Vaginal Exams(VE): who needs them in labour?

This is an extract from a great article by Nurturing Hearts Birth Services on vaginal/cervical exams:

Vaginal Exams – when are they neccesary in labour?

I get the call … I head over to the family’s home and she wants her cervix checked. And I wonder…why? Is it to prove to me that she’s in labor? I believe her…and I doubt that’s the main reason.

The main reason women want their cervix checked in labor is to prove to THEM they are in labor! They can’t just let it be what it needs to be…and my question would be this – what does it matter? What you are feeling is valid and real, and what is going to be is what is going to be…

I don’t care where your cervix is when I arrive! I’m not going anywhere,…I’m here until this stops or we have a baby. The only time I can see the value in an internal exam is if labor doesn’t seem to be progressing in a way that we would expect, and I may want to check to see if there is an answer I can find (such as a baby’s head being crooked in there, for example). It is not to see how fast your progressing, really…as long as you are moving forward, I do NOT care how fast it is going!

Take your time, have your baby in your own time…so long as everything is healthy. But for a normal labor, I don’t care how long it’s taking, I don’t care what your cervix is doing…I accept your labor is what it is and will take as long as it needs.

What about to see how much longer you will be in labor? I’ve seen women go from 4cm dilated to birth in an hour! I’ve also seen them take 12 hours to go from 8cm to birth. Okay, so that doesn’t help.

What about when you feel the need to push? Here is where I’m going to get the biggest chair-squirming from nurses and OB’s (and even a bunch of midwives). When you begin pushing your baby out, do I need to check your cervix to make sure it’s “okay” to push because we’ve made sure you’re fully dilated? (you know, to make sure you don’t ‘swell your cervix’) No, I don’t. Usually women don’t start pushing by all of a sudden full-on full body pushing…usually you hear a catch in their voice during the contraction, a grunt, a tightening. Rarely does this happen when she is fully dilated, it’s almost always in transition…and I’ve never seen little grunty pushes swell a cervix.

What about when she does those full-body pushes? For the first 15 minutes or so my response is “YOU GO GIRL!” After that I look (externally…but LOOKING at the mother) for signs that the baby has moved down and therefore she’s fully dilated. Yes…you can actually see signs on the outside without touching mom! If she’s pushed for a while with no external signs, then and ONLY THEN will I ask if I may slip ONE finger in and see where the head is and if there is cervix I can find.

This past year I did 8 births in a row…with a total of 1 internal exam (because the mother said that with her previous babies she was “stuck at 8cm” for hours until her water was broken artificially and she felt for the last couple of hours that she was again “stuck”. This being her forth baby, I believed her…checked her cervix, she was, indeed, 8cm and we broken her water and she had her baby 15 minutes later. Did I mention that I have a HUGE amount of respect for the wisdom of mothers?? I’m always humbled by it..) I actually feel sorry for my apprentices – because cervical checks is going to be the LAST skill they master with me…because I just don’t do them very often.

Sometimes I will see a woman that loses all confidence in her body and the process for no reason other than societal anxieties and fears that everyone has given her that birth is scary and doesn’t work 32% of the time (our current cesarean rate).  Sometimes that mother needs to regain her confidence and that can sometimes be accomplished with an internal exam that shows that her cervix is blossoming open.  It’s wonderful to be able to help a woman regain the trust in her body!  (also runs the risk of finding out she’s not as open as she hoped and having her completely give up…even though her cervix could blossom open quickly and at any moment!)

So let me summarize my position on this subject:

REASONS NOT TO DO AN INTERNAL WHILE IN LABOR: to make sure you’re really in labor, to see how much longer it will be before the baby is born, to make sure it’s “okay” for your to push.

REASONS TO DO AN INTERNAL WHILE IN LABOR: to make sure (after given ample time) that things are progressing (no matter how slowly) and that there aren’t issues that need to be addressed.

Question: Why do you need external validation that your body is perfect? And why is it that I as a Midwife respect the phenomenal perfection that is your body more than you do?