Vaginal examinations

The topic of Vaginal Exams in labour often comes up in classes and quite a lot of people assume that having a vaginal examination is just part of labour and birth. They are surprised when they find out otherwise. These are some of the common questions people ask me:
Are they compulsory?
It is worth knowing that although the NICE guidelines (https://www.nice.org.uk/gui…/cg190/chapter/Recommendations) recommend a vaginal exam every 4 hours throughout labour they are not compulsory. Your informed consent should always be gained before you accept or decline any offer of intervention including a vaginal exam. Do bear in mind that the more vaginal exams you have, the more the risk of infection increases. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183634/.
Will a VE tell me how long it will be until my baby is born?
No not really, it tells you where you are at that point in time but doesn’t how long you have left, it isn’t a crystal ball. 🔮
Can I request one?
Yes you can, it is your body your choice.
Are they useful?
This depends on why you are requesting or agreeing to one. For example sometimes someone might request one as they want additional information to make a choice about their labour or birth.
Are there other ways that a midwife can tell how my labour is progressing?
Yes there are other ways that a midwife can tell where you might be in your labour journey. You can ask a midwife to observe you instead she will be able to watch and observe your breathing/sounds, movement, behaviour, posture and length/intensity of contractions. This article by MidwifeThinking is worth a read: https://midwifethinking.com/…/understanding-and…/ and this set of resources by sarawickham.com: https://www.sarawickham.com/…/labour-progress-resources/
How accurate is a vaginal examination?
No method of assessing labour is 100% accurate, that applies to vaginal exams too in fact there is research that suggests that there is less than 50% accuracy between medical practitioners (https://pubmed.ncbi.nlm.nih.gov/17567418/). So one midwife might tell you, you are 2-3 cms dilated and the other might say 3-4 cms dilated. These two articles are also worth a read: https://midwifethinking.com/2015/05/02/vaginal-examinations-a-symptom-of-a-cervix-centric-birth-culture/ and AIMS https://www.aims.org.uk/…/vaginal-examinations-in-labour
“I was told I wouldn’t be able to have pain relief/be admitted to hospital unless I consented to a VE”.
To give your consent it has to be freely given, reversible, informed, enthusiastic and specific (FRIES). So if you are agreeing because you have been told you won’t get pain relief or won’t be admitted to the labour ward/birth centre then you are not giving your consent freely as you being put under pressure. This essentially is coerced consent which goes against the NHS guidelines of consent to treatment here: https://www.nhs.uk/conditions/consent-to-treatment/
Are there other ways of assessing progress?
Yes there are other ways including:
– The purple line of dilation
– Sounds and noises the person in labour is making
– Leg warmth
– Emotions/Introspection
– Contraction frequency, strength & length
– Rhombus of Michaelis
– The foot pivot
PLEASE NOTE: Some of the above answers reflect a labour and birth that starts spontaneously so if your labour is being induced, vaginal examinations might be part of the package of having a managed labour. Please get in touch if you would like more specific information about induction of labour and I will happily signpost you to some additional resources.
Please do educate yourself before your labour and birth whether that is reading trusted birth books (I have a list if you need a good birthy book), following evidence based accounts on social media (again send me a DM), hiring a doula (there quite a few of us locally) or going to a face to face antenatal class. All of these options can help you to know your rights and have an understanding of the pro’s and con’s of the advice or recommendations from a midwife/doctor whether that is vaginal exams or other interventions. Being aware of what you are agreeing to and knowing the alternative options too can help you to make informed choices.

Some further reading about the cervix and vaginal examinations:

Whether you decide to have a vaginal examination in labour is always your choice have a read of this AIMs article: Vaginal Examinations in Labour

Why do midwives sometimes give you two figures of cervical dilation & not just one figure? The Eco Midwife

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