Saying NO to an examination...

[peeapod]

I wanted to share my experiences from yesterday but didn't really want to so publicly. I hope this helps someone here as I can write more open and anonymously.

So yesterday I was experiencing tightening pain across my tummy. These started at about every ten minutes and wasn't disapearing after a bath or relaxing etc.

They were pretty damn painful and when they got to every 6 minutes it was decided that it was best to go to hospital to make sure everything was ok.

When I entered the assessment unit on the ward I was asked to undress from the waist down and cover myself up. I did so, but when the midwife came in she was like you'll need to take your knickers off. I said uh, why?

She said, so I can examine you. I said what do you mean? She said well I need to know how dilated you are and I can only do that by examing you.

After explaining that actually thats the exact reason why I am booked in for a C section next week (and completely freaking out over these pains because I have such a low pain tolerance) she huffed and said well you wont get a C section based on a few contractions. I stood my ground (with my ohs help) and she eventually said that she would go and get the doctor to explain it to me.

When the doctor came in he was really lovely. He showed us that the monitor I was on wasn't recording any contractions, and that thats what its job was (as well as recording baby's heartbeat). He asked if he could feel my tummy which I agreed too, luckily it co-coincided with one of these pains and he was able to reassure me that these were just very severe braxton hicks because he couldn't feel any tightening of the uterus.

I just wanted to share with you my story because I really think its important for women to be 100% clear on examinations, especially internal ones. I was in such a vunerable position and it was just assumed that I would consent. The midwife wasn't able to deal with my refusal without resorting to threats and misinformation, which without my partner being there could have forced me into consenting to what would have been an incredibly traumatic experience, could have actually started labour and increased the risk of infection. Ironically if I had consented it would have actually made my C section more in doubt because thats the reason why I needed one..

If anyone is in a position they don't feel comfortable in whether thats in labour, pregnancy or anywhere remember that no-one should have the power to force you into consenting to things you really don't want to do. Especially remember that its your body and your boundaries and that health professionals need to respect that.

I don't look on it as the midwife or the doctor being in charge of my care, but I see it as a collaboration and a negotiation. If a procedure needs to be completed in a certain way and only that way I never assume, and I always ask questions and I always feel 100% comfortable before I consent to it. In case of emergencies I try to plan in advance and my oh also knows my tolerances etc.

Work with the professionals, they might know whats best clinically but they don't know you and your personal situation.

[Mmolly2013]

Wow so lucky you and your partner were able to stand your ground. I'm having my first baby I'm 24 and I've never had a smear test or anyone down in that area.

So I'm dreading the day someone wants to have a poke around as I'm not sure how I'll react, I feel violated at the thought if it but I'm going for a VB so I suppose it's inevitable.

[Ducky23]

I'm glad I found this

With my first I found the examinations as painful as the contractions when they came to do them I was literally in tears and pretty much eating the gas an air machine! And I have a very high pain threshold! At one point my mom had to tell them to step the hell away from me!

I am now pregnant again and was DREADING the examinations. Do you think I could put this in my birth plan and it would be followed?

[TestingTestingWonTooFree]

I think on the basis though that examinations are frequent and usually people consent to them, it would make sense from the outset that you're not willing to have them. In your shoes I would have raised it when asked to undress.

[MummytoMog]

Sorry, I'm not clear - you're having a c section because you prefer not to have internal examinations? Or you have a previous trauma that makes vaginal examinations upsetting and/or painful?

I don't think it's terribly helpful to suggest that there's something intrinsically traumatic or dangerous about internal examinations. If you don't want one, then yes you should of course be able to refuse, but they are a fairly normal part of labour and delivery for most people (not all, and I accept that some people feel very strongly about it). I just don't want any first timers to get the impression that they should willy nilly refuse an internal. As a rule, they're perfectly safe and painless.

[BobPatandIgglePiggle]

You should have stated that before undressing to save the time and hassle. Seems likeca silly thing for you to have done if you knew you were going to refuse an examination.

Spoling for an argument possibly?

[HiawathaDidntBotherTooMuch]

I too find vaginal examinations very painful. After my first birth experience, for my second, I put it in capitals in my birth plan that I would only consent to an examination with entonox. It was the only thing that was actually in my birth plan. No way was I consenting to a sweep at a GP surgery. I was happy to have one in the hospital, where entonox was available, but no way to without it.

[snoggle]

You don't need to have internal exams if your labour is progressing ok. There is no evidence to say that they are helpful or necessary unless there is a problem or you actually want to know how dilated you are. Midwives can tell in many other ways how your labour is progressing.

I didn't have any at all with DC2, not that I refused, I just had a really good pair or midwives who said none of it was necessary. DC1 on the other hand, pushed into loads o interventions and was examined loads of times.

[EEasterChick]

Well done OP, in labour some medical professionals csn start treating women as if their choices and needs don't matter. For my second birth I refused internal exams too and stated it in my birth plan. It was a VB and it just wasn't necessary for me to know measurements etc., I just needed to relax. You have every right to refuse any intervention that doesn't help you to birth your baby.

[peeapod]

As I said its not about point blank refusal. it is completely about choice. It is about negotiation, respect of a womans body etc etc.

My reasons behind why shouldn't matter. It didn't yesterday and it hasn't for my C section. It just is.

As this article that I found yesterday shows www.ncbi.nlm.nih.gov/pmc/articles/PMC3749030/ it has become a normalised part of labour when it shouldn't necessarily have to be. there are alternatives, and there are ways that the woman can at least feel in control of the situation.

Getting professionals to realise that it can be a really traumatic experience and that its not normal is really important.

The thing was testing that the midwife gave it as an instruction, not a question, suggestion nor did she provide an explanation of why. When you are in pain and in an inherinately vunerable position someone in a position of power telling you to do something without these things makes it really hard to say no to.

I just want others to realise that it is possible to say no, to ask why, to check and make sure its essential, to ask for and expect some respect.

It isn't an accurate measure of how far along you are or how long you have to go as these things can change very rapidly. I recommend looking at the article I posted and exploring your options. sorry I forgot to post it earlier.

[squizita]

Peeapod that is for the US not the UK? There are really quite big differences between the protocols for 'normal' birth between the US and the UK (right down to what the word 'midwife' means - in the US, it is a job description with no basic training as opposed to here, which is why for example American studies on risks for midwife-led home births aren't terribly relevant to the UK).

Have you a UK source stating it has formally become the norm here?

[BobPatandIgglePiggle]

Your reasons are your own

The way you went about it was childish

[peeapod]

its a uk source.. it says laboUr.

Please don't call me childish. thats really insulting. I was technically put in a position of being a child, but that was not my fault.

Trust me, I had and have no intention of going into labour. I had no clue as to what to expect with the term "examination"...

sorry im not an expert.

[BobPatandIgglePiggle]

Rubbish - 'undress from the waist down' was never going to result in anything else

I'm not disputing your reasons, just your behaviour. That is not the way to get midwives to treat you in the manner you need.

You simply could have said you'd prefer to explore other options before taking your trousers off and waiting for a confrontation.

[IdaClair]

Examinations are not inevitable.

I have been pregnant four times and examined once, not in labour, for a good reason, with consent.

[peeapod]

ok should I make myself completely clear?

She said as she was leaving the room undress from the waist down and cover yourself up with the blanket.

There was no discussion possible, no opportunity for negotiation until she returned. At my first opportunity I said no.

I am highlighting the power that the midwife had over me. I was in pain, i had been all day I wasn't exactly thinknig straight. If I had "allowed" myself to get into that position when it is so traumatic for me then I just wanted to share how easy it is to get into that position, and to get out of it..

[BobPatandIgglePiggle]

She wasn't in a position of power.

You are infantalising yourself.

You could simply have sat with your clothes on until she returned and explained your position

Midwives aren't an enemy to be fought against.

[peeapod]

ok, if you prefer I can alter it to say i didn't take my trousers off but still faced the same difficulties if that helps?

end of the day my feelings about who was in power and who wasn't are the important thing, not the actual power relationships.

but hey.. lets divert this discussion away from the real point to serve your personal attack on me.

[5madthings]

She should have explained what she wanted to do and why and got your informed consent and if you didn't consent then discuss any outcomes and alternatives.It is wrong the way in preg and birth they often assume consent and often without explaining what they want to do and why etc.

[MrsCakesPremonition]

For anyone reading this thread and feeling worried , I just wanted to say that I did not find internal exams painful or requiring any pain relief. The HCPs were respectful and considerate, taking time to explain what they needed to do and why. This was over the course of several years, two births, an ectopic and IVF .
The OP is right about talking to the people caring for you.

[GeraldineFangedVagine]

HCP's are often in a position of power whether intentionally or not. Any HCP working within their code of conduct should inform their patient the rationale for any treatment or investigation, especially something as intimate as an internal. Before the op was told to undress her consent and understanding should have been sought. After discovering the op was unwilling to proceed she should not have been made to feel unsupported or pressurised. That is not the way to form a cooperative relationship.

[MultipleMama]

I'm don't understand why the OP is being attacked for this. The OP was sharing her experience and encouraging others to stand their ground and know what they are consenting to. In no way did I read that she was telling them it was painful or anything like that, only that sometimes, sometimes, complications can occur.

To all first timers; know your options and know what you want. If you want to refuse, you can.

I wish I felt more empowered and stronger in myself to say no to internal examinations. They weren't painful just uncomfortable but the embarrasment is what made it traumatic for me. I now have 6 DC and during my other 4 PGs I have refused vaginal examinations unless it was absolutely necessary.

[swampusdonkus]

I found the OPs post helpful in highlighting that it is wrong for HCPs to assume that it is ok to just carry out an internal examination without informed consent. The OP is not trying to worry first timers here, just point out it is within our rights to understand what is being asked of us and make a decision accordingly. Some find such exams traumatic.

[NigellasDealer]

i agree . having given birth to twins with minimum examiinations I was totally freaked out to have a young HV come to my house and demand to inspect my vagina! when i said NO to her she looked really taken aback as though I had no rights over my own body and was huffing and puffing at me for the rest of the visit as though i was being really difficult or something! Thanks but I know my own body!

[Busymumto3dc]

I have had 3 dc

Examined during labour with all 3

Examined at 16 wks with one due to a bleed. And at 38 weeks with another due to thinking waters were leaking.

I didn't find any of these examinations painful. I think if you can relax it's much better

[5madthings]

I don't get the negative stdiff towards tho op either, with my first preg I was given n internal a few times wwithout consent, I didn't realise I could say no! I had just been t the basic nhs birthing classes and it had not been covered, just presented as matter of fact that it wwould be done and I had a consultant re do an examination the midwife had just done wihtout asking, or ssaying he was going to. I eas commute bed having just had the midwife do the internal when he came in, looked at my notes ans then proceeded to eexamine me without saying a word. He was very rough and I was in agony with spd, when I asked him to stop as he was hurting me he saod 'you are pregnant, get used to it it's journal's!!

The midwife was very aapologetic afterwards.

I was much more clued up with my next four and made sure they explained what they wanted to do and why and at times refused the treatment if I felt it was unnecessary.