By the third trimester of pregnancy most women have had enough, they want to labour and give birth, they want to welcome their babies! They are so desperate for signs of impending labour that they consent to a vaginal exam. They are hopeful that it will tell them labour is near, but what if it doesn’t?
A vaginal exam in late pregnancy frequently steals the wind out of the sails – especially for a VBAC hopeful – and women start to feel as if they are failing to progress. But how can you fail to progress before labour even begins?
Why must your cervix be dilated before you are even forty weeks?
What care providers fail to do when they suggest a pre-labour vaginal exam, is to explain two crucial things.
- Vaginal exams may be routine, but they are also OPTIONAL:
- Routine vaginal exams prior to labour are NOT evidence based and give no useful information.
That’s right. A vaginal exam can NOT predict labour, nor can it forecast how long labour will be. The only thing it can do is provide either false hope or a feeling of defeat. However there is no reason for either. Being 3cm, and fully effaced, at 38 weeks means nothing because there may be no changes in the following week. Conversely, showing no signs of dilation doesn’t mean that the baby won’t be born before the week is out.
A vaginal exam does one thing, and one thing only. It shows where things are at in that one moment in time, not where things will be in an hour or a week. A vaginal exam is not a psychic investigation, it’s a snapshot in time. No more, and no less.
Women often say that they like to know what’s happening, and that’s understandable! After morning sickness, an expanding waistline, constant trips to the toilet all day …. and night, it’s conceivable that someone would want some idea of when they get to cuddle a baby and stop peeing all night.
Some more cynical, evidence based care proponents, might suggest that the pre labour vaginal exam is useful for a care provider who wants their client to feel as though her body is dysfunctional. Thus making her more compliant, and susceptible, to interventions that speed labour – or end it (a caesarean) in a fashion that more suits their convenience.
Sadly, rather than supporting a woman gently through the last days of pregnancy, and watching her health closely, many care providers begin pressuring women to induce, or to have a caesarean rather than waiting. The first step in that process is usually the seemingly innocuous, routine vaginal exam.
Women’s bodies know how to give birth, but many surgeons and midwives don’t know how to WAIT for birth. Before a woman consents to a routine vaginal exam she should have a good idea how she will feel if the results don’t mirror her anticipation, and what recommendations her care provider will make based on the results.
The vaginal exam has been indelibly written on our cultural psyche (see here: Obstetric Culture), few people ever question their necessity, in fact many believe they are vital for pregnant and labouring women, but the truth is that they are nothing more than a tall tale. One with horror story proportions for many women.
Since the dawn of time babies have been born without anyone assessing the cervix, prior to OR DURING LABOUR. When a woman is in labour a vaginal exam CAN provide useful information, however the routine vaginal exam is quite pointless.
Convincing the majority of women to forgo all vaginal exams is a complicated process given how prevalent they have become, but surely it’s not so hard to convince just a couple of women to decline routine pre-labour cervical checks. Surely!
By refusing pre labour vaginal exams a woman stays in control of the situation, and protects her vulnerable emotional state. There are plenty signs of ill health that should obviously be monitored for, but cervical dilation, or lack thereof is not one of them.
REMEMBER THIS IF YOU REMEMBER NOTHING ELSE:
UNLESS YOU LIKE HAVING STRANGERS PROBE YOUR VAGINA, IT’S OK TO REFUSE VAGINAL EXAMS.
REFUSING OR CONSENTING TO A ROUTINE A VAGINAL EXAM COULD MAKE OR BREAK YOUR ENTIRE BIRTH – SO CHOOSE WISELY AND BE FULLY INFORMED ABOUT THE RAMIFICATIONS OF ANY CHOICE YOU MAKE
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