Questions I need to ask my midwife... - Mothering Forums
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#1 of 13 Old 05-20-2006, 10:43 PM - Thread Starter
 
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There are a few things that I need to ask my midwife at my next appointment, but I thought I would reach out here to see if anyone can answer my questions...

Prenatal Internal Exams: Do prenatal pelvic exams determine anything other than how much you have effaced/dialated? Are they really necessary?

Internal Exams during Labor: Same question as above. Are these really necessary? Can't they tell what they need to know by watching/timing contractions and by allowing me to push when I have the urge? (I'm not to big on the internal exams, if you can't tell)

Taking blood during Labor: With my DD, they took my blood when I was admitted to the hospital...I wasn't expecting this. Does anyone know what this blood sample is used for or if it is necessary (or is possible to refuse it)?


Thanks!
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#2 of 13 Old 05-20-2006, 11:02 PM
 
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Unfortunately I can't help too much only to say that though I don't know why they need to take your blood you CAN reject it. I just had a friend today who was telling me she did.
I don't think they are looking for anything except dialation and effacement during internal exams and I do know that my home birth midwife won't do them unless I ask for one, and rarely during labor. So there must be some other way she plans to keep track of my progress. Hope others have clearer answers for you. :-)
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#3 of 13 Old 05-21-2006, 08:06 AM
 
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You certainly can decline any of those procedures. I never had any of them and gave birth just fine. The only internal exam I had was 6 weeks postpartum after my first baby.
Just talk to your midwife and tell her how you feel.

- Krista

milk donation : mother to Ryan (6), AJ (5), Nate (2), Maia (1) all born at home, I have a kid-friendly food & bento blog, : :
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#4 of 13 Old 05-21-2006, 12:12 PM
 
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I have only had one internal exam since I've been pregnant, and that is because I had some spotting and we wanted to make sure everything was OK.

I'm not sure if there will be more exams as labor approaches (and arrives!).

Here's a link I found that talks a little bit about it:
http://parenting.ivillage.com/pregna...e_3ptc,00.html

--k
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#5 of 13 Old 05-21-2006, 02:06 PM
 
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I'm not pos. about this, but I think that I remember that one thing that they like to check for during an internal while you are in labor is that when you feel the urge to push, they want to make sure that you are in fact fully dialated. if you are not, and you start to activly push with a little "lip" left, then you could cause your cervix to become inflamed, or swollen and could inhibit the baby coming down.

I think this is the case anyway...
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#6 of 13 Old 05-21-2006, 10:25 PM
 
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You can absolutely refuse all of those. I have no idea what the blood is drawn for, perhaps to check your blood type? Don't know. But IRT the internals, during the prenatal visits, I believe it's only to check dilation/effacement, and that's really not an issue unless you are hoping for induction. During labor the less internals the better, especially if your water has already broken, b/c it can increase the chance of bacteria getting to the baby. Like a pp said though, if you feel the urge to push, they may check to make sure you are fully dilated so you don't do all that work for nothing.

Mom to DD#1 8/04, nursed 43 months, DD#2 8/06, nursed 21 months and DD#3 9/08, still nursing strong
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#7 of 13 Old 05-22-2006, 08:45 AM
 
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Quote:
Originally Posted by tatgurl
I'm not pos. about this, but I think that I remember that one thing that they like to check for during an internal while you are in labor is that when you feel the urge to push, they want to make sure that you are in fact fully dialated. if you are not, and you start to activly push with a little "lip" left, then you could cause your cervix to become inflamed, or swollen and could inhibit the baby coming down.

I think this is the case anyway...
The way my midwives know, is that when you start feeling pushy, try not to push, just breathe through the contractions, or give mild little pushes every few contractions. When you're really fully dilated, your body will push no matter what you do. Apparently my midwives could tell just in the change of my breathing and vocalization when that change happened (with my first birth they came bolting up the stairs from the living room, they just knew it was time).
So I think it depends on the experience of your midwife, and whether or not she relies on exams to determine dilation or other signs.
Obviously if you'd rather know how many centimeters you are you could request an exam, but I'd rather not know. Besides, just because you're fully dilated doesn't mean you're ready to push; sometimes the baby still needs to get into a better position, and pushing before you feel like pushing can sometimes do more harm than good.

- Krista

milk donation : mother to Ryan (6), AJ (5), Nate (2), Maia (1) all born at home, I have a kid-friendly food & bento blog, : :
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#8 of 13 Old 05-22-2006, 11:15 AM
 
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Quote:
Originally Posted by veganf
The way my midwives know, is that when you start feeling pushy, try not to push, just breathe through the contractions, or give mild little pushes every few contractions. When you're really fully dilated, your body will push no matter what you do. Apparently my midwives could tell just in the change of my breathing and vocalization when that change happened (with my first birth they came bolting up the stairs from the living room, they just knew it was time).
So I think it depends on the experience of your midwife, and whether or not she relies on exams to determine dilation or other signs.
Obviously if you'd rather know how many centimeters you are you could request an exam, but I'd rather not know. Besides, just because you're fully dilated doesn't mean you're ready to push; sometimes the baby still needs to get into a better position, and pushing before you feel like pushing can sometimes do more harm than good.

- Krista
Well said on all accounts, Krista. Sounds like you have/had great midwives!
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#9 of 13 Old 05-22-2006, 11:27 AM
 
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Quote:
Originally Posted by LizzysMommy
Prenatal Internal Exams: Do prenatal pelvic exams determine anything other than how much you have effaced/dialated? Are they really necessary?
effacement/dialation is the only thing to my knowledge that they determine. It should also be said that prenatal effacement/dialation is NOT a good indicator of when labor will begin... people can walk around being 2-3cms dialated for WEEKS w/o labor. If considering induction (which I would certainly hope not) prenatal effacement/dialation can be an indicator of the likelihood of successful induction.

Also, some practitioners claim to do prenatal pelvic exams to ensure that you have "adaquate" space in your pelvis for a vag birth. This is absolute crap. The only thing that can determine that is laboring with each individual baby.

Quote:
Originally Posted by LizzysMommy
Taking blood during Labor: With my DD, they took my blood when I was admitted to the hospital...I wasn't expecting this. Does anyone know what this blood sample is used for or if it is necessary (or is possible to refuse it)?
I'm pretty sure the main reason is to do a blood type & crossmatch for a transfusion in case you hemmorage. I think most hospitals do that. They probably also run a CBC to have a current snapshot of your iron stores, state of your platelets (for clotting), etc.

By the way, I think it's GREAT that you're thinking about this stuff ahead of time & want to engage w/ your midwife about it! Good luck
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#10 of 13 Old 05-22-2006, 11:52 AM
 
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Pelvic exams before/during labor are completely optional if you are low-risk and allowing some fetal monitoring (at a hospital, you'll have a tough time getting no fetal monitoring and no pelvic exams both).

The blood type at most hospitals has to be drawn just before the blood is given. I know people at the hospital where I worked that would receive 5 type and cross lab draws during their stay, b/c they required blood 5 times. Therefore, if it really bothers you, they can always type and cross just before giving you blood (or just use O negative) in the unlikely event of a hemorrhage. A CBC might be helpful, to check your white blood count and for pre-existing significant anemia... I would probably not fight that one if you're not super needle-phobic. Pick your battles and what not...

Good luck,
Erin
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#11 of 13 Old 05-22-2006, 02:29 PM
 
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Not only do internals not give you any useful info because you can be 0cms and go into labour that day or walk around for weeks very dilated, but they are also one of the leading causes of infections in pregnant women.

Jam 7, Peanut Butter 5, and Bread 2.

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#12 of 13 Old 05-22-2006, 02:33 PM
 
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blood draws for a tube to hold are good for 72 hours. They are indeed in case you need blood. Drawing just in an emergency often isn't an option (a type and screen take a couple of hours in most labs and then the remainder is cross-matched with the blood to be transfused) and if you can have matched blood it's better to save the extremely limited supply of O neg for people who are in accidents, etc. and have no chance of doing a type and screen in advance.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#13 of 13 Old 05-23-2006, 01:46 AM
 
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The hospital where I worked could do the type and cross in about 20 mins, but I agree, that if you're going to pick your battles, the initial blood draw would not be one that I would pick. In an emergency, 20 minutes is a LONG time. Even if you're a hard stick, that would mean it's more likely you would have trouble getting a blood draw in an emergency.

That being said, I understand if you're truly phobic about blood draws, this may be a non-negotiable for you.

My personal battle will be that I'm hoping to keep the internal pelvics to a minimum (have never had one that didn't leave me in pain)... would like to save my deep breathing through pain for contractions...

Good luck, all you mamas,
Erin
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