Can you REALLY birth without having a Vaginal Exam?

Doula in Edmonton
Ha! So true Forrest Gump…

So I’ve gotta say, vaginal exams SUCK. I’ve experienced them myself and I’ve watched the clients I support as an Edmonton doula struggle through them countless amounts of times. However, most of us Edmonton mama’s just accept the uncomfortable pain because they are very important. After all they tell you how far dilated you are! Because… dilation will tell you how much longer you’ll be in labour for right? Sorry friend, there’s no way of predicting how much longer you’ll be in labour for.

But what if I told you that you could actually have a baby without getting ANY vaginal exams? That before medical advances birthers had no vaginal exams and managed to get a baby out? That scientifically, there is ZERO evidence that shows better birth outcomes with more vaginal exams? Many people are never told this and many care providers spin this part of birth so that women think that this info (dilation, effecement) is useful and necessary. I’m here to tell you today that it’s not.

I recently took a Spinning Babies course and it was life-changing as a doula in Edmonton.  One of the issues with offering birth doula services is that I am not trained or able to do a vaginal exam. Before taking this course this used to frustrate me so much as I felt like I couldn’t truly help a woman without knowing exactly where she was in her labour. After the course, I learned many valuable lessons that I will take with me to every birth I support! Number 1 – If anything would matter about a vaginal exam, it would be if the care provider could tell the baby’s position and/or station. Dilation and effacement are not steady or predictable variables during labour… eeeeevery birth person opens and thins at her own rate. However, if you knew what position a baby was in you could help the birther to position her body better for her pelvis to open. You could also guess by how far up or down the baby’s presenting part is as to which part of her birth canal is preventing progress. Such an important thing!

So after learning how valuable knowing baby’s position and station came lesson Number 2 – you don’t need a VE to determine these two things! It was almost unfortunate for me to hear originally how important station and position were, so I asked the question “as an Edmonton doula on her own with a birthing couple, how do we know?”. The answer: look at what the birther’s body is telling you. Is the contraction pattern steady? Is it consistent? Is she having pain, and where? The reason that birth happened prior to our medical system is because as birth supporters we can intuitively tell what stage the birth person is at just by being with her (or in contact with her). At the very least, as a birth doula I can keep the mom at home (without the presence of warning signs of trouble) to cope and allow baby to come down naturally and easily. THIS was probably the greatest take-away from the Spinning Babies workshop I took.

The last valuable lesson came from a birth I was at with a midwife at home. This lesson, Number 3 – not all women will be fully dilated when their body begins fetal expulsion (pushing). Known as the early urge to push, many women feel “grunty” or “pushy” before their body is ready to push. So should they be? There’s hardly any evidence about adverse outcomes but the small research that has been done has linked no adverse outcomes to women who do push early (you’ll likely hear things like swollen cervix, damaged cervix, exhaustion, etc. as reasons why you should not push before you are dilated). So crazy enough, if we feel the urge to push early, we are usually told to wait until we achieve some random measurement of one of the organs at play instead of listening to what our body tells us!

Is your mind blasted?? So was mine when I began to learn all of these things! It’s pretty exciting to hear that enduring vaginal exams is not necessary. VE’s are yet another choice you have to make while you are in labour (notice how I say YOU, birthing person, and no one else). For some, the comfort of knowing how far along they have gotten provides a sense of relief. It can be very exciting to hear of progress, but it can also be disheartening if you haven’t gotten as far as you thought you have. It’s so important to know yourself, know how you’ll react to the information you hear, and also to know that those measurements are tricky little buggers! If you want to hear your dilation, effacement, station with an open mind, then a VE wouldn’t be a bad idea. It’s like with anything else in childbirth – educate, prepare for all scenarios, and let the process take over.

How many vaginal exams did you have in labour? Did you hate them, or not mind them too much?

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