Are vaginal examinations necessary during labour?
Today came across article, written by Kelly Sawyer who is the Deputy Consultant Midwife at Maidstone and Tunbridge Wells NHS Trust.
I found her research interesting. With my passion for encouraging pregnant women to take upon themselves to do their own research so that each pregnant woman can make the right choice for themselves I wanted to do a summary of the report and also encourage you to read it yourself.
Before we start I want to explain a little bit about the hormones. Oxytocin commonly known as the the love hormone. In a physiological labour natural oxytocin will work with contractions/surges giving off natural endorphins and melatonins (your body’s natural pain relievers). The more relaxed you are the more of these hormones. If you are not relaxed, your body will tense up and prevent these hormones from working. (I will talk more about this another time).
This article I’ve decided to review is called “Respectful Vaginal examinations project”. This has me questioning things. Why do we need such a project? This to me suggests that women aren’t feeling respected? Or giving informed consent.
Did you know in any medical setting to have a VE is a choice? Even in labour.
If you’re reading this and you have had a ‘VE’ before:
Did you know you could say no?
Were you told your full risks, your benefits or alternatives for if you decided not to accept?
Asking these questions give us a personalised answer to why it’s necessary for us as an individual to accept or not accept. Because most of us know, not every woman, baby, birth is the same.
Quoted from the article “Critics of the VE claim that modern-day maternity care has become too ‘cervix-centric’ and the VE is relied upon so heavily because it is the only way to quantify labour in numerical terms, not because of its accuracy.[3] A Cochrane review in 2013 concluded that there is no evidence that routine VEs in labour improve outcomes."
One of my personal opinions on this, we do know having a VE is a proven way to see how labour is progressing, and of course i believe there are times when it’s beneficial or necessary. However i question how this interrupts a natural physiological birth process. Especially if a woman hasn’t officially given consent, making her anxious this would rise in her catachalomines and adrenaline stopping those love hormones I mentioned earlier.
Though the VE’s are put in place to see how labour is progressing, there is no proven time limit on when exactly a woman’s cervix will dilate. It's important to consider how the hormones are a huge protagonist in the birthing process.
To quote again "Two recent large-scale studies by Gluck et al. (2020a[6]; 2020b[7]) found that having five or more VEs increases the chance of experiencing a raised temperature (which may be a sign of infection) during labour, and can also increase the risk of a serious (third- or fourth-degree) tear.
Numerous studies have suggested that the experience of the VE for the birthing person is often a damaging one, with some reporting feeling pain and embarrassment during a VE.[8],[9] Worryingly, several studies have found that some women and birthing people felt coerced or intimidated into having VEs without giving their full informed consent."
During Kelly’s research she did an audit on 55 different women in labour. She found that each person in labour had more 6 VE’s, performed by 4 different practitioners (and that they were given more than the srandard of practice 4 hourly VE check).
My personal comments on this are to question the consistency or the measurements with their being 4 different midwife’s, rather than the same midwife doing the them throughout.
Quoted again from the article "Only 17% of respondents knew about the alternatives to a VE, including their right to decline, and 54% felt that they didn’t have a choice whether to have a VE or not. This raises issues around how informed the consent given for a VE truly is within maternity care, and how well practitioners discuss the risks, benefits and alternatives of a VE."
I hope with this information it encourages women to ask more questions about your body and your care pregnant or not. This when you can feel happy and comfortable with care knowing that you have informed consent.
Below I will attract a link for the article I'm speaking about.
And for anyone like me who really likes to delve deep in to research, here is a link to Dr Rachel Reed's blog 'The Midwife thinking' on Vaginal examination. (Dr Rachel Reed is one of my favourite sources to get information on, as she is a highly respected, very intelligent academic midwife. Teaching birth workers all over the world always putting first women, women's rights and herstory. Not history.
I would love to hear your feedback on todays blog, and any questions you may have for future blogs you would like me to bring to you?
If you are pregnant I wish you a beautiful empowering journey and birth. P.s don't forget to subscribe. Moll xoxo
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