5 Very Good Reasons To Refuse Vaginal Exams In Labour

5 Very Good Reasons To Refuse Vaginal Exams In Labour

Vaginal exams are such a normalised part of the maternity care landscape in 2016 that for millions of women, there is no question about whether they will have them or not. Women not only believe they are wholly necessary, but aren’t aware that they are at liberty to reject them if they want to.

Here’s the first thing you need to know about vaginal exams in pregnancy or labour. They are NOT compulsory, and you are NOT required to have them. No one, no matter who they are, is allowed to touch your body without your consent. This is the law, and it covers health care providers not just strangers on the street. If your hospital won’t admit you in labour until you’ve had one, tell them you’ll go and have the baby in your car instead. Don’t forget to remind them how much television news loves a good birth outside of the hospital story.

So now that you know that, we can cover the reasons WHY you might choose to avoid them.

  1. They aren’t accurate: The idea that your cervix will somehow be an exact number of centimetres dilated when you need to push your baby out, is absurd! All women are different heights, we have different sized feet, our hearts are all different sizes. We have different sized cervixes too, in different sized vaginas, and all our babies are different sizes. On top of that all care providers have different length fingers, and without an actual ruler in your vagina, they can only estimate how dilated you are anyway. Many women talk about how one provider said they were Xcm dilated, and another said they were Ycm dilated within a short period of time.Here’s a little experiment you might like to try

    AIM: To assess how accurately multiple people gauge measurements and whether their estimates are identical.

    METHOD:

    1. Get a ruler and have several people feel how long 1cm – 10cm is.
    2. Ask them to memorise how each length feels.
    3. Find some familiar household objects that are between 1cm and 10cm                                                
    4. Blindfold everyone and see how many can guess the correct length of familiar objects, using only two fingers. You could put a rubber band around their fingers to make it harder and more “vagina like”. 

    OBSERVE: Does everyone guess the same length for each object? How many people’s fingers comfortably stretch to 10cm? 

    * Someone might make the point that care providers spend many years feeling and measuring cervixes, so they are better at it, and that might well be true. But as we can see from our experiment, different people make different estimations of the same familiar object.

  1. They don’t tell you how long labour will be, or when it will start: No matter how dilated your cervix is, your care provider can not, under any circumstances, predict how long it will be until you give birth. If your care provider does vaginal exams before labour, and your cervix isn’t dilated at all, it doesn’t mean you’re not going to go into labour. Conversely, if your care provider says you’re 3cm before labour, it doesn’t mean you’ll go into labour in the next half hour. A cervical exam tells you one thing, and one thing only. Just like a photograph, it tells you what is happening in one moment in time, not what will happen within the hour. And as we discussed in point 1, it’s possibly not even an accurate measurement of that moment. Some women have babies in under an hour hour, others take three days. Some do stop / start or prodromal labour for weeks. All of these are normal, and as long as the woman and her baby are healthy, why does it matter how long it takes? It’s important to add to that statement that mental and emotional health are included, we’re not just talking about physical health. Although our culture has a view of birth that suggests it is a purely physical event, it isn’t.
  1. They can cause infection: We all believe that hospitals are a highly sterile environment, but annually there are many many deaths from infections that are caught in hospital. Do a quick google and you’ll see just how often hospitals end up with antibiotic resistant superbugs sweeping through their wards and wreaking havoc. Superbugs aside, there are also two other infections that can cause trouble for babies in the uterus. These are group B streptococcus, which you have probably heard of, and chorioamnionitis, which is less well known. Both hang out in your vagina, and are generally not a problem. However when a care provider performs a vaginal exam, there is a risk that any infection present, either in the environment (like a superbug) or in the vagina, will pass through the cervix into the uterus.
  1. It might steal the wind out of your sails: As we briefly discussed in point 2, emotional health plays a very important, often overlooked role in birth. Imagine you’ve been labouring contentedly all through the night, you feel like you’re doing well, you’ve totally got this! Then someone comes and tells you that you need a vaginal exam, and you discover that you’re “only 2cm dilated”. Despite being in labour for 12 hours, you’re only 2cm!? You might be in labour like this for another year! Oh doom and disaster! There goes that wind, right out of your sails! And here’s what follows. Because of the lack of progress you’re given synthetic hormones to speed things up. Soon the contractions are so hard and fast you’re overwhelmed, but there’s still no change in dilation. You opt for an epidural because you just can’t do it anymore. And another 12hrs go by with no change. Next thing you know you’re being wheeled into an operating theatre for a caesarean. Failure To Progress is stamped all over your medical records. Your body is obviously a dud … or is it? Google The Cascade of Interventions, it’s common, and you need to know about it.
  • Failure To Progress is the leading cause of caesareans. Vaginal exams are the test used to diagnose it. Slow labour is not an emergency that requires medicating with synthetic hormones. Obviously there can be health problems arising from a prolonged labour, but the focus should be on health, not on how fast the birth is. A two hour labour can have complications, should we not intervene because it’s a fast labour? A thirty hour labour might be healthy, the woman and baby may be content labouring, why intervene if there is no health concerns? Once again, we need to remember mental and emotional health! Avoiding hearing numbers that leave you feeling defeated, is vital to good mental health in labour.
  1. Because you don’t want strangers touching your vagina: There are around 7 billion people in the world. You get to decide which ones are allowed to touch your vagina. Being a doctor, nurse, or midwife does not mean that they are automatically added to the shortlist. For the majority of women having a normal healthy labour, there’s no need to increase the quota. Women spent hundreds of thousands of years going into labour, and giving birth without anyone ever poking their vaginas. We have not become the most prolific species on earth because of vaginal exams.

And now you know all about why you might opt out of routine vaginal exams in late pregnancy, and in labour! It’s important to know that there are some rare instances when a vaginal exam can be useful for the decision making process, but unless your health is on edge,  you can labour and give birth without anyone ever touching your vagina. Even when it’s time to push! That’s right, you can totally push a baby out without anyone EVER touching your hoo ha! And if you’re the sort of person who says hoo ha, that’s probably appealing.

FOR FURTHER READING

Vaginal exams - green latex medical gloves
Vaginal exams are routine, but they are not compulsory
License: Creative Commons CC0.

Birth Without An Epidural Isn’t Superhuman!

You Can’ Fail To Progress BEFORE Labour

Can You Avoid Failure To Progress

Mother Guilt At Birth – When The Love Isn’t Instant

Maternity Mythology Debunked For The Modern Mother

Maybe You Need A Caesarean, Maybe You Don’t

16 Responses to "5 Very Good Reasons To Refuse Vaginal Exams In Labour"

  1. silo  24 May, 2016 at 10:52 pm

    This is a very good article with important information. However, I take issue with the author’s first reason to refuse vaginal exams. I think she may be slightly misinformed. Although we (I am a homebirth midwife) report cervical dilation in centimeters, that’s actually a misnomer. Dilation in centimeters really reflects “amount” of dilation, not the literal diameter of the cervix. For example, if I say that a woman is 5cm dilated, I am not actually referring to a literal 5cm diameter. What I mean is that her cervix is 50% dilated. Similarly, 9cm dilation doesn’t mean that her cervix is actually 9cm across (the author of the article is correct in saying that all women are different sizes), but that the woman’s cervix is 90% open. So, keep this in mind when reading this otherwise very informative article.

    Reply
    •  28 May, 2016 at 8:06 pm

      Great comment! Thank you. The problem is that WOMEN believe it is a literal measurement.

      Reply
      • Gem  12 July, 2016 at 1:32 am

        Women do believe it is a literal measurement because you are using literal terminology, how about changing your language and saying to a woman you are about 90% open and baby will be here soon. Rather than using 9cms it’s not a womans fault that she isn’t informed when the information you are giving is essentially misleading.

        Reply
  2. Jacky  30 May, 2016 at 7:37 pm

    Thank you Silo for your comment. I too am a homebirth midwife and although I don’t perform many vaginal exams I totally agree that it is not about the actually cm’s but often more about how much of the cervix needs to “move out of the way” for the baby to pass through. So as Silo says it is more about %.

    Reply
    •  2 June, 2016 at 10:31 am

      The problem is that women aren’t aware of that. Women think it’s like someone holding a ruler up their vagina. Thanks for stopping by and taking the time to comment! I hope you’re out there spreading the word!

      Reply
      • silo  3 June, 2016 at 2:52 am

        Yes! I think it’s important to share this information as widely as possible.

        Reply
  3. Jennifer Dunlop Gierok  6 July, 2016 at 1:41 pm

    More needs to be said about how quick doctors are to do c sections now days. It’s amazing how many c sections are done at any hospital in a day now. Its not bad enough your hormones go from to the moon all the way to down in the dumps after having a child but add onto that the pain and stress and suffering from having your stomach and uterus cut open that can make for a terrible time for any new mom. Or moms with 5 kids already for that matter. Child birth has become so sterile and full of drugs that most women dont even know what it feels like to push or have control over her own body during labour. Our bodies know what to do and when to do them. Doing what doctors say when they say is bs. Do what your body says to do. Dont feel bullied by anyone while having your baby. Take controle,even though it may seem hard when in that much pain but you can do it. And in most cases its much faster without all the drugs and “needed intervention “. Love this article. Love it!

    Reply
    •  6 July, 2016 at 5:33 pm

      Yes!!! I agree completely, there’s no nearly enough woman centred information available. We’re aiming to change that RIGHT HERE!

      Reply
      • Emilie  6 March, 2017 at 5:41 pm

        Agree that less intervention is better BUT I would much rather have a C-section and come out alive with a healthy baby, than die in the process. Childbirth used to be the leading cause of death for women. But yes the pendulum has swung too far the other way, and has over-medicalised the childbirth process often for fear of lawsuit particularly in the US.

        Reply
        •  11 March, 2017 at 12:10 pm

          You’d be hard pushed to find a woman who WOULDN’T rather have a caesarean than die or lose her baby don’t you think? Your comment is strange when you really think about it. You find me ONE woman who’d rather die or lose her baby than have surgery.

          Also the highest death rate in the world from childbirth is recorded in Sierra Leone at 2.05%. A war torn, rough and famine ridden country, and still 97.05% of women give birth to live infants and survive birth themselves. Western women have this idea that we all used to drop like flies when giving birth, but we wouldn’t be the most successful species on the planet if we were so terrible at giving birth.

          I’m not sure what any of this has to do with vaginal exams though ……

          Reply
  4. Amy McCardie  9 July, 2016 at 4:58 pm

    With my first birth I was examined by a student midwife and then a midwife each time. Although I know it is vital students have this opportunity, it was very uncomfortable and disheartening to know I’d stayed at 3cm for twenty hours. My second birth was at home. They only just about managed to be examined and I was fully dilated. Mentally this was a huge difference.

    Reply
    •  9 July, 2016 at 11:07 pm

      Yes, it makes such a huge difference to mental wellbeing doesn’t it! I never have vaginal exams at my homebirths. Thanks for stopping by and sharing your experience!

      Reply
  5. Heather  26 February, 2017 at 3:36 am

    While I agree that cervical exams should be limited, especially after rupture of membranes, this article is not coming from a very medically informed point of view, i.e. point one. Unless there is a way to view the cervix completely, the only way to measure it’s by estimating, so of course there are the limitations and guesswork mentioned. Doesn’t mean it isn’t a valuable indicator, and effacement is already measured in percentage, which would also be confusing to everyone. The only way to avoid cervical exams completely and make them medically unnecessary, is to have completely intervention free, medicine free delivery, which most women do not want after actually feeling contractions.

    Reply
    •  11 March, 2017 at 12:14 pm

      WHY don’t women want unhindered births? Because our entire culture has medicalised birth to such a degree that women anticipate birth as one long medical intervention, and can be left traumatised by an unhindered birth. If we stopped medicalising birth, and started to view it more as the biological event that it is, then women might start seeking out unhindered births, and vaginal exams could be used when they are useful, but not as a routine that interrupts the natural process.

      Reply
  6. Anon  3 March, 2017 at 12:05 am

    I had a vaginal exam by a midwife while I was at home, having planned and hoped for my baby to be born at home. She came out during the night and seemed really cross to be there, and was very dismissive about my chances of being able to ‘cope’ with a homebirth, even though I was feeling calm and confident at that stage. I had had a sweep done by my regular midwife two days before, and another vaginal exam by another midwife, both of which weren’t that uncomfortable and I felt fine about them. But when this midwife examined me, she was incredibly rough and it was much more painful than the sweep – it was supposed to just be an exam, but in any other circumstances would have felt like a serious assault as she was really shoving her fingers very hard and ignoring my obvious pain and distress. My husband was there and was very upset watching my reaction and how rough she was. I didn’t report this at the time and really wished afterwards that I had – I ended up having my baby in hospital and although I was able to have a water birth, with many positive aspects to the experience, this was one of the most horrible invasive things I’ve ever been through, and I felt I didn’t have any recourse to complaint as vaginal exams are so normal (it never occurred to me to refuse one, even though I’d read a lot about birth beforehand) and because I felt I’d sound stupid/wouldn’t be believed. I totally accept that the majority of midwives are very kind and caring, and I was unlucky, but I think that they should have to explain that you have a right to refuse vaginal exams – I wish I’d told her to stop, and I feel bad to think that this could happen to other women seen by this midwife.

    Reply
    •  11 March, 2017 at 12:16 pm

      I’m so sorry you experienced this. You said that under any other circumstances it would be an assault, I put it to you that it WAS an assault, and that assault in birth is frighteningly common.

      Reply

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