# VEs in Late Pregnancy- Their Emotional Value?



## MegBoz (Jul 8, 2008)

It seems it's common to have vaginal exams at the weekly appointments post 36W of pregnancy. I had co-workers I didn't even know well and friends-of-friends ask if I was dilated!

When they asked, of course they all got a lecture







about how it doesn't really mean anything - you can be firm, high & closed & have the baby that night, likewise you could be 3cm and walk around that way for 2 more weeks. Besides I was GBS+ & the VEs just increase the risk of infection.

The strange thing was, they all replied, "Oh yeah, I know that. But I still wanted to know if anything was happening down there."







I've heard this repeatedly.

So it is as though there is a disconnect between

The intellectual realization that this data means nothing (without labor, of course)
& The emotional desire to view it as "progress" & a good thing (a sign that birth is coming soon)
As we know, of course birth is "imminent" - you're pregnant!









Ya know, I think I realized I too might have been tempted to be disappointed if I was still hard & closed at 41W. Again, the intellectual realization might not be adequate to stop the emotional disappointment. (Likewise, if I were 3cm, I'd probably get even MORE anxious for things to start.)

So what was your choice- did you have VEs in late PG? & why do you think people consent to them even if they know the are worthless? Are we all just so desperate for insight into WHEN because the NOT KNOWING is too tough to handle? (My DS went to 41W4D and I did find the issue of not knowing when to be really difficult.)


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## WifeofAnt (May 2, 2010)

I'm not sure if I'm going to allow them but I heard of a woman who walked around for *three weeks at 6 cm*!!!


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## vanislandmama (Dec 22, 2009)

Funny things about humans, we let emotional thought trump rational thought. My DH and I were just talking about this last night. It's kind of like all the old wives tales we have about whether we are carrying a boy or a girl. So many times over it has been proven that there is no correlation between heart rate and sex. Same goes with the shape of a womans belly. Round and out: boy, high and wide: girl. The only thing it depends on is the the shape of the womans body pre birth and the way the uterus and baby are lying.
Deciding to get checked is an emotional choice woman make with the hopes that the doctor will say something exciting. Unfortunately, it usually only leads to more anxiety and disappointment. We got so close to end and want to hear that we are almost there. We know that it doesn't mean anything, but for some reason we still do it. I learned this the hard way with my first. My MW told me a week before my due date that I was 2 cm and effaced and baby was way engaged and that she thought I'd have my baby within a week. Well, that sure did make the next 3 weeks feel like an eternity. I was 10 days past my due date.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *WifeofAnt* 
I'm not sure if I'm going to allow them but I heard of a woman who walked around for *three weeks at 6 cm*!!!

Oh yeah, that reminds me, one mama I know got induced simply because she had been 4 cm for weeks! No other reason! She said her OB said she'd never heard of a woman walking around at 4cm for so long. WTH?! That's a reason to induce?!
I remember thinking "OK, so that's reason # 8 million to decline the VEs - so we don't have to have that discussion!"


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## Ola_ (Sep 5, 2008)

Quote:


Originally Posted by *MegBoz* 
The strange thing was, they all replied, "Oh yeah, I know that. But I still wanted to know if anything was happening down there."







I've heard this repeatedly.

Hmm, do you think they really knew that, or maybe just didn't want to seem ignorant?

I pity the person who asks me about what's happening in my vagina - they're gonna get an earful!


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## nia82 (May 6, 2008)

I think most women don't know they can refuse the exams! I sure didn't know with DS... I was with an obgyn and it just was normal... Now I know better and won't allow them at all with this pregnancy. It's horribly painful, potentially dangerous (infections or unwanted membrane sweeping!) and just no reliable information...

@ Megboz: wow that is creepy... I'm starting to think obgyns do the exams to push inductions....


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## VillageMom6 (Dec 2, 2008)

Quote:


Originally Posted by *vanislandmama* 
We know that it doesn't mean anything, but for some reason we still do it.

So true, so true, so true!

I've spent the last eight months explaining to my family and friends how checks mean nothing... it's just to satisfy curiosity... usually it leads to disappointment... this time I'm refusing all checks until I feel the urge to push.

Well, guess what? I just turned 36 weeks and I caved. Completely caved. One week ago I was all "No checks!". Yesterday? "Could you check me, please?"

Gah, it's going to be a long month!









(I was 1 cm. dialated, by the way. When do you think I'll go into labor??)


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## Magali (Jun 8, 2007)

I just got them last pregnancy because my Dr. said "Now I will check your cervix."







Of course she didn't mention that it was a really useless piece of information







. And honestly I didn't really know what any of it meant...even if there was a point.


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## harli (Mar 17, 2010)

I really think that most people don't realize they mean nothing at all. Heck I don't think most OBGYN's realize they mean nothing, at least not the ones I've dealt with.

I actually just had a 'discussion' with my MIL about this today. My sister was due yesterday and MIL was asking how far along she has progressed. I told her that my sis hasn't had any VE. MIL seemed shocked and was asking 'well how are they going to know around when she will deliver?'. I told her the VE's don't tell you that anyway and that you can reverse dilate or even be like me who was 3-4 cm's dilated for months on end. She proceeded to strongly INSIST that a good doctor can tell around when you will deliver by looking at the thinning of the cervix and how much you are dilated.







She does that all the time, where I will explain something and she will INSIST that I'm wrong and she is right. I just politely smile and nod and wait for my eye to start twitching in frustration.

MIL is also HIGHLY against midwives telling me how I will kill my baby (not preg. yet) if I go to one. Guess she's in for a surprise huh?


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## bella99 (Sep 25, 2008)

You know, I really didn't mind them. And even though I knew they didn't predict anything, they helped me feel like the end was near, even if it was 1-4 weeks away. I knew my doctor wouldn't sweep my membranes (he doesn't believe in it) and wouldn't push an induction (doesn't induce prior to 42 weeks), and after going through fertility treatments, I guess I was used to people being all up in there









At my 36 week appointment, I was 1 cm, 80% effaced, and baby was at 0 station.

At my 37 week appointment, I was 2 cm, 100% effaced, and baby was still at 0 station.

At my 38 week appointment (38w3d), I was a little over 2 cm, 100% effaced, and baby was at +1 station (and boy was that uncomfortable with a head between my legs).

My daughter was born at 39 weeks exactly. In retrospect, my appointments did show a progression towards my body prepping itself, week by week.

I think the thing is, even with factual information in front of us, by the end of your pregnancy, most women are looking for a sign, any sign, that labor is close, that the time to meet your baby is near.


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## Turquesa (May 30, 2007)

Quote:


Originally Posted by *nia82* 
@ Megboz: wow that is creepy... I'm starting to think obgyns do the exams to push inductions....

Oh, that's not the only rea$on, unfortunately.









With that factor, unwanted membrane sweeping, and fishing for induction excuses, they can then push VEs by playing on the emotional aspect that MegBoz has described. "But don't you want to know...?"


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## Turquesa (May 30, 2007)

Quote:


Originally Posted by *bella99* 
I think the thing is, even with factual information in front of us, by the end of your pregnancy, most women are looking for a sign, any sign, that labor is close, that the time to meet your baby is near.

Oh, don't worry.







There are plenty of signs--abs swollen out to kingdom-come, extreme fatigue, peeing every 5 minutes, losing your mucous plug, pushy relatives wondering "when," pushy OBs pushing induction . . . these indicators are no more mathematically accurate at predicting labor than VEs and constant ultrasounds. I do agree that the psychology is complex, and women and their doctors are willing to convince themselves to believe in the pseudoscience of frequent VEs. There's nothing like believing that you can control the uncontrollable and predict the unpredictable.


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## jennica (Aug 10, 2005)

With Ds, I didn't know it meant nothing. Had I known that at the time I would not have done them as they were really uncomfortable. My midwives acted as though they meant something, and I trusted their judgment on it. After all, they were midwives practicing in what I thought was a natural birth friendly hospital. At my last prenatal, the midwife then stripped my membranes without my knowledge or consent. That is when I realized it was something I should have been refusing in later pregnancy, but it was too late by that point. This time I have had no exams at all, and my homebirth midwives haven't offered any. I don't plan to have any in labor either.


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## dannic (Jun 14, 2005)

Quote:


Originally Posted by *vanislandmama* 
deciding to get checked is an emotional choice woman make with the hopes that the doctor will say something exciting. Unfortunately, it usually only leads to more anxiety and disappointment. We got so close to end and want to hear that we are almost there. We know that it doesn't mean anything, but for some reason we still do it. I learned this the hard way with my first. My mw told me a week before my due date that i was 2 cm and effaced and baby was way engaged and that she thought i'd have my baby within a week. Well, that sure did make the next 3 weeks feel like an eternity. I was 10 days past my due date.

yup.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *Ola_* 
Hmm, do you think they really knew that, or maybe just didn't want to seem ignorant?

Hm, good point. I suppose that's possible, but at least with one woman, I can picture her face & the tone of her voice when she replied, "Oh I know [it means nothing] I just wanted to hear that something was going on down there!" It did seem like she was sincere that she knew. So it sounds like the classic case of disconnect between the intellectual realization of fact & emotional desire to view it as "progress."

Quote:


Originally Posted by *nia82* 
@ Megboz: wow that is creepy... I'm starting to think obgyns do the exams to push inductions....

Oh, absolutely! I read about the "Sneak-Attack Induction" before. Basically, go for the weekly check up, have the VE, told you are dilated -- then told, "Oh, you're in labor! Head on down to L&D right now! Congrats! You're going to meet your baby today."

Then when you arrive at L&D, and -surprise, you're not progressing! So they "speed things up a lil' bit" with pit, AROM, etc.

Basically... they induced you when you really thought you were in labor & then once you arrived they needed to just "speed up." Scary thought.


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## broodymama (May 3, 2004)

With DS1 I was 4 cm dilated for 8 weeks (preterm labor), then 6 cm at 39 weeks when he was finally evicted.







(AROM induction before a hurricane evacuation.)

With my others I had no VEs during pregnancy or labor and it was much more peaceful.


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## SwanMom (Jan 4, 2007)

I had 1 VE during this pregnancy (when I was in labor: I was 5 cm dilated). The baby came out fine without more! Not even when it was time to push.

My midwife did say that having a VE late in pregnancy increased your chances of birthing before 41 weeks. Anyone know about that? I still declined.

Also, does anyone else think it's weird how being pregnant gives everyone license to ask about the state of your cervix? I had all sorts of acquaintances ask me how dilated I was...I didn't mind, but it was still odd/funny.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *SwanMom* 
My midwife did say that having a VE late in pregnancy increased your chances of birthing before 41 weeks. Anyone know about that? I still declined.

Never heard that. Now there is some research that sweeping membranes can make you birth faster (i.e. decrease the risk of going beyond 41W) but some research shows it makes no diff. But, of course VE & membrane sweep aren't synonymous.

Of course, maybe it's a correlation vs. causation issue - the HCPs doing lots of VEs are clearly not practicing evidence-based medicine. So maybe they're the same HCPs who push induction on due-date.







So that would lead to that "correlation" that mamas having regular VEs in late PG don't go beyond 41W.

Quote:


Originally Posted by *SwanMom* 
Also, does anyone else think it's weird how being pregnant gives everyone license to ask about the state of your cervix? I had all sorts of acquaintances ask me how dilated I was...I didn't mind, but it was still odd/funny.

I do think it's weird! I wonder if it's an American thing to be so bold to ask about that. For example, we're apparently the only ones who want to know a baby's weight. I was on a con call at work with a guy from the UK & his team based in The Netherlands (people from India, Israel, Sweden, etc.) & he announced the birth of his 2nd child & said, "oh, and for the Americans who like to know, the baby's weight was..."







it hadn't occurred to me that this was not a universal tradition. When you think about it, it _is_ weird.

Anyway, overall, being PG seems to make people think your body is not your own & the universe has license to butt in - touching your belly (I never had strangers do it, but I've heard others have.)


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## Addie (Dec 19, 2009)

I delivered with a hospital-based midwife practice, and their policy was no VEs unless the mom requested one. I didn't have one until my 40 week appointment, and even then it was more of a "well, sure, why not" type thing than a "we need to know what your cervix is doing." I asked the midwife about the policy once, and she reiterated that the information gleaned by doing VEs beginning at 36 weeks doesn't really do anyone any good, but they offer them because some moms just want to know, and some moms come in and say that their friend/mom/sister is demanding to know.









At my 40 week appointment, the midwife could barely even find my cervix because it was still so high up (and, I'm tall







). This confirmed my suspicions that nothing was going on because I'd had nothing even resembling a contraction yet. She checked again at my 41 week appointment, after days of increasingly persistent contractions, and lo and behold I was 6 cms! Baby was born the next morning.


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## nia82 (May 6, 2008)

OT: People ask about baby size and how long your labor was back home too (Germany). Nobody ever asked me if I was dilated or effaced though.


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## Turquesa (May 30, 2007)

Quote:


Originally Posted by *Addie* 
but they offer them because some moms just want to know, and some moms come in and say that their friend/mom/sister is demanding to know.









Oh good grief.


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## Twinklefae (Dec 13, 2006)

I did one, on a Friday appt, when I was 41 weeks. We were discussing membrane sweeping. She couldn't even FIND it it was so high and tight.

I went into labour on Monday.


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## Quinalla (May 23, 2005)

I was pretty "meh" on this issue, so since my OBs standard practice was VEs starting week 37 IIRC I didn't push it because it didn't really matter to me. But yeah, when people asked, I would tell them and then immediately follow up with "...But it doesn't mean anything..." and go on to explain why. Granted, since I gave birth at 38 weeks, I only had one, so maybe I might have started pushing back if I felt it was too much at some point. And my birth was so fast, I only had two VEs, one when admitted to triage and one I asked for because I felt I was complete and was, so I guess for me, VEs were never an issue really


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## Smokering (Sep 5, 2007)

...They DO routine VEs before labour??? My midwife didn't do any until I was in labour. I absolutely hate VEs... there's no way I'd have up to 6 of them for no good reason! Yikes!

Also, in New Zealand people ask about a baby's weight, but not length. I'd always thought knowing the length was an American thing?


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## CEG (Apr 28, 2006)

I am a CNM and I try to talk people out of routine VEs and very very rarely succeed, even after I explain that it means nothing. Granted, I work in a practice where people are not trying to avoidintervention but the discomfort along would be enhough for me to say no, even if I had no philosophical objection.


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## Pirogi (Apr 5, 2007)

I had one VE when I was around 20 weeks with my first baby, because I had a history of HPV, LEEP, and I was worried about incompetent cervix. It was all for naught; my cervix was long and firm and high. I went into labor on my own at 37+4. I had 2 or 3 (?) VEs during labor, without the backup midwife asking or getting consent. Annoying.

I won't be having any this time.

This may not be a popular opinion, but I really think that our and our care providers' (some of them) fascination with VEs (and other interventions) has to do with gender roles. Poor, helpless, miserable pregnant women who need to be saved. Strong, smart, typically masculine, white coat care provider whose job is saving. It wasn't so long ago that one of the most respected obstetricians of the time, Dr. Bradley, was paternalistically addressing women in childbirth education books and classes. Immensely helpful to many of the women giving birth at that time and now? Yes. But his tone and some of his message grates on some of my more feminist nerves. Nevertheless, most women then and many today still carry those cultural/societal expectations of distressed damsel/gallant doctor. VEs (and other interventions) are an illusion reinforcing the whole concept.

ETA: I am not trying to make anyone feel bad for getting or wanting VEs. I am having a hard time all of the sudden getting the right words and tone to come across the way I want, and not just online. I think I am going through some weird pregnancy hormonal things right now.
(Save me!







)


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## MegBoz (Jul 8, 2008)

Pirogi,

Really interesting post. I could see how that could play a part.


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## Turquesa (May 30, 2007)

Quote:


Originally Posted by *Pirogi* 

This may not be a popular opinion, but I really think that our and our care providers' (some of them) fascination with VEs (and other interventions) has to do with gender roles. Poor, helpless, miserable pregnant women who need to be saved. Strong, smart, typically masculine, white coat care provider whose job is saving. It wasn't so long ago that one of the most respected obstetricians of the time, Dr. Bradley, was paternalistically addressing women in childbirth education books and classes.

Love your post! FWIW, it's popular with me.









My mother has always prefaced her opinions with "I'm not a feminist but . . . " (Translation: "I am a feminist and . . . "







) Anyway, I won't say much more out of UAV concerns, but she knew Dr. Bradley and can validate the content in your post.

Because obstetrics is a male-dominated profession (not just in number of OBs, but also in its overarching philosophies), I think that in terms of what you've described, there's no guarantee that a female OB will be any better.


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## Sudonk (Nov 29, 2005)

Quote:


Originally Posted by *nia82* 
@ Megboz: wow that is creepy... I'm starting to think obgyns do the exams to push inductions....

It's not your imagination, that is becoming routine. It used to be that OBs would do a cervical exam and say, "Well, there's nothing happening. Obviously, your body needs help getting this birth going, so we need to schedule an induction." But now I've known several women in the last year who were told, "Wow, you're (X) cm dilated! We need to induce you right away!" And I've even known a woman who was told that since she was "so far along" it was _illegal_ for them to "let her leave"! It's ridiculous. And the ironic thing is that the women I know who dilate significantly before their birth begins don't even have particularly fast births. Two women I know who have a history of dilating to 8 prior to the start of their birth still have 5-8 hour births once things begin. Hardly an emergency! I recently discussed this topic with a midwife who observed that women who have truly precipitous births aren't going to be walking around largely dilated for weeks. When they're 8 cm, they're probably minutes from meeting their baby, not weeks!


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## VillageMom6 (Dec 2, 2008)

I thought of this thread and you lovely ladies yesterday at my midwife visit.









She is definitely not paternalistic and does not suggest/encourage/require VEs but I asked for one. (I'm 37 weeks)

I _know_ it tells me nothing valuable but I _liked_ hearing that last week I was 1cm and the baby's head was "floating" while this week I am 2cm and the baby's head is at -1.

Since when is pregnancy an entirely logical experience??


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *VillageMom6* 
I _know_ it tells me nothing valuable but I _liked_ hearing that last week I was 1cm and the baby's head was "floating" while this week I am 2cm and the baby's head is at -1.

Since when is pregnancy an entirely logical experience??

















, well you, and others, seem to have confirmed my theory in the original post - that although we _intellectually realize_ that the data means nothing (with regards to precisely _when_ we'll meet our baby) we still want to know anyway because _emotionally, we FEEL better knowing._

But let me ask you this, you said you LIKED hearing that you'd made "progress." A key question, I think, is *Would you have been disappointed, upset, or frustrated if you had made zero progress?*

I felt that intellectually I WOULD have been upset if, at 40W, I was still hard, high & closed. I just felt that that was stress I didn't need. Likewise, if I was like 3 cm, 80% effaced, etc. I might have become even MORE anxious - making the next 11 days I waited all that much harder.

So,







, point being, I too am guilty of not being logical. But I made the decision that I'd rather not know because it could cause me stress. So rarely in our lives can we "opt out" of stressful things. It's so rare that we have an opportunity to utterly remove or otherwise avoid a source of stress (Well, not without any negative consequences). When I do have that opportunity, I take it.


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## billikengirl (Sep 12, 2008)

Quote:


Originally Posted by *MegBoz* 

So it is as though there is a disconnect between

The intellectual realization that this data means nothing (without labor, of course)
& The emotional desire to view it as "progress" & a good thing (a sign that birth is coming soon)

This is exactly what I experienced. I knew (and preached to others!!!) that there's no crystal ball up in there, but I *STILL* requested VEs at 39/40 week appointments. I just couldn't help myself, I wanted to know, even though I knew knowing meant nothing. And then when I was 40w+2d and measuring big and baby was still high it started to get in my head that there was something wrong with my body. So I still preach that it's a bad idea. I had the baby the next day, and I was 1cm/30%/baby nowhere near dropped 12ish hours before going into labor.


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## VillageMom6 (Dec 2, 2008)

Quote:


Originally Posted by *MegBoz* 
But let me ask you this, you said you LIKED hearing that you'd made "progress." A key question, I think, is *Would you have been disappointed, upset, or frustrated if you had made zero progress?*

Oh, haha, YES! I would have been totally bummed!









But in my defense, I am only 37 weeks. I have always gone to at least 39.5. So if I had made no progress between 36 and 37 weeks, I would have been bummed, but gotten over it quickly. It's just too early to worry about it.

Now if I was 39 weeks and still high and tight? That would send me into a funk that would last until baby arrived, whether that was 14 days or 14 hours later. You are *so wise* to avoid that source of potential stress.

I completely intended to take the same patient, non-stress-adding approach. I was going to decline any checks until I felt the urge to push.

I had also considered not finding out the baby's sex at the 20 week ultrasound and I was going to wait to pee on a stick until AF was officially late.

Sooo... I'm at a 2, it's a boy and I got a BFP at 10 days post ovulation.


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## BlackSheepPDX (Aug 28, 2008)

Quote:


Originally Posted by *billikengirl* 
I knew (and preached to others!!!) that there's no crystal ball up in there

This cracked me up. So....that bowling ball between the legs feeling isn't the crystal ball?

As for exams, last pregnancy, I had one at 41+ weeks just because I didn't know WHAT to think at that point and probably didn't really make the connection about it not mattering anyway. I then was checked once during labor, when I just wanted to know "if it was working" (lo and behold, my "crimeny, is this working, because I'm getting really tired of it" was my version of transition, and I was 9cm).

I won't be checked this time prior to labor, and then, only if I am feeling a strong need for reassurance when I'm well into it. Otherwise, I believe that my body is going to do its job, and I don't need anyone poking around up there.


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## MsBlack (Apr 10, 2007)

To my way of thinking, prenatal VE is primarily if not entirely a ritual with various underlying meanings and purposes. I agree with Pirogi that it's a paternalistic thing, one of numerous acts and words used by OBs (and sometimes hb mws too) designed more than anything else to serve the creation of a power structure in the mother-doctor relationship. Well, not just ' doctor control over patients', and the corresponding participation by patients to essentially 'submit' to the doc's power--but also feeding both parties' sense of 'power over birth'.

As some have pointed out, VE has no true value as a measure, or predictor; even within minutes of birth, VE can be misleading as a source of info (thinking now of the mama whose baby was posterior, cervix was high and very posterior, no more than 3-4 cms--hard to tell because hard to reach--and having contrax every 4min but only 45 seconds long--who had a sudden, VERY intense shift in labor and was pushing her baby out 15 min later). The informational/predictive value of VE is even LESS reliable prior to labor's onset. It has NO predictive value, at any time! But it has come to be so important, one way or another in the course of care, and a woman's experience of, and relationship with, her care provider (and the provider's relationship w/her of course).

We have been taught, over the course of one short generation, to accept and even 'believe in' the power of prenatal VE (and I'm so glad to be older than that...never had ONE VE during pregnancy, never had it offered even, never missed it!). We were taught by OBs in the last 20 or so years...whether directly by our own OB, or indirectly by our friends/relatives who went before us in babyhaving...not just to 'allow' prenatal VE, but to WANT them, to VALUE them, to feel that something is 'missing' if they don't occur!

As a feminist, as a 'rhetorical critic' (an analyzer of words, images and actions under the assumption that they all have symbolic significance to people along with any 'material', literal significance), as a mom and 'Trust Birth' mw, I've had some 30 yrs to consider all matters 'pregnancy and birth'. And I will tell you that the great majority of VE is done as a ritual with almost NO real value as an assessment tool (occasionally it can be--at least for those of us with insufficient knowledge of 'non-VE methods' of determining some issues w/labor). Actually, a great deal of what happens in our care has far more symbolic significance than of actual value. Not to say that there should never be anything 'ritual in nature' in our lives or prenatal care...that would be impossible, for one thing--ritual and symbol are enormously important to us, are an intimate part of how we communicate and form our selves and relationships, our lives and societies, religions, all of it. It's just the things we don't KNOW are ritually based, the things we believe have 'real', material value, that have so much power over us.

But, with or without 'actual assessment value', VE can sure be of great value in the establishment of power relations between doc/mw and 'patient', and in the securing of our sense of control over birth! So, anyway--I won't say that a woman should or shouldn't have VEs in pregnancy, and I won't tell anyone how to feel about their prelabor VEs, should they choose some...I just hope to prompt further thought about all this, so that women can make truly informed (informed and aware on all levels) and FREE decisions about it.

So--maybe, knowing (well, agreeing to some extent anyway?) that VE is so primarily a symbol, a ritual with 'hidden agendas' and not so obvious impact on us, a woman might even choose to allow them so that her doc/mw won't feel threatened by her, will have some notion of her 'adequate compliance with protocol' and not get buttons pushed







that don't warrant pushing. By the same token, a woman who really wants, say, a normal birth with no/few 'interventions', might begin during pregnancy by refusing VE as a way to show that she is already taking charge of things.

People have different ways of establishing their power in relationships, and getting what they want, however--I'm not saying that 'refusing VE/other testing' is THE way to demonstrate your will to take charge of things. Still--when you know what's going on beneath the surface, are aware of the symbolic force of particular words/actions, you give yourself more power to choose, and more understanding of why one might make this choice or that one!









To wind it up...VE is a ritual, and has little to no material value. Use it accordingly or don't, all for your own good, and nothing else!


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## Pirogi (Apr 5, 2007)

Quote:


Originally Posted by *BlackSheepPDX* 
(lo and behold, my "crimeny, is this working, because I'm getting really tired of it" was my version of transition, and I was 9cm).

That was exactly my experience of transition too! I never had "I can't do this anymore/I don't want to do this/take me to the hospital/kill me NOW!" thoughts. The only thing I said to my husband the entire labor (except like, "Water," or "Trashcan - puke!") was to look at him in the eyes and say, "What if it's not _working_??" Bless him, he said, "Oh, it's working, honey," and that satisfied me at the time. Of _course_ it was working, why wouldn't it be working? His good response/my openness to his suggestions at that point in the labor probably kept me from requesting anything like a VE from the midwife.


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## autumnfairy76 (Oct 14, 2007)

I do find very much that the "wanting to know" is very much an american thing as well as the fact that in other countries, like in my experiences France and Italy, we are given much much less information on our pregnancies and test results. For example, with my last birth in France I was only told after a vaginal exam that resulted in enough concern to put me on a partial house rest with home midwife visits, that I was "shortened". There was no percentage effaced information given, no dialation info, there was no info on stage (-1, 0) etc of baby there was just a vague "shortened". The only numbers I was given in labor was how many cms. I was. In fact, in Italy, I had to ask the ultrasound tech many questions about the baby (length, heart rate) because NONE of this info was given. It was one of MANY incidences where the health provider was irritated for my asking too many questions for things they felt I didn't need to worry about. I think part of it is there is a much greater tendency to trust drs. opinions as the word of God and that one should never question authority. I find it very very annoying, but on the other hand, with this pregnancy since I am so much more comfortable with it, I have a better trust that my body is doing great, and I don't crave that information as much. I am still amazed at how much information women are given on their pregnancies in the states. I think in a lot of ways not knowing leads to less interventions too. Which with socialized medicine, you don't have as much of a push for interventions for more money...


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## MsBlack (Apr 10, 2007)

Quote:


Originally Posted by *autumnfairy76* 
I do find very much that the "wanting to know" is very much an american thing as well as the fact that in other countries, like in my experiences France and Italy, we are given much much less information on our pregnancies and test results. For example, with my last birth in France I was only told after a vaginal exam that resulted in enough concern to put me on a partial house rest with home midwife visits, that I was "shortened". There was no percentage effaced information given, no dialation info, there was no info on stage (-1, 0) etc of baby there was just a vague "shortened". The only numbers I was given in labor was how many cms. I was. In fact, in Italy, I had to ask the ultrasound tech many questions about the baby (length, heart rate) because NONE of this info was given. It was one of MANY incidences where the health provider was irritated for my asking too many questions for things they felt I didn't need to worry about. I think part of it is there is a much greater tendency to trust drs. opinions as the word of God and that one should never question authority. I find it very very annoying, but on the other hand, with this pregnancy since I am so much more comfortable with it, I have a better trust that my body is doing great, and I don't crave that information as much. I am still amazed at how much information women are given on their pregnancies in the states. I think in a lot of ways not knowing leads to less interventions too. Which with socialized medicine, you don't have as much of a push for interventions for more money...

Thanks for sharing your perspective, which I find so interesting. Can you say how 'not konwing leads to less interventions, too' ?

I can see how, if a woman just doesn't have the info from her doc and the technicians, then PARENTS are less likely to push for inteventions themselves. And I have thought (from the perspective 'across the pond' where we DON'T have socialized med) that socialized medicine, with no profit-concern for docs but a greater eye for saving $$ on the part of the administration, might be less likely to push for costly interventions of the sort that are not strongly evidence-based. And I would really like to hear more from you on this idea that 'not knowing leads to less inteventions'. I find your thought on this makes me very curious to hear more


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## autumnfairy76 (Oct 14, 2007)

First, just to clarify, I am an american. So I myself struggle with this wanting to know and feeling like I should know exactly what is going on, but at the same time, I see in previous posts on this thread, the information causing an unneccessary increase in anxiousness by the parents which could lead to requests or like you said, agreeing to more interventions. I also see perfectly healthy babies of my friends being born at home, UC and with midwives, who have had much less exams and information given to them through ultrasounds, tests etc and then go on to have natural births with no interventions. It's not that they are un informed, or under informed, they are just not over informed, over tested, over examined. If that makes sense?
I felt under informed in Italy, but it was really a cultural thing. Everything was fine with the pregnancy, and in retrospect they *were* giving me a proper amount of prenatal care. I just felt that culturally I was being dumbed down. That they felt I was not intelligent enough to handle knowing more about my body. That I didn't need to worry my little head about it.
I'm ok with knowing less now in with this pregnancy, but only because I trust my body more, not the doctors. At least in Italy I was encouraged to put this faith in my body whereas, when I came to France at 6mo preg with DD I was told to put faith instead in the Drs who would "take care of everything" Sorry to get a little OT here...


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## WifeofAnt (May 2, 2010)

Quote:


Originally Posted by *Addie* 
some moms come in and say that their friend/mom/sister is demanding to know.

















You know pregnant women are stripped of all their dignity as human beings when people ask how things are going in their vaginas.


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## MsBlack (Apr 10, 2007)

Quote:


Originally Posted by *WifeofAnt* 







You know pregnant women are stripped of all their dignity as human beings when people ask how things are going in their vaginas.

Yes, right--????









Makes me appreciate my Amish and Mennonite families all the more, their sense of dignity and privacy is great. Don't even 'announce' pregnancies (except to close fam members) until 'it's time to change the dress'--which means, finally needing to switch to maternity clothing. When they show in church, at oh, say 20wk or beyond, in their chosen maternity style of dress, only THEN does the community get invited to know of their blessing. And even then, while sharing with others for the sake of info and reassurance is certainly allowed and encouraged in their midst, this is undertaken very cautiously w/respect to who is spoken to. No one else would dream of asking anything but the most banal and general of pregnancy questions, or making any sort of comment. In some of the Old Order families, pregnancy is simply NOT MENTIONED at all (except to closest fam members).

Can you imagine? Mind you, these women become as informed as they wish to, with the help of family friends and care providers, and are otherwise usually well-supported (you don't have to be told a woman is pregnant at a certain point; neighbors may begin to offer to do her laundry or canning).


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## Kelly1101 (Oct 9, 2008)

I get the VEs. I'm obsessed with knowing. And yes, I really DO know that it could mean nothing. But I still want to know if I'm dilating-- if my OB wouldn't do it, I would try to check myself.


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## umsami (Dec 1, 2003)

I've always been with OBs who have done them--but part of the reason may be that they've always wanted to induce me at 39 weeks due to diabetes. This pregnancy, I still have diabetes... but it's super well controlled and the baby is measuring much more middle of the road vs. my 10 pounders. So, both the Maternal Fetal Medicine guy and my OB are fine with letting me go to at least 40 weeks...and then taking it from there. My OB (and the other OBs and CNMs in her practice) does not do VEs at all late in pregnancy. She'll only do them if somebody needs an induction to assess if it's likely to be a favorable induction.

I have to say... it's been weird not having them. I'm so used to hearing you're xyz cms dilated, etc. Part of me loves the fact that I'm being treated as a normal, healthy pregnancy, though. Nobody has asked me for details on my cervix, except my DH (a physician). Still, with all of the knife to the cervix type pains I've had the past few weeks, I'd love to at least know that they're doing something. (I'm 99% sure they are.)


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## Galatea (Jun 28, 2004)

Quote:


Originally Posted by *MsBlack* 
To my way of thinking, prenatal VE is primarily if not entirely a ritual with various underlying meanings and purposes. I agree with Pirogi that it's a paternalistic thing, one of numerous acts and words used by OBs (and sometimes hb mws too) designed more than anything else to serve the creation of a power structure in the mother-doctor relationship. Well, not just ' doctor control over patients', and the corresponding participation by patients to essentially 'submit' to the doc's power--but also feeding both parties' sense of 'power over birth'.

As some have pointed out, VE has no true value as a measure, or predictor; even within minutes of birth, VE can be misleading as a source of info (thinking now of the mama whose baby was posterior, cervix was high and very posterior, no more than 3-4 cms--hard to tell because hard to reach--and having contrax every 4min but only 45 seconds long--who had a sudden, VERY intense shift in labor and was pushing her baby out 15 min later). The informational/predictive value of VE is even LESS reliable prior to labor's onset. It has NO predictive value, at any time! But it has come to be so important, one way or another in the course of care, and a woman's experience of, and relationship with, her care provider (and the provider's relationship w/her of course).

We have been taught, over the course of one short generation, to accept and even 'believe in' the power of prenatal VE (and I'm so glad to be older than that...never had ONE VE during pregnancy, never had it offered even, never missed it!). We were taught by OBs in the last 20 or so years...whether directly by our own OB, or indirectly by our friends/relatives who went before us in babyhaving...not just to 'allow' prenatal VE, but to WANT them, to VALUE them, to feel that something is 'missing' if they don't occur!

As a feminist, as a 'rhetorical critic' (an analyzer of words, images and actions under the assumption that they all have symbolic significance to people along with any 'material', literal significance), as a mom and 'Trust Birth' mw, I've had some 30 yrs to consider all matters 'pregnancy and birth'. And I will tell you that the great majority of VE is done as a ritual with almost NO real value as an assessment tool (occasionally it can be--at least for those of us with insufficient knowledge of 'non-VE methods' of determining some issues w/labor). Actually, a great deal of what happens in our care has far more symbolic significance than of actual value. Not to say that there should never be anything 'ritual in nature' in our lives or prenatal care...that would be impossible, for one thing--ritual and symbol are enormously important to us, are an intimate part of how we communicate and form our selves and relationships, our lives and societies, religions, all of it. It's just the things we don't KNOW are ritually based, the things we believe have 'real', material value, that have so much power over us.

But, with or without 'actual assessment value', VE can sure be of great value in the establishment of power relations between doc/mw and 'patient', and in the securing of our sense of control over birth! So, anyway--I won't say that a woman should or shouldn't have VEs in pregnancy, and I won't tell anyone how to feel about their prelabor VEs, should they choose some...I just hope to prompt further thought about all this, so that women can make truly informed (informed and aware on all levels) and FREE decisions about it.

So--maybe, knowing (well, agreeing to some extent anyway?) that VE is so primarily a symbol, a ritual with 'hidden agendas' and not so obvious impact on us, a woman might even choose to allow them so that her doc/mw won't feel threatened by her, will have some notion of her 'adequate compliance with protocol' and not get buttons pushed







that don't warrant pushing. By the same token, a woman who really wants, say, a normal birth with no/few 'interventions', might begin during pregnancy by refusing VE as a way to show that she is already taking charge of things.

People have different ways of establishing their power in relationships, and getting what they want, however--I'm not saying that 'refusing VE/other testing' is THE way to demonstrate your will to take charge of things. Still--when you know what's going on beneath the surface, are aware of the symbolic force of particular words/actions, you give yourself more power to choose, and more understanding of why one might make this choice or that one!









To wind it up...VE is a ritual, and has little to no material value. Use it accordingly or don't, all for your own good, and nothing else!









MsBlack, I love you. Mixing rhetoric and midwifery. Thank you.

Personally, I don't get why people like them. I don't even want my husband's whole hand in my vagina, let alone some random doctor. The very thought is horrendous!!!

I am also suspicious of care providers who "need" to do them in a normal labor to "see how you're progressing." My MW could tell by the length and pattern of my contractions and by my behavior how I was progressing... and transition and being complete and the urge to push were also quite obvious. It makes me sad that doctors who are supposed to know about birth cannot tell these things in a normal labor without constantly sticking their hands where they don't belong.


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## nia82 (May 6, 2008)

Interesting... I see why some women need to know, and while I need to know too about my pregnancy, VEs are not on my schedule. They are so painful and uncomfy and give so little information that I will never ever do them again!

OT: I can talk about maternity in Germany and all the test that are done in the US are done too in Germany. 3 routine ultrasounds, GD, bloodwork and VEs in late pregnancy. However you can always refuse everything and obs don't fire you. If you choose a midwife, it's much more like a HB midwife here in the US. Oh and you are given all the information. I guess Germans like printouts and everything neatly organized in a folder (you get a Mutterpass, aka mother's passport - every single lab result, sizing, weight, blood pressure, ultrasound is recorded in there, also VE information such as effacement and dilation). I had my 20 week scan with DS in Germany cause I was there for 4 weeks, and I got papers about where my placenta is, how big the femur, head, belly, organs are and such... So there are information-obsessed people as well across the Atlantic


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## Youngfrankenstein (Jun 3, 2009)

Quote:


Originally Posted by *MsBlack* 
The informational/predictive value of VE is even LESS reliable prior to labor's onset. It has NO predictive value, at any time! But it has come to be so important, one way or another in the course of care, and a woman's experience of, and relationship with, her care provider (and the provider's relationship w/her of course).

We have been taught, over the course of one short generation, to accept and even 'believe in' the power of prenatal VE (and I'm so glad to be older than that...never had ONE VE during pregnancy, never had it offered even, never missed it!). We were taught by OBs in the last 20 or so years...whether directly by our own OB, or indirectly by our friends/relatives who went before us in babyhaving...not just to 'allow' prenatal VE, but to WANT them, to VALUE them, to feel that something is 'missing' if they don't occur!


I love all of this! I had a few VE's with my homebirth mw because I wanted her to sweep my membranes. She never could because the baby floated way too high. And, frankly, I should have just been patient and not done it but I was one of those who wanted some information. It was frustrating to see no progress from week to week.

OTOH, I had NO VEs during labor. When I felt I needed to push, she said I could push....

I love the image of a crystal ball up there.


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## MsBlack (Apr 10, 2007)

Gosh, ladies, thanks--I was wondering if anyone at all had read that lengthy post or got a thing from it







I know, I know, I'm strange, always mixing my feminist rhetorical critique into my midwifery (and parenting and well, everything).









Glad to know some did read it, and a few even liked my thinking there


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## Galatea (Jun 28, 2004)

Quote:


Originally Posted by *MsBlack* 
Gosh, ladies, thanks--I was wondering if anyone at all had read that lengthy post or got a thing from it







I know, I know, I'm strange, always mixing my feminist rhetorical critique into my midwifery (and parenting and well, everything).









Glad to know some did read it, and a few even liked my thinking there









I was a cultural anthro major and rhetoric was one of my favorite classes... but we never talked about vaginas.


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## VillageMom6 (Dec 2, 2008)

Quote:


Originally Posted by *MsBlack* 
Glad to know some did read it, and a few even liked my thinking there









Oh, I read it and enjoyed it and in the end I was still thinking:

But I just want to know!









It's my body and I want to know what is going on with it.


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## Twinklefae (Dec 13, 2006)

Quote:


Originally Posted by *Galatea* 
I am also suspicious of care providers who "need" to do them in a normal labor to "see how you're progressing." My MW could tell by the length and pattern of my contractions and by my behavior how I was progressing... and transition and being complete and the urge to push were also quite obvious. It makes me sad that doctors who are supposed to know about birth cannot tell these things in a normal labor without constantly sticking their hands where they don't belong.

But that's a 'standard' labour. Not all labours are standard. A posterior or otherwise malpositioned baby can throw all of those tools out the window. I had the urge to push starting at 3cm. A friend had INTENSE contractions, so intense that her care providers thought she was in transition at 5cm. THANK GOODNESS that someone checked - or serious damage could have been done to a cervix, or worse, a baby.

I agree that prenatal checks are a bit silly - my family doctor offered, but said up front that it wouldn't mean anything.


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## Galatea (Jun 28, 2004)

Quote:


Originally Posted by *Twinklefae* 
But that's a 'standard' labour. Not all labours are standard. A posterior or otherwise malpositioned baby can throw all of those tools out the window. I had the urge to push starting at 3cm. A friend had INTENSE contractions, so intense that her care providers thought she was in transition at 5cm. THANK GOODNESS that someone checked - or serious damage could have been done to a cervix, or worse, a baby.

I agree that prenatal checks are a bit silly - my family doctor offered, but said up front that it wouldn't mean anything.


That's why I said "normal labors."


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## Kelly1101 (Oct 9, 2008)

Quote:


Originally Posted by *Twinklefae* 
But that's a 'standard' labour. Not all labours are standard. A posterior or otherwise malpositioned baby can throw all of those tools out the window. I had the urge to push starting at 3cm. A friend had INTENSE contractions, so intense that her care providers thought she was in transition at 5cm. THANK GOODNESS that someone checked - or serious damage could have been done to a cervix, or worse, a baby.

That's why I prefer to be checked in labor. I wouldn't trust someone saying "oh, you're at so-and-so cm's" if they didn't know for sure.


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## Galatea (Jun 28, 2004)

Quote:


Originally Posted by *Kelly1101* 
That's why I prefer to be checked in labor. I wouldn't trust someone saying "oh, you're at so-and-so cm's" if they didn't know for sure.

But that's the thing - my MW wasn't determining a number in her head, nor was she announcing one to me. She was watching me, and I was in my head laboring. Were my contractions getting closer together and longer, was I able to cope with them by means of changing position or backrubs, was I getting more serious, etc.? No number was needed. There seems to be a big gulf between a medical/doctor/hospital view of labor and the MW/homebirth/natural view of labor - one waits watchfully, and the other has to do something and quantify something.

Like I said, I have very normal labors, and sadly, many women do not have the opportunity to have normal labors b/c they are being induced or augmented or anesthetized and so do not progress normally, nor are they even able to be aware of their labors. I had one epidural birth and so I see the possible need for being checked there since you don't feel anything. (Though in my case, it wasn't necessary as transition was marked by the usual shaking, nausea, etc., and when the epidural wore off, the urge to push kicked in.) But that is not a normal labor as it has been altered by the anesthesia.

What has not been addressed here is that checking for dilation also causes problems - most commonly, when a woman is told she is at 10 cm, and told to push, despite having no urge to push. (This may come from the doctors being used to dealing with anesthetized women who don't feel the urge to push, but they should not transfer it to non-anesthetized women.) I, and many other women, have a period of resting before the urge to push kicks in. Being told to push during this phase is often counterproductive and just plain tiring, and an example of how having that all-important number is not a good thing and serves to ignore what is actually happening. Is the mama ok? Is the baby ok? Then why does it matter if she rests for a half-hour at 10 cm? Why is that number more important than what her body is trying to do on its own?

So - checking dilation is not always necessary nor is it always bad. Sometimes it tells you useful things, and sometimes it serves to ignore the actual labor and causes problems. I stand by what I said - I am suspicious of a doctor who needs this number constantly in order to support a woman in normal labor.


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## Kelly1101 (Oct 9, 2008)

Quote:


Originally Posted by *Galatea* 
So - checking dilation is not always necessary nor is it always bad.

I agree with this part.

Really I'm just about choice on this issue, although that seems kind of crazy obvious-- I mean, a woman's right to decide what does or does not go into her vagina should kind of go without saying.


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## lovingmommyhood (Jul 28, 2006)

Quote:


Originally Posted by *VillageMom6* 

(I was 1 cm. dialated, by the way. When do you think I'll go into labor??)


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## Pirogi (Apr 5, 2007)

MsBlack - I always love your posts. But if I were to intimate that every time, you would think I was stalking you.









Isn't it also true that a woman can be not quite 10 cms, have the urge to push, and quickly dilate as baby is pushed out? Dilation is really irrelevant.

I do support a woman's right to have whatever or whomever in her vagina, though.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *Galatea* 
What has not been addressed here is that checking for dilation also causes problems - most commonly, when a woman is told she is at 10 cm, and told to push, despite having no urge to push.

& there's the issue of infection as well!! With as much as 1/3 of women testing positive for GBS & it being proven that VEs increase the risk of GBS infection in baby, I wonder what the _true percentage_ of GBS infection in babies would be if regular (like hourly!) VEs weren't so common in labor?

Quote:


Originally Posted by *Galatea* 
Is the mama ok? Is the baby ok? Then why does it matter if she rests for a half-hour at 10 cm? Why is that number more important than what her body is trying to do on its own?









Good questions. What comes to my mind is, "It's important because HCPs don't know any better."







They don't know that a resting period is healthy, normal & not a problem. They just have so little experience with NCB, that they're used to having to _tell a woman when she's 10 cm_ and then having to _tell a woman she's having a ctrx & needs to push._ They're just so far removed from the natural process.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *MsBlack* 
Glad to know some did read it, and a few even liked my thinking there









Just catching up on the boards & read it in full & also LOVED IT!! (& had planned to post that I loved it even before I saw this post.)
Fascinating stuff. I love your posts in general! Thanks for writing it.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *Kelly1101* 
Really I'm just about choice on this issue, although that seems kind of crazy obvious-- I mean, a woman's right to decide what does or does not go into her vagina should kind of go without saying.

That is interesting. Of course a woman, obviously, always has the right to refuse anything going into her vagina. No question there.

But does it work in reverse? *Does a woman always have the right to demand a prenatal VE even though her HCP isn't inclined to do one?*

I have to say, "Um, no." I don't think I _do_ support that! For one thing, I've read here that VEs are billed as separate charges for insurance - so the HCP makes more money. & Obviously anything that raises healthcare costs can affect us all.

For another thing, I just don't think in general that people have a right to demand utterly, completely useless & worthless medical procedures. Granted, the VE is harmless & not a big deal & culturally a common ritual. So I'm not about to hope on a soapbox & say prenatal VEs should be banned or anything like that. But since the question was raised, I do have to say demanding prenatal VEs (in the absence of a cause, such as wanting a Bishop's score to assess potential for induction) is pointless & worthless. So I can't say that I support a woman's "right" to have it.


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## Kelly1101 (Oct 9, 2008)

Quote:


Originally Posted by *MegBoz* 
That is interesting. Of course a woman, obviously, always has the right to refuse anything going into her vagina. No question there.

But does it work in reverse? *Does a woman always have the right to demand a prenatal VE even though her HCP isn't inclined to do one?*

I have to say, "Um, no." I don't think I _do_ support that! For one thing, I've read here that VEs are billed as separate charges for insurance - so the HCP makes more money. & Obviously anything that raises healthcare costs can affect us all.

For another thing, I just don't think in general that people have a right to demand utterly, completely useless & worthless medical procedures. Granted, the VE is harmless & not a big deal & culturally a common ritual. So I'm not about to hope on a soapbox & say prenatal VEs should be banned or anything like that. But since the question was raised, I do have to say demanding prenatal VEs (in the absence of a cause, such as wanting a Bishop's score to assess potential for induction) is pointless & worthless. So I can't say that I support a woman's "right" to have it.

Of course any HCP should be able refuse to do certain procedures on any patient. But in that case, the woman is free to go find someone else who WILL do those procedures.


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## llwr (Feb 24, 2009)

I've never had them. I figured they were useless and painful.

However, if I have another, I may. My 2nd labor was about 2 hrs long and I nearly had the baby in the car. So if I'm walking around at a 4 maybe it'd be good to know...


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## MsBlack (Apr 10, 2007)

Quote:


Originally Posted by *Pirogi* 
MsBlack - I always love your posts. But if I were to intimate that every time, you would think I was stalking you.









Isn't it also true that a woman can be not quite 10 cms, have the urge to push, and quickly dilate as baby is pushed out? Dilation is really irrelevant.

I do support a woman's right to have whatever or whomever in her vagina, though.









Yes, a woman can be even less than 'not quite 10'--even 8 cms (or possibly less, I don't really know) and have the urge to push--and dilate quickly as baby descends. I don't always check, but mainly listen to women in labor (look, listen, etc) and support them in doing what feels right to them at the time. But there have been a couple times someone wanted me to check, I found they were a 'loose/stretchy 8" (or 9)cms...I advised they wait, they couldn't, and baby was born soon!

Otherwise, people, sorry to hijack with a little personal neediness with my earlier comments about that post of mine







Thanks for your affirmations though







I know I go ON AND ON at times...and also venture into kind of obscure/abstract realms...I really don't expect *everyone* to read and comment...really! But it is a nice thing to know at least some do read, and some do appreciate, for sure. My need has definitely been filled for the week


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## Melly24 (Mar 30, 2008)

Quote:


Originally Posted by *Smokering* 
...They DO routine VEs before labour??? My midwife didn't do any until I was in labour. I absolutely hate VEs... there's no way I'd have up to 6 of them for no good reason! Yikes!

Also, in New Zealand people ask about a baby's weight, but not length. I'd always thought knowing the length was an American thing?

I had my membranes stripped at 41 weeks by my midwife. I was shocked to learn that VE's are routine well before labour in other countries too. It's just not done here (by midwives anyway).

No one here in NZ asks about head circumference either.


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## umsami (Dec 1, 2003)

I have to share my favorite quote on the subject, that I found on a blog....

" your pre-labor cervical dilation is not a Magic 8 Ball. It cannot predict when you will go into labor."


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## rightkindofme (Apr 14, 2008)

I'm curious about what is going on with my body. I always interrogate my acupuncturist about what is going on with my tongue/pulse too. I don't seem to find VE nearly so painful as many of you.







I don't have many I've had one this pregnancy and I doubt I'll have another pre-labor. I had that one because I wanted to know if the CONSTANT REALLY ANNOYING contractions were causing any actions. My midwife more or less told me, "This is the point in pregnancy when some health care providers start doing them weekly, I don't see a need for that but I'll do it if you want me to." I did want her to so she did. It really wasn't a big deal.

And I was really freaking glad that I had them last time. I didn't start to dilate at *all* until 36 hours in (with contractions every six minutes) when my midwife checked me and broke up the scar tissue. When I hadn't made much progress four hours later and I was starting to hallucinate I had a lot more information for the hospital. When the doctor kept telling me that they should give me pitocin because I wasn't progressing I felt really ok with yelling (rather loudly--I was pi$$ed that they were waking me up from my nap for this) "Have you f'in checked me?! How the f do you f'in know if I am progressing if you haven't f'in checked me?!" She would check and I had made more progress and I told her to get out of my room. I was SO ok with those exams. They gave me a lot of basis for resisting interventions.









I promised my midwife that I would try not to yell like that this time.


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## Kelly1101 (Oct 9, 2008)

Quote:


Originally Posted by *rightkindofme* 
I don't seem to find VE nearly so painful as many of you.









I think it depends on the OB/MW. Mine never makes VEs uncomfortable. You literally barely feel it and it takes all of three seconds. I have heard that some OB/MWs have to like, dig around in there-- I probably wouldn't be so okay with it if that was the case with mine.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *Kelly1101* 
I think it depends on the OB/MW. Mine never makes VEs uncomfortable.

Yeah, I just had an initial check-up with my MW since I'm 8 weeks & decided to consent to a pap smear & pelvic exam. It was soooo no big deal! She's kind of a small woman, so I guess that helped, but it was the least uncomfortable pelvic exam I've ever had! It really wasn't uncomfortable at all!

The MW who attended my DS' birth did check me to confirm I was 10 cm & that wasn't painful either.

But, as I said, there are so many other reasons for declining - like if I was 41W & still hard & closed, I would have been that much more disappointed. (Cuz I was _already_ quite disappointed!)


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## VillageMom6 (Dec 2, 2008)

At my appointment yesterday we discovered that I had not changed over the past week. I'm still 2cm and 50% effaced. Okie dokie.

I said to the midwife, "Well, I know it means nothing. I could go into labor tonight or three weeks from now."

She said that she wished all of her clients understood that and took the same attitude.









I did not have my membranes swept, which took an amazing amount of restraint on my part. I'm not the most patient person but I'm only 38 weeks. Baby will come when he's ready.

I just wish I knew when that would be!


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## Turquesa (May 30, 2007)

Quote:


Originally Posted by *MsBlack* 
To my way of thinking, prenatal VE is primarily if not entirely a ritual with various underlying meanings and purposes. I agree with Pirogi that it's a paternalistic thing, one of numerous acts and words used by OBs (and sometimes hb mws too) designed more than anything else to serve the creation of a power structure in the mother-doctor relationship. Well, not just ' doctor control over patients', and the corresponding participation by patients to essentially 'submit' to the doc's power--but also feeding both parties' sense of 'power over birth'.

As some have pointed out, VE has no true value as a measure, or predictor; even within minutes of birth, VE can be misleading as a source of info (thinking now of the mama whose baby was posterior, cervix was high and very posterior, no more than 3-4 cms--hard to tell because hard to reach--and having contrax every 4min but only 45 seconds long--who had a sudden, VERY intense shift in labor and was pushing her baby out 15 min later). The informational/predictive value of VE is even LESS reliable prior to labor's onset. It has NO predictive value, at any time! But it has come to be so important, one way or another in the course of care, and a woman's experience of, and relationship with, her care provider (and the provider's relationship w/her of course).

We have been taught, over the course of one short generation, to accept and even 'believe in' the power of prenatal VE (and I'm so glad to be older than that...never had ONE VE during pregnancy, never had it offered even, never missed it!). We were taught by OBs in the last 20 or so years...whether directly by our own OB, or indirectly by our friends/relatives who went before us in babyhaving...not just to 'allow' prenatal VE, but to WANT them, to VALUE them, to feel that something is 'missing' if they don't occur!

As a feminist, as a 'rhetorical critic' (an analyzer of words, images and actions under the assumption that they all have symbolic significance to people along with any 'material', literal significance), as a mom and 'Trust Birth' mw, I've had some 30 yrs to consider all matters 'pregnancy and birth'. And I will tell you that the great majority of VE is done as a ritual with almost NO real value as an assessment tool (occasionally it can be--at least for those of us with insufficient knowledge of 'non-VE methods' of determining some issues w/labor). Actually, a great deal of what happens in our care has far more symbolic significance than of actual value. Not to say that there should never be anything 'ritual in nature' in our lives or prenatal care...that would be impossible, for one thing--ritual and symbol are enormously important to us, are an intimate part of how we communicate and form our selves and relationships, our lives and societies, religions, all of it. It's just the things we don't KNOW are ritually based, the things we believe have 'real', material value, that have so much power over us.

But, with or without 'actual assessment value', VE can sure be of great value in the establishment of power relations between doc/mw and 'patient', and in the securing of our sense of control over birth! So, anyway--I won't say that a woman should or shouldn't have VEs in pregnancy, and I won't tell anyone how to feel about their prelabor VEs, should they choose some...I just hope to prompt further thought about all this, so that women can make truly informed (informed and aware on all levels) and FREE decisions about it.

So--maybe, knowing (well, agreeing to some extent anyway?) that VE is so primarily a symbol, a ritual with 'hidden agendas' and not so obvious impact on us, a woman might even choose to allow them so that her doc/mw won't feel threatened by her, will have some notion of her 'adequate compliance with protocol' and not get buttons pushed







that don't warrant pushing. By the same token, a woman who really wants, say, a normal birth with no/few 'interventions', might begin during pregnancy by refusing VE as a way to show that she is already taking charge of things.

People have different ways of establishing their power in relationships, and getting what they want, however--I'm not saying that 'refusing VE/other testing' is THE way to demonstrate your will to take charge of things. Still--when you know what's going on beneath the surface, are aware of the symbolic force of particular words/actions, you give yourself more power to choose, and more understanding of why one might make this choice or that one!









To wind it up...VE is a ritual, and has little to no material value. Use it accordingly or don't, all for your own good, and nothing else!









Ms. Black, this post has absolutely NO PLACE on MDC.









. . . . It belongs in a women's studies journal.







Don't post too many astute insights. I'd hate to see somebody pilfer them.


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## MsBlack (Apr 10, 2007)

Quote:


Originally Posted by *Turquesa* 
Ms. Black, this post has absolutely NO PLACE on MDC.









. . . . It belongs in a women's studies journal.







Don't post too many astute insights. I'd hate to see somebody pilfer them.



























Yeah, if I'm going to spend so much time thinking and writing about this stuff, I suppose I should do under my real name and seek some recognition and maybe even some income from it LOL

thanks, I needed that!


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## Magali (Jun 8, 2007)

Wow MsBlack. I just read your post. And I have got to say, in my situation, the VE I had at 18 weeks was totally about 'adequate compliance with protocol' . I had declined a pap and a breast exam. My Dr. asked if she could at least, please, check my cervix. It was completely unecessary and I felt so beat up by the visit at that I point I just said "yes". I actually find that most things I agree to at prenatal visits are about protocol...not because *I* think they are important. Interesting.


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## MsBlack (Apr 10, 2007)

Quote:


Originally Posted by *Magali* 
Wow MsBlack. I just read your post. And I have got to say, in my situation, the VE I had at 18 weeks was totally about 'adequate compliance with protocol' . I had declined a pap and a breast exam. *My Dr. asked if she could at least, please, check my cervix*. It was completely unecessary and I felt so beat up by the visit at that I point I just said "yes". I actually find that most things I agree to at prenatal visits are about protocol...not because *I* think they are important. Interesting.

Yeah--because if she doesn't *at least* get you to lay down and let her put her hand in you for NO reason whatsoever, how on earth will she begin to assert her control over your body...and mind???









Sheesh. I'm glad you posted that story...it really does emphasize, IMO, my point about the ritual nature of VE. That might be the most ridiculous thing I've yet heard about VE during pregnancy (showing how ridiculous SHE was--not you! Well do I know of that 'beat up' feeling that basically coerces women to feel they must allow--can't deny anymore-- *some* needless invasion just to placate the aggressor a little)


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## VillageMom6 (Dec 2, 2008)

Quote:


Originally Posted by *Magali* 
I actually find that most things I agree to at prenatal visits are about protocol...not because *I* think they are important.

Oh, wow. That is not cool. I'm sorry that you were (are) treated that way.

My end-of-pregnancy VEs are all about _my_ wishes and my curiosity. My midwife would be perfectly happy to do none, if that's what I prefered.

I love midwives.


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## MonkeysInk (Aug 11, 2010)

A coworker's daughter recently had a baby and after her appointments, her mom would come in and report the daughter's dilation, effacement, etc. Once, she asked me if I'd dilated before DD was born and was totally surprised when I said that the midwives gave me the option of VEs at the weekly exams, which I consistently declined. The mom was totally surprised that I was given a choice in the matter. *That's* what weirded me out - why _wouldn't_ it be my choice?


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## Calleiah (Jun 22, 2009)

I had my first experience trying to buck the system today. I declined a CE at my 36 week visit. My doc came in and LAUGHED at me, called me a "silly goose" and then proceeded to lecture to me about why she would be doing a CE on me next week. Her reasoning? Because she cant be sure if the baby is head down if she doesnt, that I might be seriously advanced in dilation and not know it (Im not, my cervix is WAY posterior right now), and she NEEDS an exam to tell her how things are going. All I could think in my stunned shock was "Lady, if you havent figured out how to palpate a baby and tell head from butt, you shouldnt be here!" Didnt say that though.

And no, I wont be going back to her. Period. There was no discussion, just her informing me I WOULD be having one next week. That = fired in my book.


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## Devaskyla (Oct 5, 2003)

If your seriously advanced in dilation and don't know it...you don't need to know it. And calling you a silly goose? I know it would go nowhere, but I'd be tempted to report her for it, just to make her aware you know that she shouldn't have been talking to you that way.

It's weird how the VE is so ingrained in us. I had 2 UC's and there was still a part of me during my labours that wanted to know how dilated I was. I had dh check me when pushing was the only thing that relieved the contractions to make sure that I wasn't swelling my cervix. Was so relieved when all he could feel was membranes & ds3's head.


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