I attended a beautiful birth three days ago at our local, newly-renovated hospital. This second-time mother was amazing. She was so in touch with her body and what she needed to do at each and every moment: walk, sit, lie down, be in the bathtub, eat, drink, lean on her husband, visualizations for intense contractions.
Natural hospital birth requires women to be in charge of their births, and the book I wrote about natural hospital birth focuses on what WOMEN can do to achieve natural hospital birth. I chose to focus on what we CAN do, rather than on the systemic issues that we can’t control as individuals. We really can’t control the hospital staff. So women who desire natural hospital birth have to be ready to work with all different kinds of providers who have all different kinds of ideas about the best way to give birth.
Still, there are certainly ways that hospital staff can support natural hospital birth. And when I encounter hospital staff who really, really support a laboring woman I want to sing their praises everywhere! There were a thousand ways that the nurses and midwives with whom we worked last week supported this natural birth. Here I want to focus on just one of those “little” big things they did. Well, actually that they did not do. After my client was admitted to the hospital from triage, she never had another vaginal examination!
Her waters were intact and she was pronounced five centimeters when we arrived, so I expected that we would have several encounters with hospital staff about vaginal examinations through her labor. Instead, they quietly monitored the baby’s heart rate and the mama’s blood pressure for eight hours and never mentioned a vaginal exam once.
Here are some of the many other ways the staff was supportive: They never turned on the light when they entered the room. (The nurse used a flashlight to find things in cupboards.) They brought us extra pillows, extra towels, and extra hospital gowns when we asked. They pointed us toward the snack room when we were hungry. The midwife brought two glasses of water for the husband and me (the doula) during the most active part of labor, when we were working hard giving back pressure and talking the mama through each and every contraction. They were supportive in so many ways.
But by answering the mother’s questions about how her labor was progressing each and every time with a smile and reassurance that everything looked “great” — instead of saying, “Well, let’s check and find out” — they gave her such a gift of confidence. It makes me want to cry from happiness. It’s such an easy thing to do: suggest a vaginal examination. The vaginal exam, by giving everyone a “number,” appears to answer the question, “How are things going?” But, of course, it does not answer the question at all. If a woman is at seven centimeters, there is no way to know whether she will progress to ten in five minutes or five hours. There is no way to know whether she is feeling strong and capable or weak and defeated.
So often women know intuitively before or during labor that hearing a “number” will interfere with their ability to trust their bodies. (More rarely, but occasionally, some women know that they will be empowered by knowing this number. These women want to have vaginal exams and use this information to help themselves. The key is: Know Thyself!) For most women, though, hearing this cold, hard “fact” speaks to our brains, our rational selves. This is not the self who needs to be in charge of labor. Rational Self needs to step aside and let Intuitive, Body Self be in charge. There are many subtle ways that our Rational Self gets reactivated in labor. Imagine a woman in active labor who is sort of floating on hormones that take her out of normal conversational range. When the hospital shift changes and the new nurse comes on, she might come in and introduce herself and ask questions like, “So are you allergic to any medications?” She just activated the rational mind of the laboring woman! An immediate consequence of even one (much less a few!) rational thought is a lowering of our ability to cope with pain. The brain waves that allow us to be in a meditative, inner state are different from the brain waves that allow us to hold conversations. These brain waves are associated with changes in hormone levels, blood flow to various organs, heart rate, etc.
So, the fact that these nurses and hospital-based midwives were willing to forgo vaginal exams for EIGHT HOURS was a gift beyond measure. This mama got to labor and remained the expert on her labor. Her bodily sensations, her noises, her movements guided how the rest of us acted. We did not ever try to push her to get labor going “more” or “better.” No one had to feel disappointed or worried about how much longer there was to go, based on a number we heard at a particular moment. We all got to focus on a woman in labor. What did she need? What helped her feel the most comfortable?
When the baby arrived, she pushed twice. The baby arrived happy and healthy. I assume she had made it to “ten.”
What was your experience with vaginal exams at hospital births?