Yesterday, a mother attending Hypnobirthing Australia Classes, asked me whether she was “allowed” to refuse vaginal examinations during labour.
Good question. ? Although can I re-phrase it? You see, the question isn’t whether you are “allowed” to refuse a procedure – but rather, whether you choose to “allow” your caregiver to perform it. The power is always with you, mama!
There are many reasons why a woman may feel uncomfortable having a vaginal examination during labour. For one, when her body is in the midst of opening up for childbirth, having someone’s fingers inserted into this sensitive and private part of her anatomy can be a very uncomfortable and sometimes distressing intervention.
Also, there can be cultural and/or personal reasons for a woman feeling violated by this often ‘routine’ procedure.
In hypnobirthing, we advocate for minimal (if any) interventions during labour and birth.
We also advocate for human rights in childbirth – and every woman has the right to be respected as the decision-maker about her own care and her baby’s care.
If a mother does not wish to have a vaginal examination, she is completely within her rights to refuse this intervention.
Please ensure that you notify your caregivers of your preferences regarding this matter.
Sometimes a vaginal examination may be strongly recommended for valid medical reasons. For example: the midwife/doctor may suspect that the baby is in an awkward position, and a vaginal exam lets them feel and assess the presentation of the baby’s head.
Often though, the vaginal exam is performed to assess a mother’s progress in labour, even though this is known to be a poor predictor of when she will give birth. (As you read through the awesome birth stories posted on this website you will come across many stories of mothers who have progressed from what was said to be “only 3-4cm” to fully dilated within a relatively short period of time!)
Vaginal examinations are a ‘routine’ intervention in many hospitals, performed at admission and also throughout labour to assess ‘progress’. However, we need to ask, where is the evidence to back up this common ‘hospital policy’ that is often imposed upon mothers in labour?
Where is the evidence?
In the 2013 Cochrane Review of ‘Routine Vaginal Examinations in Labour’ by Downe S, Gyte GML, Dahlen HG, Singata M; the authors concluded the following:
“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.”
So can you guess my answer to the mum who asked me whether she was “allowed” to refuse vaginal examinations?
Say no more. ?