Vaginal Exams in Labour
Vaginal exams in labour are a hotly contested topic, with many women increasingly choosing to decline them.
While a vaginal exam is a useful part of a midwife’s toolkit in assessing progress of labour, it is a snapshot tool - giving a few only of that specific moment, which could quickly change - and should never be used alone. Above all, if a woman feels she is further along in labour than a vaginal exam says she is, she should always be listened to.
“The VE is a useful assessment in some circumstances, but it’s routine use in an attempt to determine labour progress is questionable. As birth knowledge evolves, and research challenges the current cervical-centric approach to labour progress, there is an opportunity to shift practice […] there is no evidence that routine VEs in labour improve outcomes for mothers or babies.”
- Dr Rachel Reed, Vaginal examinations: a symptom of a cervical-centric birth culture
Vaginal exams can be an infection risk, especially if the woman’s waters have broken. It is not uncommon for a vaginal exam to “show” that a woman is nowhere near giving birth, causing her upset and despair, only for baby to actually make an appearance within a very short time frame. As ever, though they can absolutely be useful and have their time and place, it is important to consider ahead of time whether you feel they are right for you (and remember: you can always change your mind!).
Gatekeeping the Labour Ward
It is, unfortunately, habitual practice in labour wards up and down the UK to do a vaginal examination to decide whether or not to “allow” a woman access to the labour ward. When declining, women often encounter coercive languages such as “If I can’t see how far along you are we can’t admit you/you’ll have to go home”, even when the woman is very aware that her body is in established labour.
“It is important to note […] that someone does not have to have a VE before they are provided with care of any kind (for example access to hospital, use of the pool, access to pain relief). Demanding this does not provide people with the genuine, free ability to say “no” and therefore is not informed consent.”
If you encounter this and do not wish to have a vaginal exam, remember you can decline. Using the BRAIN acronym can help you sound out your thoughts to medical staff - “What are our alternatives?” - in a way that may help you feel more confident and sound more assertive, if that’s something you struggle with.
Regardless, you never have to let someone put their fingers up your vagina if you do not want to, and they cannot refuse you access to the labour ward on this basis.
A Brief Note on the Partogram
A large part of the reason cervical status is routinely assessed in labour is so that staff can fill out something called a “partogram”. This is essentially an outdated checklist with timescales that a labouring woman is expected to fit into. Unsurprisingly, it turns out all women’s bodies are different and will work differently, and the partogram is increasingly seen as outdated and useless.
“The idea that birth should be efficient originated in the 17th century when men used science to redefine birth. The body was conceptualised as a machine and birth became a process with stages, measurements, timelines and mechanisms. This belief continues to underpin our approach to childbirth today.
“Since use of the partogram became widespread, researchers have found that Friedman's graph does not represent normal labour progress. In contrast, research has found that cervical dilation patterns vary widely between individual women, and the average length of labour is much longer than in Friedman's findings.”
