high and tight.

I went into labour on Monday.

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#23 of 76 Old 07-27-2010, 05:17 PM
 
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I was pretty "meh" on this issue, so since my OBs standard practice was VEs starting week 37 IIRC I didn't push it because it didn't really matter to me. But yeah, when people asked, I would tell them and then immediately follow up with "...But it doesn't mean anything..." and go on to explain why. Granted, since I gave birth at 38 weeks, I only had one, so maybe I might have started pushing back if I felt it was too much at some point. And my birth was so fast, I only had two VEs, one when admitted to triage and one I asked for because I felt I was complete and was, so I guess for me, VEs were never an issue really

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#24 of 76 Old 07-27-2010, 11:23 PM
 
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...They DO routine VEs before labour??? My midwife didn't do any until I was in labour. I absolutely hate VEs... there's no way I'd have up to 6 of them for no good reason! Yikes!

Also, in New Zealand people ask about a baby's weight, but not length. I'd always thought knowing the length was an American thing?

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#25 of 76 Old 07-28-2010, 12:03 AM
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I am a CNM and I try to talk people out of routine VEs and very very rarely succeed, even after I explain that it means nothing. Granted, I work in a practice where people are not trying to avoidintervention but the discomfort along would be enhough for me to say no, even if I had no philosophical objection.
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#26 of 76 Old 07-29-2010, 04:49 PM
 
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I had one VE when I was around 20 weeks with my first baby, because I had a history of HPV, LEEP, and I was worried about incompetent cervix. It was all for naught; my cervix was long and firm and high. I went into labor on my own at 37+4. I had 2 or 3 (?) VEs during labor, without the backup midwife asking or getting consent. Annoying.

I won't be having any this time.


This may not be a popular opinion, but I really think that our and our care providers' (some of them) fascination with VEs (and other interventions) has to do with gender roles. Poor, helpless, miserable pregnant women who need to be saved. Strong, smart, typically masculine, white coat care provider whose job is saving. It wasn't so long ago that one of the most respected obstetricians of the time, Dr. Bradley, was paternalistically addressing women in childbirth education books and classes. Immensely helpful to many of the women giving birth at that time and now? Yes. But his tone and some of his message grates on some of my more feminist nerves. Nevertheless, most women then and many today still carry those cultural/societal expectations of distressed damsel/gallant doctor. VEs (and other interventions) are an illusion reinforcing the whole concept.

ETA: I am not trying to make anyone feel bad for getting or wanting VEs. I am having a hard time all of the sudden getting the right words and tone to come across the way I want, and not just online. I think I am going through some weird pregnancy hormonal things right now.
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#27 of 76 Old 07-30-2010, 11:41 AM - Thread Starter
 
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Pirogi,

Really interesting post. I could see how that could play a part.
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#28 of 76 Old 07-30-2010, 12:05 PM
 
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This may not be a popular opinion, but I really think that our and our care providers' (some of them) fascination with VEs (and other interventions) has to do with gender roles. Poor, helpless, miserable pregnant women who need to be saved. Strong, smart, typically masculine, white coat care provider whose job is saving. It wasn't so long ago that one of the most respected obstetricians of the time, Dr. Bradley, was paternalistically addressing women in childbirth education books and classes.
Love your post! FWIW, it's popular with me.

My mother has always prefaced her opinions with "I'm not a feminist but . . . " (Translation: "I am a feminist and . . . " ) Anyway, I won't say much more out of UAV concerns, but she knew Dr. Bradley and can validate the content in your post.

Because obstetrics is a male-dominated profession (not just in number of OBs, but also in its overarching philosophies), I think that in terms of what you've described, there's no guarantee that a female OB will be any better.

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#29 of 76 Old 07-30-2010, 01:56 PM
 
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@ Megboz: wow that is creepy... I'm starting to think obgyns do the exams to push inductions....
It's not your imagination, that is becoming routine. It used to be that OBs would do a cervical exam and say, "Well, there's nothing happening. Obviously, your body needs help getting this birth going, so we need to schedule an induction." But now I've known several women in the last year who were told, "Wow, you're (X) cm dilated! We need to induce you right away!" And I've even known a woman who was told that since she was "so far along" it was illegal for them to "let her leave"! It's ridiculous. And the ironic thing is that the women I know who dilate significantly before their birth begins don't even have particularly fast births. Two women I know who have a history of dilating to 8 prior to the start of their birth still have 5-8 hour births once things begin. Hardly an emergency! I recently discussed this topic with a midwife who observed that women who have truly precipitous births aren't going to be walking around largely dilated for weeks. When they're 8 cm, they're probably minutes from meeting their baby, not weeks!
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#30 of 76 Old 07-30-2010, 02:02 PM
 
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I thought of this thread and you lovely ladies yesterday at my midwife visit.

She is definitely not paternalistic and does not suggest/encourage/require VEs but I asked for one. (I'm 37 weeks)

I know it tells me nothing valuable but I liked hearing that last week I was 1cm and the baby's head was "floating" while this week I am 2cm and the baby's head is at -1.

Since when is pregnancy an entirely logical experience??

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