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.
- 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.
- Get a ruler and have several people feel how long 1cm – 10cm is.
- Ask them to memorise how each length feels.
- Find some familiar household objects that are between 1cm and 10cm
- 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.
- 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.
- 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.
- 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.
- 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.
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