Just like all other decisions throughout your pregnancy and birth, it is up to YOU. You have the option to accept vaginal examinations. You have the option to decline vaginal examinations. You have the option to just have an examination at a particular point in your labour if you really want to find out how dilated you are.
But why wouldn’t I want to have internal examinations, why would I decline.
Well the choice is always a personal one and one that needs to be made in the moment. It should ALWAYS be something that your midwife gains your consent for.
Reasons for potentially declining internal examinations:
Well, firstly, it is worth noting that cervical examinations can interfere in the natural birth process, and that they are only ever really a snapshot in time, they aren’t a predictor of what has happened, or what is going to happen. i.e. if you find out after hours of intense labour that you are only 2-3cm, that can impact on your confidence, on your anxiety and can interfere with your hormones which can then slow down progress because you think you are going to be in labour for hours. But if you weren’t interfered with, your labour may have progressed much quicker from that point. It isn’t an indicator of how your labour is going to go. Conversely, you may be examined and find out that you are 7-8cm progressed and think it’s nearly over, but could then slow down and take a lot longer. Knowing how dilated you are doesn’t really help you progress.
Secondly, vaginal examinations can be really uncomfortable. It isn’t usually pleasant having a strangers hands rummaging around your most intimate area.
Thirdly, cervical examinations can lead to accidental rupture of your membranes which can have a knock on effect on the rest of your labour and could lead to unnecessary interventions.
And lastly, they can introduce a risk of infection, and if your waters have broken early in labour, it is advisable to avoid internal examinations altogether so as to minimise the risk of infection.
But how will the midwife or me know how far progressed I am?
Well a skilled and experienced midwife will be able to assess your progress using other observations:
1. ‘The Purple Line’ or ‘The Bottom Line’. This is a purple line that appears on a labouring women and runs up the natal cleft (aka the bum crack!) The more dilated she is, the higher the line goes. Studies have shown this line to be present in approx. 80% of non induced labours. It usually shows up at around 3-4cm, is at its strongest around 7-8cm and then seems to fade at almost full dilation. So it is a good sign for your birth support team to watch out for.
2. Your emotions. You may not always notice the change in your demeanour as your progress through labour, but those around you most certainly will. I definitely felt the change myself as I progressed, much more focused and unable to concentrate on anything else. On my hypnobirthing course, we discuss the distinct emotional stages most women go through, and this is really good for the birth partner to understand so they can also assess your progress.
3. The sounds you make. Many women are able to control the sounds they make in the early stages of labour, and will usually be laughing and joking, going about their normal business. But as things progress, many women will be unable to stop themselves making very instinctive sounds more like groaning and moaning. This can be a sign that things have progressed, and then as the woman reaches full dilation she may quieten and not make much noise at all.
All these different observations can show how your labour is progressing, so you see it really isn’t necessary to have examinations if you choose not to.
If you’d like to learn more about the stages of labour, how you can tap into your natural birthing instincts, all the things you can do to stay calm and in control at each stage then you need to book onto my hypnobirthing course. Group sessions run once a month, on a Saturday. I also offer private sessions in the comfort of your own home.