We are SO deeply conditioned, by tv and social norms, and a cervix centric birth culture to believe that vaginal examinations are necessary. Have you ever queried it, even in your own mind?
There must be a solid reason, strong evidence that it improves outcomes, you imagine- why else would women be routinely subjected to hands in their vaginas, usually requiring them to get onto their backs- for most women, a very uncomfortable position during labour.
I had a client who was a sexual assault survivor, and so felt particularly strongly that this was something she didn’t want. After MUCH negotiation during her pregnancy, her caregivers eventually conceded to making a note of “no unnecessary vaginal examinations” in her notes. Right- so unnecessary examinations are fine for everyone else then?
I’m not saying they’re never helpful or useful, but I am saying that you ought to know- their routine use is not supported by the evidence.
You can read the full Cochrane Review by clicking here, or check out the conclusions below.
On the basis of women’s preferences, vaginal examination seems to be preferred to rectal examination. For all other outcomes, we found no evidence to support or reject the use of routine vaginal examinations in labour to improve outcomes for women and babies. The two studies included in the review were both small, and carried out in high-income countries in the 1990s. It is surprising that there is such a widespread use of this intervention without good evidence of effectiveness, particularly considering the sensitivity of the procedure for the women receiving it, and the potential for adverse consequences in some settings.
The effectiveness of the use and timing of routine vaginal examinations in labour, and other ways of assessing progress in labour, including maternal behavioural cues, should be the focus of new research as a matter of urgency. Women’s views of ways of assessing labour progress should be given high priority in any future research in this area.
What is my point here?
That you should refuse all examinations? No. Just that you should know you have a choice, and that you should question the need for one. What are the risks and benefits? What are we going to do with this information? What alternatives could we consider? There may be times you are happy to go ahead, and others where you’re not.
It’s always up to you what goes into your body, as it is at any other time in your life, and you are far less likely to feel troubled by any part of your birth experience if you feel these were choices that you conciously opted in on.
This is what we want for you- we don’t care if you want a home water birth, an epidural or a C-section. We only care that your decisions are fully informed and supported, and that you have the tools to navigate the lot with calm confidence.
If you need support to learn how, options start at just £10 with Breakfast Birth Prep with Steph on a Saturday morning. If you’re looking for you and your partner to be comprehensively prepped, our group or private hypnobirthing courses may be right for you. I offer one space each month on a ‘pay what you can afford’ basis- if you need one of those spaces, get in touch with me firstname.lastname@example.org