Vaginal Exams During Labour, What To Expect.
In my last blog post I talked about vaginal exams that are done prior to going into labour. Now let's talk about the vaginal exams that are done once labour starts.
If you are having a hospital birth with an obstetrician your first experience with vaginal exams will happen when you enter the hospital and head to the labour and delivery triage. When you have midwifery care, it's possible this part could be done at your home if you and your midwife choose. But for this blog I'm going to focus on obstetrical care.
In Triage you and baby will be assessed by a nurse, you'll be put on the fetal monitors for 30-45 mins or so, to make sure baby is tolerating things well and how far apart your contractions are. Once your nurse has done their assessment, they will alert the OB or OB resident to come in and do a vaginal exam. This exam will determine if you are dilated at all, if the cervix is thinning or softening in any way and how high or low the baby is in the pelvis. Generally speaking, if all is going well and there are no medical complications present with you or baby, they will admit you once you have reached Active Labour. In Canada that is usually after you have reached 4 cms dilation and your contractions are chugging along, usually around 3-4 minutes apart. So that means if you are not that far along, it's possible you will be sent home or be told go walk around and come back in a certain amount of time.
This time in triage can be unsettling. It's not uncommon for your contractions slow down. Any anxiety or stress you may be experiencing can cause your stress hormones to rise and subsequently reduced your oxytocin levels. Oxytocin is the hormone that gets your uterus contracting.
Try to use noise cancelling headphones and or an eye mask to block out the external sounds and lights and concentrate on your breathing and moving through your contractions.
Once you are admitted and moved to your labour and delivery room, you will likely not get another vaginal exam for many, many hours. Some teaching hospitals may do them more frequently, however with the increased risk of infection with vaginal exams, most hospitals won't do them unless there is an indication you are close to pushing, or if they feel you should be close to pushing but you don't appear that way.
How would they know if you were close to pushing without a vaginal exam? Well, we can tell from the outside that things are moving forward.
If your contractions are getting longer, stronger and closer together
If your bloody show (bleeding that occurs as they cervix things and opens) is increasing in quantity
If you are starting to shake, get nauseous or begin vomiting (Welcome to Transition)
If your partners jokes stop being funny....True but untestable, especially if your partner wasn't funny to begin with.
Generally what I see as a doula is, you won't get a vaginal exam until about 4-6 hours after you have been admitted, unless you express a desire to poop or push.
Another risk with vaginal exams is, you could be a little disappointed if you aren't as far along as you had imagined you should be. Labouring away for hours, you may feel you have made particular progress. But then be told that you are only dilated a small amount, much less than you had anticipated, well, that can be soul crushing and possibly create some stress for you. Remember we are looking to avoid stress in labour. In midwifery care, it's common practice for the midwife to not tell you how dilated you are unless you specifically ask. They do this to keep your mind focus on the task at hand, dilating, and not focus on what you've done or what might happen in the future. Essentially stay in the moment.
Read more about how stress can affect your labour with this previous blog post.
Not being told your dilation is possible to do in obstetrical care, you just have to tell them ahead of time so they don't blurt it out. I've only had one OB client do this and she ended up going completely unmedicated. That wasn't the plan, but she was able to just stay in her own headspace and labour away without focusing on numbers. Something to think about. 😉
There are a few options available to you when it comes to vaginal exams.
You can go into the hospital and consent to any exam they wish to do.
You can limit the amount of exams you have, especially if you are birthing in a hospital that routinely does a large number of them or they are regularly done every hour.
You can refuse them all together if you like. Yes, you can refuse any or all of them. Talk to your doctor about this option if you are concerned about getting vaginal exams. Talk to your doctor about the benefits, all the risks and any alternatives you may have available to you.
The thing to remember about vaginal exams is, it's your vagina. It doesn't belong to the doctor, or the hospital or anyone else. It's yours and you get to call the shots. Your consent is required to do an exam on you and if you do not consent, the answer is no.
I have only seen once in 18 years as a doula, where a doctor, a resident, didn't take no for an answer. Plus, once you are admitted, the nurse who is looking after you will usually give you a heads up when the doctor will do one. Usually it sounds like, "Dr. So and So will be by in the next hour to check on your progress." This will allow you to mentally prepare for what's coming. I've never seen, though that doesn't mean it doesn't happen, when a doctor storms in, squeezing on some latex gloves and blurts out at you to lay down. This scenario would be traumatic for anyone, and I would encourage refusal at that point until the doctor learns some bedside respect.
Finally, I would include any thoughts or concerns about vaginal exams and how you would like to be treated in your birth in a birth plan, or labour wish list.
You can find an activity for creating a Birth Wish List in my teaching portal.
