Dec 142012

“Oh, I forgot to mention, you might bleed or go into labor tonight because I just stripped your membranes.” – OB to mother after a prenatal appointment that included a vaginal exam.

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  62 Responses to ““Oh, I Forgot To Mention, You Might Bleed Or Go Into Labor Tonight…””

  1. So the doctor performs a procedure without consent and then gives the side effects of said procedure as an after thought? How professional!/ sarcasm

  2. Not my submission, but this happened to me with my first baby. It led to all sorts of interventions and I narrowly avoided a c-section. Nightmare. I’m so sorry, OP!

    • I know a woman who bled like a period for 24 hours after a 37-week vaginal exam. The practice refused to admit they’d stripped her membranes. I counseled her not to consent to any further VEs. She and her husband went there and looked furious and intimidating for the next appt and refused VEs. The doctor finally admitted that the standard weekly vaginal exams in the last four weeks give no useful information.

      But they denied up down and sideways that the doctor had stripped her membranes.

      • Have you ever considered the fact that maybe he didn’t? Bleeding in late pregnancy can have other origins then doctors and fetal loss. There is so much pressure in the area it could have been any number of things giving out and bleeding, after all we accept a small amount of blood as a sign that labor is about to begin even without anybodies intervention. I just don’t see the point in assuming, that guy had to be lying.

        • The doctor performed a painful VE and then she bled for 24 hours at the same kind of flow as on a heavy day of her period. And information I didn’t mention above, she never experienced bleeding like that after any other vaginal exams, and she didn’t experience any other bleeding at all during three pregnancies. It’s the aberration that’s the problem, not just the single incident.

          While I agree that positive corellation doesn’t necessarily indicate causality, it’s far, far harder to believe she spontaneously bled like that for 24 hours and it just happened by weird coincidence to be after a very painful VE.

          • Unless the bleeding was from a lesion on the cervix. If he burst it, then she would be in a great deal of pain and bleeding very heavily until it closed. The problem is that there are so many explanations that are valid. Why jump to the worst?

          • How hard would it have been to explain that to her? And wouldn’t it have been obvious when the OB pulled out her hand and found blood all over the gloves? Instead, bleeding started afterward, and whenever she called the office, she was told repeatedly, “No, this is perfectly normal. It happens to every woman after a cervical exam.”

            The lack of transparency and the inability to offer a coherent explanation (not to mention the outrageous lie that every woman bleeds like a period after a cervical exam) is why we settled on the stripping-the-membranes conclusion.

            I think the worst possible explanation, though, would be that the doctor was incompetent at doing VEs and causes every woman to bleed like a period for twenty-four hours after every exam, though. When you think about it, the explanation the office offered was actually worse than what we think happened. ;-)

  3. Informed consent is for pussies. *harhar*

    • Also, purely out of curiosity, how frequently are VEs typically performed in pregnancy, say, in the US/Canada, in the past 10-20 years?

      I haven’t even been offered one yet in 7 visits (I’m 29 weeks)– let alone have it an assumed part of a visit– and plan on declining them even in labor unless there’s a really pressing need or concern*. If I had to guess, it seems like most women get them weekly or biweekly, starting at, what? 36 weeks? Or is that not accurate? Sooner? Later? How often do women typically get them in labor?

      *My HB CNMs are super-cool about informed consent and IIRC, don’t even offer VEs more than once or twice during labor… maybe they offer around 40+ weeks as well? But knowing them, they will have no problem if I tell them up-front no VEs unless absolutely necessary. They have had no problem with my completely declining doppler (just started using a fetoscope @ ~22 weeks) and weight checks throughout pregnancy, even though those things are fairly standard for them.

      • I was under the impression that they are standard starting at 37 weeks. I believe that VE are performed earlier than 37 weeks if the patient is showing signs of early labor, or if there are complications that might necessitate an induction prior to 37 weeks.

        Btw, I live in WA state. I had my daughter at a freestanding birth center with a midwife. She offers VE starting at 37 weeks, but only if I’m okay with it. I had a VE at my 37 week appt, and went into labor before my next appt.

        The only VE I had in labor was after I had been pushing for a while with no progress. [I think she wanted to rule out a cervical lip. Everything was fine.]

        Next time I’m pregnant, I’m going to refuse the routine VE prior to labor.

      • I just had one ‘offered’ to me for the first time at my 35 week appointment (Dr. was quite perturbed by my refusal… wonder why I would do such a thing??), so I’m thinking you’re right that they start offering around 36 weeks as standard procedure.

        (Slightly OT– still trying to figure out how to avoid the check-in cervical checks at the hospital and still get checked in… Same Dr. told me that they won’t check you in at this hospital without confirming that you are truly in labor through 2 CEs. Because *of course* there is NO other way to determine if a woman is in labor, none.)

        • That’s terribly frustrating! It would be nice to tell you it’s your right to decline, etc., and it is, but IDK what I’d do in your situation. Hm.

          • I know it is… trust an [insert corporation name here] hospital to get around informed consent however they can. At this point I’m wondering if I’ll have to just camp out in the parking lot until he’s crowning or something… ><

            VEs and CEs are pretty traumatic for me under the most understanding and gentle of circumstances. I am NOT consenting to them during labor because it *will* stall me out. (Which would render their 'just 2 checks' idea useless anyway… I would either show no change or show regression, leading them to send me home since I'm 'not really in labor'.)

            I don't know if suggesting the couple different ways to measure labor progress that I'm aware of would be more helpful or hurtful in this situation. (the distance between xiphoid process and fundus during a contraction and the length of purple line extending from natal cleft are the two I'm thinking of here)

          • I gotta be honest with you– I think they’d laugh at you or look at you like you had two heads if you suggested either.

            I think (?) the best option might be for you (or more likely, your birth partner, as you probably won’t be in the right state) say in as nice yet as firm a way as possible, “I know you like to do an internal exam upon admission, but I’m afraid I do not/she will not consent to that. If there is any additional information we can provide to you, we will be happy to.” All with a big, understanding smile and lather, rinse, repeat as necessary. “I’m sorry, but that won’t be possible. We can wait here in the lobby/etc. until I am/she is pushing, if you prefer.” IDK– just throwing that out there.

          • That’s kinda what I would expect too. :/

            Also, I like your idea better than the parking lot– I’m due in January… the parking lot will probably be pretty cold. :) Husband is incredibly stubborn when he wants to be, so I don’t think he’ll have a problem repeating himself over and over if I can’t.

          • (((Laura)))

            Best of luck– I’ll be rooting for you!

          • I’d also suggest wearing something they can’t get past w/o you actively participating (ie pants or really long skirt) so they can’t just come in and try to do one while you sit there in shock.

          • Oh definitely! (I really hope no one tries anything like that at any point in my labor, because while I very well might sit there in shock, husband has NO qualms about returning what he considers physical violence with physical violence of his own… I don’t want anyone to get hurt and definitely don’t want him to end up in jail/custody!)

          • Have you been able to have a conversation with your care provider, gently explaining that VE are traumatic for you, and is there any way that they can be almost entirely avoided? If your doctor is supportive (or even just grudgingly agrees), the nurses might be more accepting of your refusal. You don’t want to spend your laboring energy fighting with hospital staff.

          • That is a deceptively complex question for me… Short story: yes, I’ve explained my issues with anxiety in general and with VEs to the two different doctors I’ve seen thus far. The one doctor was totally supportive and didn’t seem to have a problem with my avoiding them altogether. Second doctor was the one who was really put out that I was declining and told me about the hospital policy… She also didn’t seem to take my anxiety very seriously. I don’t even know if I believe her at this point about whether it’s a hard-and-fast rule in the hospital or not. She may have just wanted me to think it was. ><

            You are right, I absolutely do NOT want to waste my labor energy fighting with hospital staff. Here's hoping that third doctor (whoever that ends up being) is more like first doctor, and I have some extra support.

            Also, I completely and utterly agree with what Jane said below about hospitals needing to 'find a way' (as though they don't already exist!) to establish labor without internal exams.

        • I think it’s okay to ask the L&D nurses if they really feel they’re in a legally defensible position if they turn away a woman in labor because she refused a procedure. In fact, I think it might be worth talking to the hospital in advance and obtaining a copy of the patient bill of rights (it should be available on their website) and bring a copy of it with you with the part highlighted where it says patients may refuse any procedure they don’t want.

          AND if you can find it on your state government website, a copy of the legal regulation stating that if a hospital accepts medicaid funding, they cannot turn away a woman in labor.

          If they insist on not admitting you until they do a cervical check, then tell them that’s fine — they can process the admitting paperwork after you’ve given birth. They do that ALL the time, and often they will let a patient labor for a while before they even start doing the admission paperwork, just to be sure she’s in an established labor pattern.

          • Easiest defense in the world, prove they knew she was in labor. They didn’t turn away a women in labor, they turned away a pregnant women who was for all they know not in labor. She wouldn’t let them check to see if she was in labor, so they didn’t know.

          • THen the system is irreparably broken if an entire labor and delivery unit cannot verify labor without sticking their fingers into a woman who has refused consent.

            If my homebirth midwife was able to verify an established labor pattern without doing any VEs, then surely an entire L&D unit can figure out some way of doing the same. Women who’ve experienced rape or abuse often find vaginal exams to be very traumatizing, and there must be a way to accommodate their needs.

            BTW, I hope you did well on your exams! Are you all clear until next semester now?

          • Oh, and this occurred to me. Oftentimes, ma lp ra ct ice decisions are in the hands of a jury, no? So it would only take an emotional jury and a tearful woman on the stand to convince the jury that the L&D nurses should have accepted the existence of regular painful contracations as proof of established labor. The woman would only have to sob that she couldn’t bear the trauma of having fingers stuck inside her after her previous past traumas, and the jury would rule in the mom’s favor.

            The hospital might be able to defend itself to the state etc, but if it actually went to the courts, or the media, it would be a totally different story. My money would be on the woman taking the day and the hospital getting a black eye after that got out.

            But really, the issue is that L&D units need to learn how to establish labor without internal exams because of the high numbers of women who’ve suffered some kind of sexual trauma.

          • Then you are right, the system is incredible broken. The law shouldn’t be based on random strangers feelings. I don’t want people deciding if something is legal or not based on how they feel about an issue. I have a feeling you don’t either, after all loads of people feel you abuse your children if you birth at home or don’t vaccinate.

          • Que truth. :-) (To quote El Bloombito.) I’ve heard about ju r i e s awarding tremendous settlements and admitting afterward that they knew the doctor wasn’t in the wrong, but “If I were in that situation, I’d need some money.” Um…. Yuck. Then everyone loses in the long run.

            What I wish is that there were two kinds of m a l pr a c t i c e cases: one being m-practice with intent to harm and one being “mistake.” Awards should be capped in the mistake category because, well, these things do happen and every treatment comes with a risk factor — and in the case of intent to harm, the penalties should involve jail time, as any other c r i m i n a l case would incur.

          • Are the moderators filtering the m, j, and c words? :/

          • I’ve had problems with comments that involve l egal terminology, so I was being proactive. I’m not sure what the trigger words are.

          • actually, the case would probably never even reach a jury, or a trial. 99 of 100 cases settle, and hospitals in particular are eager to avoid a costly trial and a potential runaway jury award.

          • Goldilocks’ response was that the hospital would say the woman wasn’t actually in labor, so that’s where I was coming from. Most likely there’d be a brush-off of the woman’s complaint.

            Come to think of it, though, isn’t the thing about not turning away a woman in labor a federal statute? And the hospital could stand to lose medicaid funding? So they’d have to fight it because not fighting it would be tantamount to saying yes, they turned away a woman in labor.

            I am not a law yer. I’m kind of glad I’m not. This stuff makes my head spin. :-D

          • Well, they wouldn’t have to fight it, because settling a lawsuit is not an admission of wrongdoing, legally speaking. An if someone did file a lawsuit, determining whether she was in labor is a question of fact, not law, so it most likely would not be dismissed right from the get go, even if the hospital raises Goldilocks’ point. OK, that’s the end of my little legal lesson, I promise! :-)

          • But how would one file a complaint if a hospital really did send away a woman in active labor?

        • I too am going to try and avoid that check to see if I am “truly” in labor. While VEs were uncomfortable for me before they downright terrify me now. My OB told me that I HAD to get one at every appointment after 37 weeks when I refused and then lied and said that ACOG required it. I now have such a fear of VEs as I now associate them with being violated.

          • I think it’s fine to request a written copy of whatever law or regulation the doctor/hospital says YOU are violating.

            And if the doctor says you’re in violation of ACOG regulations, what is ACOG going to do? Revoke your membership? :-) Whereas I bet the doctor is in violation of ACOG guidelines in so many ways (early induction, episiotomy rate, repeat C guidelines, etc) but somehow you the patient “need” to consent to VEs?

            I’m sorry that happened to you. That’s so disgusting.

      • My OB practice only does them once when you go to your first appointment (to make sure your cervix is closed, so I was told) and when you check into the hospital in labor to “make sure you are really in labor and can stay”. they only do the one check at the hospital though, not two. The only other time I had one during labor was to check that i was at 10 before I started pushing. My practice is very hands off- and they even said that checking for dilation in the last weeks of pregnancy is totally useless because it predicts nothing. In fact, the doctor who delivered DS told me he’s seen patients walking around at 3-4 cm for weeks, and patients who were closed up tight and gave birth the next day, which is why they stopped checking. That seems to be the minority opinion though- all my friends who’ve had kids got a VE every week starting around 36 weeks.

        • I’m in NJ btw, if that’s relevant.

          • That’s pretty great– and especially impressive in NJ, which has one of the highest C/S rates (and presumably intervention rates) in the country. I am almost certain NJ is in the top 5.

          • Yeah, the hospital I delivered at supposedly has one of the worst c-section rates too and is thought of as a baby factory by people around here. Of course I didn’t know this at the time… but I’ll probably still go there for the next one because I like my OB group and that is where they deliver.

          • I think that we might have the same doctor. Are you willing to say what county you are in?

        • I was pretty lucky at my practice: they didn’t do VEs late in pregnancy unless the client reported discomfort that suggested a baby contemplating emergence–except of course for Doctor Eeyore, who insisted on using the dildocam on fat women.

        • Yeah, I was at 4 cm for four weeks with my last. Well, no I wasn’t, I was at 5 cm the last couple weeks!

          LOL. Gotta love those predictors.

      • I had a routine pap & exam at 6 or 8 weeks, then at week 39 (on my birthday, no less), I got my first & only pre-natal VE. She said I was maybe 1″ & nothing was likely to happen for another week or so. So of course I spent all of the next day (Xmas Eve) in labor & had my beautiful baby girl Christmas morning. The the dr arrived, she smiled and said, “Well, who thought we’d be here this morning?” (And no, the dr did not strip my membranes.) I live on the coast of BC.

  4. This happened to a friend of mine right after she said do not do it! She was 17 and was really informed with her birth., andtandthis was the only intervention. She is having trouble with it because she really wanted zero interventions, and everyone tells her it’s no big deal. It IS a big deal! And it physically hurt her and made her cramp for hours before real contractions started.

  5. Can you repeat that to my lawyer? Here (tn) they want to do ve’s every week from 36 weeks on and strongly encourage induction at 38 weeks.

    • Induction at 38 weeks?! Why? What the hell could be the rationale for forcing nearly every baby born in Tennessee to be born prematurely? That’s insane! (Any professional feeling the urge to chide me on my tone, this is what your tone should be! Seriously, what the HELL?)

      • The doc told me *nobody*goes into labor naturally anymore so they *have* to induce me and it’s dangerous to go past 40 weeks so they induce at 38 weeks since there’s no reason to wait. Went on to tell me if I didn’t agree to induction by 41 weeks they’d have my “husband” consent for me. (i’m not married) I went onto labor naturally at 37.5 weeks.

        • And exactly how were they planning to incapacitate you so that your husband would be in a position to give consent for you?! Mind-boggling.

          • As I’m not married, my fiancee has no legal medical control and known not to cross me since we were 15, so I’d love to know the doc’s thought process.

          • dude, if my husband were to be asked he would never go against my wishes

        • Wow. Just wow.

          Apparently, in his opinion, the human race is so damaged, it can’t reproduce on it’s own? Maybe it’s just Americans, cause last time I checked, plenty of women go into labour naturally in other countries.

        • Semi-related story: When I was seeking out a tubal ligation, my doctor flat out refused me, told me I couldn’t make that decision without my husband consenting. I wasn’t married. I told him so, and he said, “Well you’d have to go get married and come back with his permission so I could do this.”

          It boggles the mind.

    • can they talk to the march of dimes ad on my radio that says “wait to go into labor naturally, until at least 39 weeks!”

  6. A friend of mine had her membranes stripped at a checkup without consent and the doctor didn’t even tell her. Later that evening, their second daughter was born in their hallway and the paramedic caught her. Funny enough, the whole reason they didn’t have a planned home birth in the first place was because her husband didn’t think they could be ready for it. #3 was a planned, successful home birth.

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