First of all, you might not be sure exactly what is a vaginal examination, or what exactly happens during a vaginal examination in labour. In a nutshell, here's what is involved, and why your care provider might be suggesting one:
A vaginal, or cervical examination(they are one and the same thing) during labour is where a midwife, or consultant, will insert their (sterile gloved) finger inside your vagina, up to your cervix. They are feeling to see how soft, high and dilated those cervix are as this information might give them a clue as to what stage of your labour journey you are currently on.
A vaginal examination won't tell you: how long you have left of your labour, when you will start feeling the urge to push, whether your baby is well, whether you are well.
Now I'll hold my hands up... back when I was simply teaching hypnobirthing (before I had real life, lived experience in the birth room as a doula) I would have probably felt that this information, gained in this particular way, is pretty un-necessary.
As I'm about to share with you in this article - there are much gentler, intuitive and less invasive ways of a skilled and experienced midwife 'assessing' labour.
And I put 'assessing' in commas, because in my experience, midwives I've had the pleasure of working alongside during a home birth don't really 'assess' unless there is a cause for concern. They are simply there... quietly observing and using their honed skills to have a background idea as to where the woman might be in labour and what help she may need next (if at all).
BUT... over the past few years, having witnessed so many different births, and supported so many different women during their labours - I know that it really isn't that 'cut and dry'. Sometimes a woman needs a vaginal examination for her own mental wellbeing.
Sometimes, particularly if a labour has been going on for days and days - there is additional information, other than dilation or 'labour progress' that a skilled midwife can gain from a VE, if that is what the Mother wants. Sometimes midwives can gain information about the baby's position from a VE, information which may then help that woman decide what she would like to do next.
So... the decision of whether to have a VE during labour (like a LOT of birth choices) isn't always black and white. Nuance and areas of grey is where us doulas come in!
There really is no 'right' or 'wrong' choice when it comes to deciding whether to have VEs during your labour or not. Not having them doesn't make you irresponsible, and having them does NOT mean you had a 'less natural' birth. This might even be one of those decisions you don't feel able to make until you're in the moment, and that's ok too.
The MOST important thing is that it is YOU who decides what happens to YOUR vagina during birth.
A lot of women who come along to one of my birth preparation courses, once they have learned about Oxytocin and adrenaline, and the things which can trigger adrenaline (invasive examinations very much being one of them!) they are often left unsure how their labour might be observed and monitored by their midwives, if they're not having those checks.
They want the reassurance (potentially) of someone gently being able to give them a clue as to how things are unfolding, or perhaps they simply want their midwife to be able to have that knowledge at the back of her mind - but they perhaps want to avoid a VE unless something feels wrong.
Well, here's where traditional midwifery comes into practice. You see, midwives sticking fingers up and into vaginas during labour is actually a pretty modern phenomena. It came into practice alongside the epidural drug. Because when a woman cannot feel her lower body, or the sensations of birth, she needs someone else to help her guess at when to begin pushing. Because a woman with an epidural in place cannot feel her contractions or the intensity of birth - she won't be moving, making noises or positioning herself in a 'typical' birthing way... all of the things a midwife would traditionally look out for when 'assessing labour'.
So here are some things your midwife could watch out for, if you don't want to have vaginal examinations:
Early labour signs:
Start/ stop contractions
Contractions around 30 seconds long
Able to hold a conversation
Facial expressions looking 'normal'
Walking around/ upright positions feel fine
Contractions coming sporadically, typically more than 5 minutes apart
Signs of 'established' labour:
Contractions becoming more regular and lasting around 1 minute
Unable to hold conversations properly between contractions
Instinctive, rhythmical movements
Feeling the need to lean over
Eyes glazed, in your own world
Noises becoming low, moaning, using sound during contractions
Breathing becoming deeper
Signs of the 'pushing' stage (or it nearing)
Rupture of membranes (your waters going)
Change in noises to become a lot more guttural/ grunting towards the end of contractions
Going up onto tip toes during contractions
Contractions feeling expulsive
Feeling pressure in bottom
Feeling like you need to poo, or actually pooing!
The Purple line (The skin between your buttoms & perineum stretches as labour progresses, as sometimes a purple line can be seen travelling upwards like a thermometer as your labour unfolds)
The Rhombus of Michalis (a small diamond shaped mound which can sometimes be seen on your lower back as your pelvis opens)
Going very inwards, or sometimes, coming OUT of your bubble and feeling much more alert (thanks to a shot of adrenaline your body has just given you!)
Smell...! It might sound super weird, but trust me, when you've been around birth a lot you just sometimes know baby is near by the subtle change in smell in the room..!
Want to learn more about the pushing stage of labour & how to support your body & mind during this part of birth? Take a read of my blog post below!
So there we have some simple ways that your midwife could be gently keeping an eye on how your labour is unfolding without resorting to a vaginal exam if you don't want one.
In my experience at having worked with some incredible midwives over the years - these ways can be so wonderful to utilise - allowing you to simply 'labour on' undisturbed.
Love from The Farmhouse,
Doula Jess x x
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