# Anyone declined internals?



## Celesse

I'm thinking of declining internal examinations during labour unless there is a problem. Its not that I have a problem with internal's I just think that if the midwives don't know for sure how many cm dilated I am then I'm less likely to be a victim of "failure to wait". 

Last labour was fairly slow and this time will be a HBAC and I don't want to give them any excuse to send me in. Plus I know they don't like to speed up labour in VBAC birth and I'm worried if things were slow then they would try and suggest a C-Section. 

Anyone have any experience in declining internals? How did the midwife respond? Was there any pressure to "just have a look and see how we are doing"?


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## Mervs Mum

Me and just about every woman I work with! :lol:

My own MW was totally fine with it and said she could she what was going on without one. She used the same external signs I use as a doula. Observing behaviour, cold legs, purple line, back 'breaking' etc. 

I have however had a MW who was clearly VERY uncomfortable not being able to do a VE. She ended up calling the supervisor of mws and it was a challenge protecting the space at times but we managed. I've had every variation of everything in between the two.

I think it's pot luck as to who turns up on the day but to have discussed it in advance as well as it being in the birth plan/prefernces is (according to the mws) helpful.


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## Kess

My MW is fine with not doing internals, in fact she prefers not to! She says she can generally tell how things are going without anyway, and knowing how far a woman is dilated isn't a reliable guide to how long things have to go anyway. She did say she might suggest one if I want to get into the pool early, as if I get in too early it might slow things down, but it's totally up to me. I hate internals, so will be declining any that aren't completely necessary.


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## Mervs Mum

You might enjoy this post.....

https://sarahvine.wordpress.com/201...-assessing-dilation-without-an-internal-exam/


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## Bournefree

I really hope that you don't get the situtation where you are having to defend the reasons why you don't want to have an invasive internal examination in labour, as you have the utter right to refuse this.

Any MW worth their salt should be able to know when you are in either 1st or 2nd stage labour without needed to do this routinely.

Your wishes should be respected - It would be totally illegal, let alone immoral for a MW or Dr to insist on internal examinations or to perform one without your expressed consent. Make it clear from the outset your refusal and make sure your support can keep answering for you, so you don't have to defend it in labour, and you are protected.

I had one internal at my own request in early labour at about 3-4 cm.. I felt I needed to know if I was in labour or not (silly hey, it was obvious to everyone else). It acted as a boost for me, and I didn't feel I needed wanted anymore than that (and infact the MW didn't want or offer to do anymore)

I think it is a great idea, and I also think what you want is the most important thing and they have to listen to you.
XXX

Kess - if you want to get in the pool "early" (I know some policies would say they like you at 5 odd cm before hand), it is upto you. Labour might slow, but what is wrong with that? You can decide to get out again, or stay in a relax. It shuldn't be a problem - but if you are in hospital they have this "policy" so it makes more efficiant use of the pools (i.e so they can turn it around faster). It's your birth, and if you have a pool to use and want to use it - use it, no matter what stage you are at!
XxX
XxxX


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## DaisyDoodles

My midwives have said they will only do internals if I ask them to and even then, they'd prefer not to... they said there's absolutely no need for anything intrusive thankfully! :winkwink:


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## Kess

Bournefree said:


> Kess - if you want to get in the pool "early" (I know some policies would say they like you at 5 odd cm before hand), it is upto you. Labour might slow, but what is wrong with that? You can decide to get out again, or stay in a relax. It shuldn't be a problem - but if you are in hospital they have this "policy" so it makes more efficiant use of the pools (i.e so they can turn it around faster). It's your birth, and if you have a pool to use and want to use it - use it, no matter what stage you are at!
> XxX
> XxxX

I'll be at home, with an IMW, so no policies at play. It'll be totally my choice if I decide to get in and accept the chance that labour might slow or prefer to stay out for a bit longer, all my MW is saying is that *IF I* want that information, she'll do an internal. It's up to me, that's just one of the few instances that her birthing mothers sometimes prefer she does an internal (she often does none at all, and will only do one if the woman asks - she may gently suggest one if she feels there is some information to be gained from doing one *that the mother may want*, but she'd never push). Thanks for sticking up for me though! :flower:


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## Bournefree

hahaha! No worries, I forgot you were home birthing! :wacko:
I would love to have an IdMW, that must be so reassuring. They are so confident in their skills and see more women all the way through there pregnancies and birth, so really get to know you and baby better. You lucky duck! :happydance:
XxX


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## indigo_fairy

I didn't refuse any last time, but boy do I wish I did, every time is was a negative reaction as I hadn't progressed to their protocol... And I guess everytime I found out I hadn't progressed it just put more and more fear into me which is a vicious circle! Especially when they said I'd got to 7cm, then 6hrs later said I was at 6cm and I was swelling, that really panicked me, but I now know swelling can be normal just because of baby pressing on the cervix, but at the time they treated it like I was about to swell up and die or something!! 

So this time, needless to say I will certainly be having the minimum of VE's, I would be happy to have one when the MW arrives (as it will hopefully be well into my labour if all goes to plan) and then again if I'm going hours and hours and feel I need to know. I'm definitely putting on my birth plan, minimum VE's and expressed consent first. I'll have DH and doula to stick up for me if I have any pressure, how frustrating that we should even be preparing for these kind of potential problems in the first place? :wacko:


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## lynnikins

i had 2 internals with ds2 one to check before i was induced then again caus i wanted to know how things were going and it surprised the MW that i was so far dilated 6cm, next thing that went through there was his head lol i knew when i was fully dilated and he was on his way out lol the MW's were telling me not to push so they had time to put on their gloves


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## Mum2b_Claire

I had 2 intenala with Ruby - one on arrival at the birth centre (as they were not sure how far along I was, they were very keen to send me home and they did, as I was only 3cm) then one when my contractions basically stopped at and the MW broke my waters to try and step them up a bit. (9cm).

I don't know if I'll have any this time or not, it depends if there is a reason to have them or not, I definitely won't agree to them at 'routine' intervals.


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## chuck

I had 2 VE's but I agreed to both. 

As I was HBAC'ing the MW's wanted to have enough info for me to be safe, I was more than happy for MW to examine me shortly after she arrived - mind you she was in no hurry what so ever, it was probably nearly 45 mins after she arrived, and another after a few hours when she was certain I was through transition (I had been sick and felt shivery) and had been for a while but I was having no urge to push and losing quite a bit of blood -so I allowed her to check what was going on.

I would have declined any other though the 2 she did were worth while to me and I think thats what you have to bear in mind, is having the MW's opinion on dilation/effacement and babies position (anterior/posterior) at that particular time of any use to YOU?

If its of no use to you then decline.


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## NaturalMomma

My Midwife never offered, she left it up to me if I wanted them or not. She said she didn't feel the need unless she thought there was a problem. I only had 1 internal and that was because it was taking baby forever to come and we thought his position was off a bit. So she checked and he was.


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## lesbianlove

thats great that you can refuse as i didnt even know u could!! i was also wondering can you refuse a check after your childs born like for stitches and stuff as iv had no stitches with either of my boys and found the ie more painful than the delivery hoping to have a homebirth with this one x


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## Mervs Mum

You can refuse anything you like!! If they suggest stitches and you dont feel it's necessary then you can refuse. :)


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## lesbianlove

well nobody ever tells u that i wished they had with ds1 and ds2 :( i had refused in hospital but it was a basic we need to do this so your getting it done and went ahead and i actualy felt sorer after it than after delivering il deffo be refusing all examinations


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## Kess

lesbianlove said:


> thats great that you can refuse as i didnt even know u could!! i was also wondering can you refuse a check after your childs born like for stitches and stuff as iv had no stitches with either of my boys and found the ie more painful than the delivery hoping to have a homebirth with this one x




Mervs Mum said:


> You can refuse anything you like!! If they suggest stitches and you dont feel it's necessary then you can refuse. :)

I really do think it's horrendous that people aren't told they have a choice! How can anyone give informed consent when they don't know one of their options is "no"? I think from too young an age we are conditioned to accept anything the medical profession say and do, and it's not right. It makes me steaming mad! This baby, and any future children, will be raised to know they have full ownership over their bodies, but that's just part of the solution. Medical professionals need to watch their language, it's all "must", "have to", "can't".


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## HayleyJA

Thanks for this thread Celesse... I'm also thinking I might want to decline VE's this time around so this has been interesting reading.

I was speaking to my sister about it; she's about to qualify as a MW. It sounds really obvious, but every VE they do must be documented as 'VE with patient consent' although in reality I don't think any of mine were positioned to me as 'Are you in agreement?' They were more 'Lets just see how you're doing...' 

It should be quite straightforward to decline any/all examinations and MWs shouldn't bat an eyelid.


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## Mervs Mum

Unfortunately they tend to word things in a way that gives you the impression you can't decline. As Kess said it's a cultural thing with the medical profession. 'I'm just going to pop a few stitches in there for you, ok?' 'let's have a check and see what's happening, ok?' 'I just need to listen into your baby for a while, ok?' 'We are just going to help speed things up a little with this drip, ok? .... And the list goes on. And you're right Kess, that's not informed choice. It's subtle, sometimes polite, inferred direction.

Unfortunately though Hayley they often DO bat an eyelid When women decline because they are not used to women taking control of their births and bodies. They are used to be the ones driving things not the women. Too many modern mws have lost (or never even learned) traditional midwifery observational skills. They don't trust the process enough not to be able to just sit on their hands and let it unfold unhindered as much as possible. They often seem to need to feel needed. Sad.


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## HayleyJA

It is a real shame... I wonder how many ladies on this forum realise they can decline? All too often I see threads across the pregnancy sections from worried ladies wondering if a MW 'puts her whole hand up there' or whether internals hurt, or asking when the MW will start routine checks for dilation, as if these elements are all part and parcel of the process. 

I guess, like you say, it is the 'norm' as most see it and unfortunately gives those in the medical profession the upper hand.

Sorry, going slightly off on a tangent here but it's quite a thought provoking subject....


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## Bournefree

I TOTALLY agree with you!

It is women too I'm afraid - I was very disheartened to read in one 3rd tri thread, where one of our homebirthing ladies was asking for advice, to hear another lady reply "I would just do whatever you are advised"

..how disempowered is that?!!

I like to say I was shocked, but I'm really not, I meet women like this all the time.. some of them are my friends! (I say this in relation to when I thought baby was breech, and I was looking at all the reseach and was still very happy to birth breech - they thought I had lost the plot! I got the "we know you really want a home birth Nicola, but you WILL have a c-section, if baby is breech won't you?!!?" ummm "NO?!, why should I?"
But they didn't have a founded answer between them.. it is just assumed.
XXx


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## pinkclaire

I refused all sweeps and checks while I was overdue, I had one internal when I first went into the BC which I was happy to have but after that I had no internals, my MW didn't offer and used other methods to see how far dialated I was. In fact I could not have asked for a better MW for the kind of birth I wanted she was brilliant! I could hear her explaining to my husband how she could tell and it was really interesting. It felt so empowering to just give birth how my body wanted without being told 'your only 3-4cm still' like I was with my son, it was so disappointing and I didn't realise how much it had affected me until I was having my second!


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## lousielou

I had no internals, though the attending midwives were keen for me to have 'just one'! :lol:


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## HayleyJA

pinkclaire said:


> I refused all sweeps and checks while I was overdue, I had one internal when I first went into the BC which I was happy to have but after that I had no internals, my MW didn't offer and used other methods to see how far dialated I was. In fact I could not have asked for a better MW for the kind of birth I wanted she was brilliant! I could hear her explaining to my husband how she could tell and it was really interesting. It felt so empowering to just give birth how my body wanted *without being told 'your only 3-4cm still' like I was with my son, it was so disappointing and I didn't realise how much it had affected me until I was having my second!*

My thoughts exactly with regards to my labour with April. I was so disheartened to be told after what I now know to be 7 ish hours of active labour that 'I can't even feel your cervix, it's posterior and closed' that I burst into tears and transferred to hospital - only to be told upon arrival by a consultant that the reason my cervix couldn't be felt was because I'd dilated fully! I really want to trust in my body this time around and no just go along with what the MW's fingers are telling her!

Sounds like you had a fab MW Claire - and congratulations on Charlotte's safe arrival. x


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## chuck

With my first I was gut wrenchingly disappointed when I was told you're stil only 4/5cm.

It was all so negative. 

'still only...'
''not doing what it's supposed to...'
'failing to progress...'
'you're going to need hekp...'

ergh, thanks I thought all these hours i'd been working really hard and getting somewhere and achieving something?!


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## L Elise

My thoughts are similar to your own, but my motivation is a little different Celesse.

This is my first, I claim no experience.

However........

My thoughts are.... just let me get on with the job at hand!

Internals? (Along with alot of other things!) My MW will have to fight me for 'em! Bring it! ;)


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## Nikki_d72

chuck said:


> With my first I was gut wrenchingly disappointed when I was told you're stil only 4/5cm.
> 
> It was all so negative.
> 
> 'still only...'
> ''not doing what it's supposed to...'
> 'failing to progress...'
> 'you're going to need hekp...'
> 
> ergh, thanks I thought all these hours i'd been working really hard and getting somewhere and achieving something?!

Chuck, I was exactly the same, I don't think they realise how these kinds of words affect us, I felt totally useless by the end of it. 

Luckily my MW this time isn't into protocol or schedules or any other thing, I know she doesn't do internals unless requested, she has the skill to know where we're at without them. Yay for that.


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## LaLaBelle

I was just talking with my doula last night about this.

We're planning on her examining me at home before we go to the hospital, to make sure I'm open enough to be admited to the hospital. (She's a midwife, too, so she can do an internal exam). Then the hospital will most likely require one for being admitted. After that, I'd prefer not to have them, because I feel like dilation isn't really an accurate measure of how far you've come, and thinking "Oh, I've only dilated a cm in two hours!" would really discourage me.

But then I want one internal exam before I start pushing, just to make sure I'm fully dilated and that it is definitely time to push.


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## Bournefree

You won't need one to know when it is time to push - your body just pushes! No conscious effort required. You don't have to have that kind of feedback? At best it is useless information and at worse, it could stall your labour creating a a cycle of negative feedback.

If you prefer not to have them, then don't. You have just agreed to 3 above, and your not in labour yet.. if you really don't want them, you have to be stronger than that! 
XxX


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## Mervs Mum

You definitely don't need to be told when to push! In fact even the Royal College of MWs say 10cm doesn't automatically mean pushing time. Have a read of this blog post. It sums it up really well and there is the RCMs paper on NOT using directed pushing....although most of it's memebers seem to have missed that one....:dohh:

https://tums2mums.blogspot.com/2009/06/are-we-pushing-too-hard.html


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## chuck

Thats a great article, i still have it bookmarked.

I was at 10cm for ages before i got any urge to push.


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## pinkclaire

Me too chuck!

I was told to do forced pushing with James and it took 50 mins, I have to say it was awful. With Charlotte I completely listened to my body, she was out in 5 mins with no stitches (and she was a large baby!) 

I mean it was always going to be easier with my second but it was a completely different feeling and so empowering! Def no need to be told to push!


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## chuck

I have a few involuntary pushes in the ambulance at the peak of contractions.

When I was a bit more settled after the transfer the urge came back but it got a point where i couldnt tell when the peak of contractions was so because i was pooped typical nhs put me in stirrups! WTG to make things harder <facepalm>

It was weird though I would get a little encouragement from MW looking at monitor or watching me bits and I would be pushing but then I had to really think about it and push through the push ifgwim?

I guess because when it got to crowning it was painful (the only painful bit) so I was kind of holding myself back a little. I do remember thinking right f**k it this is going to hurt so just bloody do it and pushing like hell to get his head out. 

I dont recall having to consciously push to get his body out though. There was a break between head and body being delivered of a few contractions though because I DO remember thinking I wonder if they'll say here he comes or reach out for him?!

It was nice they didnt try to force the pushing but they did have to encourage me when it was best to do it as I couldnt tell to put enough effort in to get baby out over the silly positioning - i was too within myself and tired by that point to challenge the stirrips.


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## SmokyJoe78

That's one of the biggies on our birth plan - no forced pushing or coaching... :winkwink:
I'm kind of guessing that if you're in the water it's harder for them to see what's going on anyway :shrug:


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## Mervs Mum

I don't get the urge to push as soon as I'm fully. With Hebe is was about half and hour or more before it hit and then mws were ace. I said should I push? And they said do what you like! :lol: so I did as Sheila Kitzinger says to; rest and be thankful! With Sid I went from 7cm at my only VE to fully in 6mins but then no urge for another 15 mins. I held back a bit at that point with them both though. I remember thinking 'oh f***...here come the farmer Giles!!' :rofl:


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## clarsair

Just a question that occurred to me about refusing internals - if you are delivering in hospital then how do they know whether you are far enough into labour to stay or whether you have to go home and wait?


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## Mervs Mum

By going to the hospital when you FEEL you are ready to stay and give birth rather than it being judged by dialation. The point is that you could arrive at hospital FEELING and looking like you are cracking on and be 'only 2cm', go home and give birth in the car park because cervix dilation alone does not and never has been a hard indicator of how long you have left! We don't dilate at the same rate!


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## pupsicle

My labour was only 5 hours long and I was pushing within 30 minutes of getting to the hospital, I didn't get an internal exam until I was 7cm and ready to push. I didn't even feel her doing the exam, but I can't say it wouldn't have bothered me if I wasn't ready to push.


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## MermaidMom

ive been considering this because i feel like it will slow my progress if theyre all up in my business. what is the danger in NOT getting them?


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## Mervs Mum

There's NO danger in not getting them!


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## MermaidMom

then what the heck is the purpose??? lol. i think i will skip out too.


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## Mervs Mum

It's really just to help mws and drs fill in their partograms!


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## MermaidMom

haha... well i will be rather unhelpful in that department :) you know i really do want to give birth at a hospital (in case something goes wrong... which i dont think it will!), but i dont really want them to do anything to me unless something is going wrong.


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## Mervs Mum

Then hire a doula and turn up pushing! :lol:


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## MermaidMom

yea im planning on having my sister who is a nurse and in school to be a midwife come and help me along/fight with the nurses so hubby and i dont have to :)


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## Mervs Mum

You won't have to fight anyone if you turn up ready to give birth! Don't do what most of the US do and arrive at the first sniff of labour. The longer you are there the more chance of interventions being pushed on you. when they start putting the emotional blackmail on your hubby and sister even though they know what you want / dont want they may find it a challenge to stay objective - they love you after all.


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## MermaidMom

thank you for all your advice!


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