Vaginal Examinations

Vaginal examinations (VE’s) or internal examinations appear to have become a “normal” part of the care during labour.

For some VE’s can be very helpful for those who have been labouring for hours and are at 4cm of dilation and are “officially” in labour.
However the flip side of this is that the number could be completely demoralising for a birthing person and reinforce the belief that “they don’t know their body” rather than encouraging them to connect to their intuition and instincts.

VE’s are invasive and yes they can be uncomfortable and for those that may be survivors of sexual abuse be very traumatic.

There is the risk that they can introduce an infection, or the amniotic sac accidentally breaks.  There is also the anomaly that when measuring that every practitioners measure cervical dilation differently.
VE’s don’t really give a lot of information.  They are a snapshot of that particular moment.  They can’t predict what is going to happen.

So, are they necessary? Sadly we hear stories of birthing people having access to birth pools restricted unless they agree to a VE. Those that have chosen to decline a VE may be on the receiving end of being refused entry to the labour ward or birth centre or pain management is denied.  Maternity staff don’t always handle their response to your choices positively.

In some circumstances it can be a good idea to perform a VE, but its use to determine labour progress is questionable (Reed, 2015).
It use to be that these were undertaken in response to a suspected pathology (something wrong) such as an obstructed labour or a mal-presentation, rather than being routine. In other words, a VE provided an assessment of a complication and helped carers determine what to do about it (Reed, 2015).
The partogram, the graph on which dilation and progress is plotted, became established practice in the 70’s and, in order for midwives to plot the graph, they needed to do regular VE’s. However we are well aware that actual labour patterns don’t fit the timeframes prescribed by the cartograms and there is no evidence to suggest routine VE’s in labour improve outcomes for either the mother or her baby. A Cochrane Review (2013), as cited in Rachel Reed’s article, states “We identified no convincing evidence to support, or reject, the use of routine vaginal examinations in labour …” Sadly the same review also states: “Given the fact the partogram is currently in widespread use and generally accepted, it appears reasonable, until stronger evidence is available, that partogram use should be locally determined.”
Interventions implemented without robust evidence require ‘stronger’ evidence before they are removed or changed and it’s unlikely that this strong evidence (i.e. randomised controlled trials) will be gained due to research ethics and the culture of maternity systems (Reed, 2015).

YOU have the right to accept or decline a VE, the hospital policy is to offer to do one, if the midwives do this they are using the correct practice.  If you are then coerced to have one this is not acceptable.  If YOU decline and the midwife/Doctor goes ahead and does it anyway this is ASSAULT.
A woman always has the right to say I DO NOT CONSENT!!