The Sacred Cow of Modern Pregnancy Care: Routine Cervical Exams

I've been meaning to write on this topic for so long that, as usual, someone else got there before me! Thankfully she did a top-notch job, so check it out!

Cervical Exams: Who Needs Them?

(If you haven't subscribed to her blog yet, do! It's been great so far, and Stephanie is a superb midwife and wonderful thinker. She has great stuff to say.)

Anyhow, back to the topic - routine cervical exams.

Cervical exams are so much a part of routine pregnancy management nowadays that women don't really think to question them. I know that I didn't. When we were on our way to our first visit with our midwife, I remember telling my husband that I was sure our midwife would do a vaginal exam along with the visit. Why? Because "that's just what you do."

(Not that I have anything against needed vaginal exams. I remember telling my mother when I was a young teen that I would gladly die of cancer rather than submit to a vaginal exam, but when that time rolled around I didn't find it that big of a deal - when needed, that is.)

After that first visit (no vaginal exam), my pregnancy progressed (to my utmost surprise) without any vaginal exams whatsoever. When I finally broached the subject with my midwife, she gave the surprising response: "It doesn't serve any purpose or tell me anything worth knowing, so I don't do them unless there is a reason to do so." Wow! What a world-changing statement! Talk about shooting down sacred cows!

During labor, it was the same thing - my midwife told me that she would do vaginal exams only if something appeared to be amiss or if I particularly requested it. When I was in active labor, I repeatedly asked "Are we almost done yet?" and she would reply "You'll be done soon, but if you want numbers then I'll have to check. Do you want me to check?" And I would think about it and decide that I would not be able to handle things emotionally if the news was "bad," so I refused the checks (thank goodness!). During that first labor, I had only one check. During my next labor with our last-born, I had no checks whatsoever, bringing my grand total of pregnancy/labor checks to one.

Cervical checks during the last weeks of pregnancy do not serve any good purpose (a ripe cervix does not necessarily portend either a fast labor or an impending labor), and I believe that routine cervical checks during labor can be actively harmful. Why?

(1) If the membranes have ruptured, cervical checks increase the likelihood of infection.

(2) They put the mother "on the clock" if she is birthing in-hospital.

(3) They are uncomfortable (read: excruciating, if done during a contraction), disturb a mother's concentration (which is vitally important), require (usually) a prone position, and can be embarrassing/humiliating when done by strangers or in front of strangers.

(4) They are unnecessary - a good care provider can tell if labor is progressing by using external signs. Here are some signs that labor is progressing: vomiting, confusion, loss of modesty, inability to talk, "I can't do this anymore" statements, the "birth smell", disorientation, change in vocalizations, etc.

(5) Most of all - they are a major source of discouragement, i.e. "What do you MEAN I've been laboring for X hours and I'm only at 3 cm?????" I can't count the number of times that I've read some variation of the following: "I wanted to know how far I had gotten, so I asked the nurse to check me and I couldn't believe I was only at X centimeters, so I got the epidural because I couldn't take it anymore." Listen - labor is HARD. Very hard. It is vital not to invite discouragement during this intense process. If I had been told "2 centimeters" or something like that when I was in that much pain, I don't know if I could have taken it. If I had been birthing in-hospital, I definitely couldn't have kept going. But being told repeatedly - "You are doing fine, your labor is going well, and you are doing a great job" - WITHOUT a number being attached to that - was incredibly heartening and was one of the only things that enabled me to make it through. In fact, it was so helpful NOT to know my dilation that I wrote it into my second birth plan - "If you need to check me, please do NOT tell me my dilation unless it is medically necessary that I should know." I really think that women would do better in labor if cervical checks were reserved for times when it became obvious that something was wrong, rather than just being a part of routine labor management.

Anyhow, I could keep writing for ages, but I will just say - read the article! Stephanie has said it all so beautifully, and I whole-heartedly agree with everything she wrote. Read it, love it, send it to every pregnant woman you know.

(As usual, this is really an issue of mother-preference. Some mamas love cervical checks and want to know every inch of progress, from pre-labor to birth - they find it energizing. If that's the case, great! But it shouldn't be forced upon women, and I definitely question its use as a routine part of pregnancy/birth care.)

Birth Story with Pictures - Lovely

This is one of the sweetest birth stories I've read:

Nella Cordelia: A Birth Story

A great and honest telling of the entrance into the world of a very precious and special little one. What a blessing that this mama has taken the time to share her story with the world.

As a side note, this is some of the best photography I've ever seen in a birth story!

Definitely take the time to read this one!

Thanks to Dou-la-la for posting this!

Interview with a Doula

Check this out! This is one of my amazing, wonderful, superb doulas, Rose Day:

A Hand to Hold Through Labor and Birth

A brief snippet:

“I come as soon as the mom wants me, whether that’s at home with early contractions or at the hospital,” says Rose Day, a birth doula and doula trainer for Nurturing Hearts Birth Services (azdoulas.com). “After the birth, lots of moms say they couldn’t have done it without me. I don’t believe that. They could. But the feeling of having been supported, of having someone there to take care of you and make sure you have what you want makes all the difference in a birth experience.”

"Studies show that constant support from a doula increases the mom’s chances of having a natural birth, but doulas are trained to provide support for any type of birth situation, including a scheduled Cesarean.

“Many times I work as much with dad or grandma as I do mom,” says Day. “I have different roles at every birth. It’s nice for dad because if I’m there he doesn’t have to worry about remembering everything from the childbirth class or feeling responsible for what’s going on when he’s never been through it before.”

Doulas a wonderful things to have, and Rose is one of the best. If you're in the area, give her a call! If you're not in the area, get someone else - but don't birth without one! Doulas are amazing women, and birth is so much better with their help!!

Another Hyperemesis Story

Cross-posted from my hyperemesis (severe morning sickness) blog:

Check out this mother's hyperemesis story!

Hyperemesis Gravidarum (HG): A Pregnancy Disease About Which Little is Understood

Hurray for correct grammar, LOL!!

At this time, I only know of four HG blogs in existence, though there are probably more. Lots of mamas have their HG-stories or blog-records of their HG-pregnancies on their personal blogs - like this story - but these stories are a lot harder to find, though they are much more plentiful.

It's always good to get HG stories out there!

VBAC in Local News!

This is more on the story of Joy Szabo (who, being threatened with a court-ordered cesarean in her home-town hospital, temporarily moved here to Phoenix for a VBAC), and I thought it was pretty cool that I knew two of the people in the newscast! Sally Stevens, Joy's doula and leader of our local ICAN chapter, and my OB Dr. Brass-Jones, are both interviewed here:

Joy Szabo Interview

I actually had no idea that Dr. Brass was Joy's OB - what a fun connection, and what a neat thing for Dr. Brass!

New HG Blog: This is Awesome!

Cross-posted from my morning sickness blog:

Okay, folks! Announcing the newest Hyperemesis Gravidarum (HG) blog!! This is really awesome!

Baby, You're Making Me Sick!

You can read her HG story, read about the various remedies she tried, and even see a video of her PICC line being put in (having an extremely weak stomach, I lasted about 10 seconds into the video).

It's so awesome to have another HG blog out there! Thank you!

Nursing in Public, Episode I: The Church Nursing Room

Okay, I'll have to admit it. I don't get it. What's up?

Here's the situation: Our church has a nursing room, directly off the sanctuary, where mamas can go to nurse infants. It's entirely enclosed, no windows, darkened, with a TV screen of the pastor speaking. There's even a sign that says "Since this room is for women and infants, no men are allowed in this room." Thus, we have a private, low-light, women-and-babies-only nursing situation.

But what do I find?

I find that women, even in these circumstances, take the time to elaborately cover themselves with nursing covers before they are willing to nurse. Baby is screaming, mama is stressed - but they won't nurse until they've swathed themselves in the heavy folds of their nursing covers.

What gives?

I mean, seriously! It's ALL WOMEN. There are no men present, and not even any children. (Not that I'd object to that, but some would.) So WHY? Do they think other women are going to be grossed out by their breast-feeding? ("I'm sitting here breastfeeding my baby, but if I see another baby nursing I'll puke!") Are they that modest that they can't show one inch of skin to nurse a baby?

I find it puzzling. All the more so because, statistically, I know that most of these women are hospital-birthers, meaning that they have undergone demeaning and immodest procedures and situations that I would never wish on anyone - such as nudity before multiple complete strangers, vaginal exams by multiple complete strangers, birth in the lithotomy position before complete strangers.... and yet they cannot possibly nurse in front of other women without being completely covered. Can I say that this is a little strange?

I'm not an "in-your-face" nurser, but I don't cover myself completely. It's an unnecessary pain in the neck! But I find myself worrying and feeling self-conscious about nursing normally when surrounded by nursing-cover moms. "Are they thinking I'm weird? Are they grossed out by the sight of me breastfeeding? Are they going to talk about me when I leave?" All my insecurities come out in the nursing room.

This past week I finally saw one woman nurse who only partially covered herself with a blanket. I could have kissed her in gratitude - I felt an immediate sisterhood. :)

Weird stuff.... Thoughts, anyone?