It got me to thinking about a birth that I attended over the winter at a local very urban teaching hospital, where people who call themselves midwives practice. Like the mother I will tell you about, many of the women who choose to birth with the midwives there are lured in because the hospital offers the option of water BIRTH not just laboring in the water. I have YET to see or hear of the tub actually making it out of the closet, even when plenty of time and healthy babies present themselves. The mother had gone that day for her 37 week visit, and the midwife had asked the nurse to set up for a vaginal exam. This was not the midwife the woman usually saw, so she was less comfortable asking questions before the procedure, and frankly, she was eager to find out (even though she knew that it wasn’t at all indicative of when she’d have the baby) how “far” she was.
When she called me later, it was to ask me about bleeding, and to tell me that she had just had the most violent vaginal exam she could remember, ever, I asked her if the midwife told her she was going to, or asked her permission (*gasp*) to “strip her membranes.” She said no, that nothing of the sort had been mentioned. The midwife had only said that she was nearly two centimeters dilated, and that she was soft and getting thin.
Let me tell you, Friends: MOST practitioners who routinely do vaginal exams have started to strip membranes at 37 or 38 weeks, routinely, as well. And I have yet to hear of a practitioner who asked permission to do this potentially infection causing and water breaking procedure. They are reaching a finger through the cervix, into the opening to the uterus. When they get there, they are separating the amniotic sac from the uterus as far up as they can reach with their finger, which releases prostiglandins, making it more likely that you will go into labor on average up to ten days sooner than you would otherwise.
Why, you might ask, is having a baby ten days sooner than they would otherwise have been born a bad thing? Well, Friends, you may be forgetting that your babies each cook at their own individual rate, so to speak. Every single human in this world is different. We have different eyes, different finger prints, our femurs and our toes are all different lengths. So are the lengths of our gestation. They are individualized to our own specific needs. So, when that is fast forwarded, do you think that it may increase the number of babies in the Special Care nursery because they are not breathing correctly, or are having other issues?
Also, there is the danger of infection (germs don’t travel up into the uterus unless they are pushed there, a finger going up there is definitely a risk factor for uterine or blood infections…blood infections because after the placenta is birthed you have a dinner plate sized wound wide open for germs to invade). This can cause bad things to happen, all the way up to still birth. Is that worth having the baby early? Wouldn’t be to me.
This particular Mama, who started my story, actually went into labor that night, and had her baby vaginally (she got there pushing—which wasn’t the plan, as she wanted a water birth, and needed time to fill the tub once she got ther—she had a fast birth). She had hoped for a low intervention experience, which is one of the reasons she chose midwives. Apparently that wasn’t the case. Even though she got there pushing, the vaginal exam earlier that day had been the biggest intervention in the whole labor and birth…it started labor before she was ready. I say this because if she had been ready to give birth, she would already have been in labor, and wouldn’t have needed stripped membranes to do it for her.
Other risks involved could have been a cesarean section, or an instrumental birth. Why? Because when you try to force your body into labor before it was ready to go into labor, you not have completed the processes you needed to complete to let the baby pass through the pelvis. For instance, you release a HUGE amount of relaxin (the hormone that causes your joints to get all gooey and loose…and your pelvis is full of joints) in your third trimester, but especially at the very end, when you are gearing up to go into labor. If you haven’t released this last big burst of relaxin you may not have left your baby the room it needs to pass through the pelvis. So, you may mostly dilate but the baby truly cannot get through the pelvis. Does this mean that NO baby can ever get through your pelvis? Nope. Not at all. It means that if you (and your care provider) had let the baby come when the BABY and your BODY were ready for labor, as opposed to the care provider’s timeline, the strong likelihood is that you would have had a vaginal birth.
Notice I mention that YOU could have let the baby come on it’s own timeline? I am not placing blame, per se. I am, however, positing that you can and SHOULD take active part in the care you receive during your pregnancy, labor, and birth. If there is no real reason (and there hardly ever is) that you need to do a vaginal exam to check your cervix at the end of pregnancy, why let your care provider do it? If it’s cause you’re scared to say “No, thank you, I’ve decided against that.” you need to do some self talk and grow some courage. This isn’t just YOUR birth we’re talking about, it’s your baby’s too. If you and your care provider let your baby come on your baby’s own timeline, especially in a hospital environment, it will mean that they are more likely to stay with you in the immediate post partum period. Because they will be READY for the stresses of labor and birth and life on the outside, they will better be able to respond in an appropriate manner.
So…if and when your care provider sends staff in to hand you the dreaded paper drape and tell you to disrobe from the waist down, think before you blindly do so. Consider just saying, “No thank you.” OR at the very least, ask some pointed questions. Ask about the risk, ask for studies to back it up. Make sure to talk to your practitioner before they do the exam and make sure that if you decide to go ahead with the exam but want to refuse to have your membranes stripped, they document that you refused consent to having your membranes stripped in your chart. A gentle vaginal exam should not be tortuous. It should NOT cause you to bleed large amounts. If those things happen, it is very likely that you had your membranes stripped without your permission.
Membrane stripping is a procedure, and as such, you should give fully informed consent before having that procedure done. That practitioners are doing so without patient’s knowledge, let alone consent, is really criminal, especially with the possible side effects of ruptured membranes and/or infection and babies being born before they were ready and suffering for it in the post partum period.
So, at the end of your pregnancy, please, knowing that having that vaginal exam tells you exactly nothing but where you are at that very moment, please consider whether having your membranes stripped without your knowledge is worth the exam. And act accordingly.