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?
As a mother of five I completely get what you are saying, unfortunate i didnt stumble on this article years ago. i think i’m going to grab a copy of your book for my midwifes office 🙂
LikeLike
Yay! I would be so honored if you shared my book that way. 🙂
LikeLike
I love it when they do that. I have had a few births where they do very limited vaginal exams. I had one mom whose water broke, she stayed home for a few hours then went to the hospital. Mom and baby were doing great and they didn’t do any vaginal exams until 33 hours after her water broke! http://enjoybirth.com/blog/2010/06/03/longest-birth-ever-part-1/ To read the whole story.
I love it when hospitals are supportive like that. I know in a neighboring hospital that would never happen. Which hospital and care provider you choose is so KEY to having a natural birth in a hospital.
LikeLike
I showed up at the hospital and the first time I was check I was 9-9.5 cm so I didn’t mind, too much… actually pleasantly surprised because thought they would tell me 7 or 8 max. I would have preferred a home birth but it wasn’t an option unless I wanted to UC. The triage nurse was very good but the CNM who delivered and other staff was not necessarily supportive. Definitely brought me into my rational mind a lot more than I wanted to be… was very glad I had not come in sooner. Still was able to have an unmedicated birth but had to fight a lot more interventions than I wanted to… especially during transition.
LikeLike
I wish all moms arrived at the hospital and found out they were 9-9.5 cm! And your situation is more common than people think. Homebirth is not available everywhere for everyone who wants it. I’m glad you had a supportive triage nurse. Hang on to that memory! Of course you deserved real support for your natural birth.
LikeLike
Thanks Birth Muse,
It actually quite a lengthy story. I wish a lot more moms found themselves so far along when they arrived at the hospital, too. My waters hadn’t even broken, either. Went on to birth my babe who was a little over 10lbs with a nuchal arm within 3 hours of my arrival (about 2 hours after first check). Labored a total of about 23 hours so most of it was outside the hospital. I also wish more hospital professionals knew what natural birth looks like and supported women through it. Blessings to you in your endeavors.
LikeLike
My daughter labored 64 hours in Dec. the only ones to do any vag exams were her midwifes and one RN in the middle of the night when she thought that she needed to push while in the bath tub–it was gas. She had a total of four exams during that the labor–admission 4cm –12 hours later 5cm, 31 hours later 7cm, 9 hours later 10cm
For a first time Mom with ruptured membranes to be left alone that long was amazing. There were other things that really were not so nice about being there–but that wasn’t one of them.
LikeLike
Wow! What a great story! As you know, there can be so much pressure to have a baby fast if the water is broken. But the best studies have shown that going even 72 hours past ROM does not have increased risk of infection (if mom stays hydrated, baby is doing well, etc). But minimizing vaginal exams in the case of ruptured membranes is SOOOO important! Was the leisurely-paced labor explained by an tilted head or just the way it was with no explanation?
LikeLike
I think that the leisurely paced labor was all about trust in her midwives. There were 4 of them.
At 38 weeks our family and her job overloaded her during Thanksgiving week. Her BP elevated and she gained 8 pounds of fluid in her ankles.
Two of the CNMs were freaked and kept wanting to induce even after her pressure came down and she dropped 4 pounds of fluid.
The other two felt that she had white coat syndrome since if she was given time could bring her BP down from 165/100 to 128/78–just by relaxing and concentrating. –and she had no other symptoms of preeclampia–her lab work was all good–no protein spilling–24 hour urine was way under 100 –recorded BP at home were all within reason. (130/78 range)
The first 24 hours we had one of the induction midwives–she recommended pitocin but took no for an answer. The second 24 hours we had the other induction midwife who was pretty nasty at one point and pretty much abandoned us the rest of the time.
At 9am one of the two encouraging CNMs came on duty and sat down and had a talk with Mom–she was kind and encouraging and not snotty. By then Mom was 7 cm and was very tired. She could trust this CNM and agreed to pit drip to help her finish. by 11 am she was complete–and the CNM left to do a delivery in the next room–labor stalled out again–and we had the nurse from hell–June was her name.
Mom quit pushing because her CNM was gone and the nurse was icky. She was complete a total of 6 hours –and pushing up hill using all of her energy to pull on a sheet–thank you nurse from hell— I hadn’t slept for two days—
The OB/GYN then came in, put in a pudential block,, used an extractor all in one push, (no time for anything to stretch) tore a 4th degree which took over an hour to repair, handed the baby off to the NICU (in the room).
Baby was LOA–maybe not as tucked as she could have been. WAY low–Mom had rectal pain for the last 12 hours.
I did go to the warmer and ask for the baby back–they told me that I neeeded Mom permission so I yelled across the room to my daughter who yelled back that she wanted her baby.–The NICU then had nothing to do and left (funny). I unswaddled the baby–fighting nurse from hell again–put her skin to skin and covered her with a blanket.
NOW my son-in-law understands……and even though we are one of 8 states without favorable homebirth laws—-it will be different if there is another one.
LikeLike
Hummmmm–I read the post about fewer cervical checks and made my comments after linking from another site. I then answered your question about the long labor from my email notification.
I just now took time to actually look over your site and the title of your book–LOL Whoops! I didn’t mean to sabotage your site.
I have been an RN for 34 years now and spent quite a bit of time in the Maternal/Child care units. While I would like to believe that natural birth in the hospital is possible–I truly think that it is a total crap shoot–you could get me for a nurse and have a great experience–or you could get June–the nurse from hell–uneducated–more interested in precedent and what the other nurse says than in the research and what the evidence says.
I commend you for writing it–every little bit helps. The thing that helps most is when women and their families have the right to choose what is the best thing for them. Competition from legal homebirth makes our hospitals better. RN’s that are willing to study the evidence and modify their practice to accommodate the newest research are rare, but there are some.
Certainly information about how to speak the hospital language helps too.
So please accept my sincere apology for the rather blunt factual description of my daughter’s experience. If I had realized what your site is all about I would have tempered it and given less information. There are plenty of women in the world who wouldn’t dream of having their baby at home but still want to birth their babies themselves. With a 33% section rate in our country they need every bit of help that they can get. You are doing a good thing.
YOU GO GIRL!!!
LikeLike
I love the long birth story! Though my book is about natural hospital birth, I support women giving birth wherever and whenever they want to: in a hospital, in a forest, on the moon. Birth is such a beautiful, natural process and I don’t think we should forgo our right to trust our bodies to do what they are meant to do just because we are in one location or another. It’s true that some women would never think of having a homebirth. Indeed, many of my book readers probably fall in that category. And they deserve to have empowering hospital births. And there are also plenty of other women who would consider a homebirth, but who end up in a hospital for a variety of reasons: risk factors, no available midwife, can’t afford a midwife and insurance will pay for a hospital birth, husbands who feel safer at a hospital, etc. No matter how a woman ends up in a hospital, she deserves REAL support.
LikeLike
YES! and AMEN! You are so my kinda gal!
LikeLike
so good to read… I just attended a hospital birth as a doula, and was soooo frustrated.
a quick wonderful labour – first time mom, SROM, in the tube, fully dilated.
and from here… I can’t understand what happened. I’ve never seen anywhere else that either OB or CNM had to check her internally with EACH contraction during stage2. Once she even asked the OB: could he please leave his hand in there at least?! putting it in is the most disturbing part for her…
Also they talked to her in every pause. Once they even came into the room and asked her height and weight. not in triage, no… in the middle of stage2. I couldn’t believe…. They had her papers, and also her partner was there to ask…
I think they were nervous b/c this hospital is not waterbirth friendly so the birth had to be quick in order to use the excuse why she gave birth there… and of course what happened? contractions got shorter, pauses longer, mom got confused… she had to get out finally, and since she was kept disturbed even outside she got Pit too… but the whole stage2 was shorter than an hour… so probably even this Pit wasn’t needed… completely pointless disturbance from otherwise nice and friendly staff.
LikeLike
I’m sending you good vibes. It’s sometimes so hard to be a doula, when you know what is possible but you and your client can’t achieve it. I try to tell myself that this OB just saw something tragic an hour ago to give myself empathy for them. The talking in stage 2 thing. That I believe is just lack of exposure to natural birth. If most of your clients are hooked up to epidurals in stage 2, you don’t have to worry about keeping chatting to a minimum. That is a long, uphill battle for all of us in the natural birth world. Thanks for sharing your story. As you know, there ARE times when we succeed in helping clients achieve natural hospital birth with minimal interference. And who knows how much interference you actually prevented? Maybe a lot!
LikeLike
the one good thing in the birthing practices in my country is that epidurals are not mainstream (yet). they are not even available 7/24 in every hospital! national statistics is not known, but I’d guess 20% or so.
on the other hand, our episiotomy rates are somewhere near 70%…
I just met this mom again today… she told me she is still happy that the OB went outside his limits for her (with the tube thing), and not very sad about the disturbance… and that she was most happy for my only comment she remembers from stage2 (when I saw her sadly confused, open eyes trying to understand what they all are telling her and asking from her): “we are not even here, forget about us… there are just the 2 of you: the baby and you”, as this was the only thing from all what has been said in the room in line with her internal sensations and struggles: achieving opening and letting go.
LikeLike
A traumatic last delivery where I had two VEs during my short 3.5 hour labour – one for the placement of prostaglandins, and one to check dilation *during a contraction* which had me climbing the bed – was one of the things that motivated me to choose a home birth for my son eight weeks ago. I would not have consented to *any* VEs.
As it happened, my midwife never made it. The on-call midwife was still blathering on about contraction timings and the length contractions had to be to be ‘productive’ when I tossed the phone away to someone else and began to push. He was born into the water and my husband’s hands after three hours of labour. No one touched my vagina or vulva except ME – at one stage between pushes I felt inside to see if I could feel his head, then, when I couldn’t, decided I’d leave well alone to avoid becoming discouraged. I like it that way – I have a real aversion to being touched there by anyone but my husband. It feels like sexual abuse each and every time.
LikeLike
Yes! Thanks for your comment. So many women feel this way about vaginal exams. Many women experience these exams as abusive, rape-like, or as actual rape, regardless of how the care provider INTENDED the exam. Our feelings are important and care providers should be trained to respect women’s feelings as well as charts and protocols.
LikeLike
Ha – I don’t get why it’s routine to check dilation prior to pushing either. It’s involuntary in a natural labour. My wonderful mother, a retired RN, is the only person I snapped at during my labour. She panicked and said “Pant, don’t push!”. I growled/grunted “I’M PUSHING!”. I couldn’t NOT push. I don’t remember the urge being so strong with my daughter. He was a little wheezy and molded from his fast descent, but I was fine, no tears and only a couple of scratches which I think came from his nuchal hand.
LikeLike
Hi — Yes, you are right that the urge to push is usually normal and involuntary. It just happens! (Although not always…) I know that the reason given for such a vaginal check is that if a woman feels the urge to push but there is still a cervical “lip” that pushing against the lip can make it swell. This can cause it to take longer to dilate fully and/or lead to tears (I’ve heard this, though I don’t know about the science of this). In my third labor, my son’s head was tilted and I did have a cervical lip while simultaneously feeling the urge to push. Whereas in my first two labors the urge to push was a great relief, in this third labor the time when I had the cervical lip AND my uterus was pushing involuntarily (because I was trying to pant through the pushes) was excruciatingly painful. 🙂 Once the lip was gone, the feeling of relief came. That said, I do not believe that this justifies vaginal exams when a woman gets the urge to push. This still seems like an area in which women should have as much autonomy as possible. For some women, a check at this time is helpful. For others, it is not at all.
LikeLike
Yes, I’ve heard about cervical lips, and I don’t have experience of them as you do because in three labours I’ve never had one. Here in New Zealand though, it’s not usual to check for full dilation before pushing. At least, it didn’t happen to me even with a very meddly midwife who wanted to break my waters and check me against my wishes, and from the accounts of others it’s not the norm. I imagine you’re likely to be checked at full dilation if you have an OB managed delivery, but here most women go with midwives.
LikeLike
This seems like a fantastic way to think about it – knowing a number won’t tell me anything useful about what’s to come, or how far the labor has really progressed, and it seems like it would just be distracting! Excited to talk to my doc about this tomorrow at my 32 week appointment!
LikeLike
I am a healthy 22 year old, I gave birth to my son on April 2, 2012. I was 39 weeks when he was born. At 36 weeks my Doctor gave me a cervix exam. This was very painful and I tried scooting up on the examining table to get away from her, she tolde me that the actual child birth was going to be a thousand times worse. I skipped my 37 week appointment because I was too scared of the cervix exam that I was scheduled for. At 38 weeks I showed up for my appointment but told the nurse straight out I did not want a cervix exam. None the less she gave me a robe and told me to strip and that they had to perform an exam. When the docto arrived I was still fully clothed. I told her I did not want an exam since it was not nessecary. I had done research on the topic. Whether I was 1cm or 4cm, no one would know when I would go into labor. Well the doctor did not take this well. She said that if anything went wrong in the pregnancy it would be my fault. She checked my fundal height with a measuring tape and after I asked her what the measurement was, she refused to tell me the height. I asked her again and she plainly said the size was normal, she did not answer my question. She stepped out of the room without a bye or another sort of acknowledgment. She made me feel guilty but I knew I had done the best by standing my ground. I went into labor at 39 weeks, when I was admitted to the hospital they checked my cervix without my consent. The nurse just slipped her fingers, once again the pain was unbearable. I asked how many cm. I was and she refused to tell me. Her excuse was that she did not want to get my hopes up. The nurse us that inwas 4cm only after my mom demanded to know. Quite ironic that they check but then don’t want to say how many cm. since they know the number does not prove anything. At the delivery room they proceeded to check me again, I was in to much pain to refuse. I had my heart set on having a drug free birth. I felt it was time to push but they told me to hold it since the doctor had not arrived. When she got there she proceeded to check my cervix again only to find that I was 10cm, this was the worst pain ever. I was in the middle of an enormous contraction and she had her hand up my vagina. Thinking about it later on, I believe this is how women that get rapped feel like. I was not able to defend myself. I kept telling her to stop, to stop it already. I had known I was ready, there was no point for another check. After 4 pushes, my son arrived. The pain of the cervical check while having a contraction was worse than the whole birthing process. I had gone to the hospital at 10:30am and delivered my son at 1:45. Everything went perfect except for the nurses and doctors that kept violating and disrespecting my body and the birth of my first child. Next time I will not let them treat me like that.
LikeLike