Dec 172012

“You have to consent to a vaginal exam and if you go anywhere else they will say the same thing.” – OB to mother at 38 week prenatal appointment, when the mother declined a routine cervical exam.

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  59 Responses to ““You Have To Consent To A Vaginal Exam…””

  1. Yes, yes! You have to consent to a vaginal exam if you want one, to allow them to do it. Because if you don’t consent they can not do it. So technically it’s right… but I don’t think he meant it that way. :P Forced consent is NOT consent!

    • All this bullying and lying about cervical checks, vaginal exams, transvaginal ultrasounds, STD checks, stripping membranes etc. bugs the hell out of me. Don’t get me wrong, I’m not against examinations per se, because they can be helpful when indicated, but it’s a choice you can opt out of (unless seriously medically indicated, then I really recommend not opting out…). Personally I didn’t mind the routine vag. exams and my gyn used a transvaginal ultrasound every time, too (seems to be more standard in Germany apparently), because he wasn’t an ass about it and would have respected a no. I liked it because I could see my baby frequently this way, and all was consented for and good.

      • You mean that your gyn used a transvaginal ultrasound versus an abdominal whenever possible, not that your gyn did a transvaginal ultrasound at every appointment, right? I wasn’t quite sure by the way that it was phrased.

        • Sorry if I haven’t been clear. My gyn uses/used the transvaginal ultrasound at the yearly checks and in early pregnancy, as soon as the baby reached a certain size he switched to the abdominal one and only used the transvaginal to check the state of the cervix every now and then (not at every appt. I think). My midwife owns a fancy new 3d/4d ultrasound and only does abdominal checks (actually did so for the missed miscarriage I had in another first trimester). I guess my Gyn (he doesn’t do obstetrics and has a small practise) simply doesn’t have a very new abdominal ultrasound (it’s standard b/w 2D, but with a good resolution), so for him the transvaginal works better when the pregnancy is still small. He’s also youngish, like in his early forties, so I guess this is what he grew up with in med school. I personally like the way he works, because he’s very thorough and gentle, always does a bimanual exam (palpation) and speculum view in addition to the ultrasound (the us only when he wants to look for something specific like cysts etc.). He doesn’t poke around more than needed, doesn’t make rude comments, never pushes exams, anything, and I’ve never had *any* discomfort, not even from pap smears, so I never questioned what he does. After following this comm for a while, I’m definitely more wary when I have to see a new gyn (i.e. when mine is on holiday, or during travel), though.

          • arzt4empfaenger

            Here in the UK, we don’t have any yearly checks and only see a gyn is there are any problems.

            Your doctor seems very thorough for a yearly exam. Is this standard for every woman in Germany? If so, may I ask what the purpose is?


          • Wow–I wouldn’t even consent to a transvaginal ultrasound while pregnant (no medical indication), much less during a standard yearly exam.

            Ultrasound is still not proven safe, and every time you zap yourself you zap all your eggs. Every time you zap yourself while pregnant, you zap all of your eggs, and all of your child’s reproductive pieces. For what? If there’s a medical indication–like a cyst–sure, but for “checking the cervix”?

          • I haven’t researched the topic in depth, but so far have found as many opinions that say ultrasound damages than those who say it doesn’t. The studies that I’ve seen so far (can’t quote now, but if you search pubmed they should be there) said in conclusion that it wasn’t proven by them that ultrasounds do harm, and considering that you can choose between a big range of frequencies and durations, I find that believable. So essentially, they’re not proven unsafe either. Of course you’re not supposed to play microwave and hold the probe with high intensity to one place for several minutes (because I’ve read people critizising the development of heat through potentially wrong use), but no doctor I’ve met so far has done that. As for the transvaginal – he only does it to confirm or rule out something when the speculum view and palpation suggests something he couldn’t see. I don’t mind the probe any more than I mind a tampon or the speculum, so the few seconds don’t disturb me. If I was experiencing anxiety, pain or anything else uncomfortable, I’d surely object. To me in theory it’s not more invasive than a digital rectal examination (which I fortunately don’t get there! Not minding it doesn’t mean I’m keen to get one, but i.e. in the ER it would belong to every thorough exam when unclear problems present themselves, just like the inspection of the patient’s body in the nude, to not miss vital details like petechia or injuries/lesions)… it’s a way of medical diagnostics, and as such it’s fine when it’s short and focused on a question/an issue.

            The cervical check aimed at the intactness of the cervix. If early signs of insufficience were showing, you’re supposed to keep an eye on it in case a cerclage is necessary. Around the due date I guess he checked for shortening etc.

          • Long story short, he didn’t check the cervix every time just for the fun of it. When he checked, he oriented himself on the current guidelines here. If you’re with a gyn, that’s what they do (more or less everywhere in the industrialized world) – in pregnancy they take blood tests a couple of times, they write CTGs, read blood pressure, check for antibodies and do ultrasounds and fill in the results into a neat little book called mother’s pass which you carry around with you, so whenever you have an issue, the treating doctor will have all pregnancy facts right there black on white. It’s great in an emergency, and if you don’t have an emergency, even luckier. It’s also simple precaution and helps to detect issues like hypertension or preeclampsia early.
            Otherwise I frankly don’t need the appointment (and yes, I know, strictly spoken you can go through the whole pregnancy without pre and aftercare). I decided to go with a gyn and a midwife, and the combination worked well for me.

          • Many of us would say that there is no reason for routine cervical checks, and it IS basically “for the fun of it”. Won’t tell you when you’re going into labor, won’t tell you how long labor is. Won’t tell you…much of anything.

            I live “in the industrialized world” and I didn’t have a single check until I was in labor. And then, it was because I requested one. One ultrasound, again, because I requested it. That these things have become routine is ridiculous. It’s even further ridiculous that these procedures are considered a favorable part of industrialized healthcare.

          • The guidelines here recommend yearly checks as part of the cancer screening, so it’s basically a precautionary standard. Of course you don’t have to go, but doctors should offer the checks. Many women don’t go to the gyn at all unless they have trouble, and that is fine as well. you’re not getting scolded when you don’t get yourself checked – after all, it’s for your own reassurance.

          • When I say “doctors should”, I meant that the association of gynaecology and cancer research recommends it to their members.

          • It’s now becoming more routine in the US to only do routine cervical checks every 3 years instead of annually. And transvaginal U/S are almost never used unless there’s reason to suspect a serious cervical issue.

          • No it’s not standard. I had yearly paps in Germany without ultrasound. Without a yearly pap, no birth control pill rx.
            Ultrasound galore is standard for pregnancies in Germany, but you can opt out. My sisters had internal scans til 12 weeks and then abdominal, they get pics each time. I declined the internal ultrasound – I knew ovulation dates and what to watch out for in case it was a extrauterine pregnancy. I only allow a 20 week scan to verify out of hospital birth is viable, I too feel one should stay away from ultrasound unless medically indicated. Checking the cervix is only necessary if it shortens super quickly and early delivery is a threat. And even then it’s not necessary and not even done in the US past 30 weeks. Mine was at 1cm at like 29 weeks and I still carried to 37 weeks without drugs.

          • “Without a yearly pap, no birth control pill rx.”

            That’s what the gynos let you believe, but it’s actually not true. Any general practitioner can write you a birth control prescription if he or she wants to. It got my Nuva Ring scripts from my “Hausarzt” for years before I switched to IUD.

          • Ha I wish I had known! I hate those examinations. The gyns claimed that birth control raises cyst risks hence the yearly paps… I’ve been gone from Germany though for years now!

          • But paps aren’t for cysts they are for cervical cancer. Paps scrape the surface of the cervix and the send the smear to the lab to check for cervical cancer. The vaginal exam /intravaginal UltraSound check the uterus and ovaries which would include cysts, fibroids etc. A full exam IS a good idea if you are using hormones, but a GP or Nurse Practitioner can do them the same as a Gyn. A GP who will write the script without doing the check at least every 3 years is irresponsible.

          • Random change of subject but not really but yes. As an 18 year old virgin trying to continue my birth control in the US, I wish I lived in the UK. I would love not being pushed for a PAP or pelvic or any of that.

  2. If you ‘have to’ and don’t have a choice, then it’s not consent. Someone needs a dictionary.

  3. “So now you know everyone, everywhere? That’s pretty cool.”

    This was at the 38 week appointment. No useful information to be gained from a routine exam, really. And I’m wondering what this doctor thinks happens if the mother doesn’t receive a vaginal exam. Does the pregnancy just remain at 38 weeks forever? Does she never, ever deliver without an exam at 38 weeks? Does the pregnancy just disappear because the doctor didn’t touch her cervix? Does the cervix wander away, never to be found again? Enquiring minds want to know! :-)

  4. Did the doc stamp his foot and whine?
    It would match his comment!

  5. This one is me. He was definitely trying to imply I couldn’t refuse the exam. He really gave every excuse under the sun. Said even the local midwives would require an exam, said ACOG said I HAD to (which I called ACOG and they don’t even have a guideline about it) and the WORST was that he was subtly throwing out the dead baby card. Saying if I didn’t get checked I would be held responsible for what happens. All of this for dilation, position and if my water had broken according to him. Seriously? Dilation isn’t a magic ball that can tell you when labor will start (I’m sure he wishes since my dd is the 20th and Christmas is right around the corner), position can change all the way up until I’m delivering and after going to a 12 week Bradley birth class I sure as hell better be able to at least suspect when my water breaks. So for a healthy, low risk pregnancy with NO other signs of labor I will skip the exams that increase my chance of infection. (I do get infections down there easily anyways)

    • Why are these docs and nurses so obsessed with vaginal exams? And the dead baby card? Seriously? “Your baby will die if I don’t check to see if you are dilated or effaced.” Just because something is routine and 99% of patients consent, doesn’t make it LAW.

    • What is it with all these doctors just itching to stick their fingers up womens’ hoohahs?

    • How did the doctor respond when you told him ACOG had no such guideline? Because after being caught in a flat-out lie, the doctor should at least have been ashamed enough to back off, not to compound the insults.

      Good luck with your upcoming birth. I hope this doctor isn’t on call.

      • I didn’t know he was lying at the time but if I see him again he’ll know not to mess with me like that again since I’m not some airhead who will blindly believe whatever he says just because he’s a doctor. I call BS when I see it.

    • He might have been so ambitious because stripping membranes often comes around 38 weeks, and often aren’t even mentioned to the mother when they perform it (some tell you afterwards).

      He may be really trying to push you to get checked so he can do this and try to make you go into labor earlier so he gets his holiday off.

      • That is definitely something I was worried about! That he would try that or accidentally break my water. Which is another risk an exam has. Funny how I “have” to have this exam that has some very real risk involved.

        • The risk of getting your membranes stripped is entirely tied to the intentions of the provider. >:-( Membranes can’t get stripped accidentally.

          • Well the water breaking would have been an accident (possibly) but I know you can’t strip membranes accidentally! Guess I should have worded that different. But I was worried about him stripping the membranes without asking because I’ve heard so many stories on here about it and a doctor here did it to 2 women in my birth class. The crazy part is that he was the number one OB my instructor recommended for a natural birth! And this OB is the second. I guess where I live there just aren’t any really good natural OBs. Midwives for me from now on!

          • It just makes me angry that we have to weigh the risk that the provider is being dishonest. You don’t say one of the risks of eating McDonalds food is that they’ll have sprinkled cyanide on your friench fries. I mean, it could happen, but it’s not one of the things you factor into your decision whether to eat there.

            I don’t know how hard it is to rupture the membranes. When they do it during labor, they use an amniohook. I suppose the doctor could be rough and try to pinch it open, but it seems like it would be difficult to do by accident unless they were pretty much ready to go anyhow…? I’m totally not a midwife or a doctor, though, so I don’t know how hard it is to rupture membranes during a cervical exam.

            Even at that, though, if it was that much of a risk factor, they’d never do a VE before viability.

      • I can’t get the info to pop up for AMA at all! Is this informed consent for vaginal exams in pregnancy? It is hard to find ANY statements regarding these issues

  6. This is why I’m nervous about declining vaginal exams with my midwife. (it hasn’t come up yet, i’m only 28 weeks) I don’t really have a problem with them, but during my last pregnancy, I had absolutely no cervical changes until the day I went into labor. The exams did nothing but stress me out worring I would never go into labor…. I hope my midwives will be more understanding than my last ob!

    • Just tell them no. They may surprise you. I told my OB i didnt want any VEs and was informed he doesn’t normally do them unless the mothers asks him to. The nurse was getting a little nervous around 42 weeks because I didn’t want one, but she only asked if I wanted one. She thought I should be curious.

    • With my second pregnancy I received prenatal care at a military hospital, and while I usually saw midwives there wasn’t one available for my 36 week appointment so I had to see an OB. I was very nervous because I was so worried about how I would deal with declining an exam and actually it was simply me saying I’m not interested in an exam when he offered and that was that. He totally respected my wishes without anything further. I guess you just never know until you try, but either way, stick to your guns.

  7. Hmmm, funny, he must not know my OB/MW. Here’s how things went at every late pregnancy appt except what ended up being my last one each time…

    Doc/MW: Do you want a cervical check?

    Me: No. I don’t think it’s necessary right now.

    Doc/MW: Ok. See you at your next appointment. Call us if you need anything

    Me: Bye

    • Same with mine. I had my first ( and only) nonlaboring VEs at 40w6d and 41w3d respectively. It was indicated so as to let us know what my options were for induction a week/few days later. (Never got to that point with either one, thankfully).

    • Exactly. I had a 36-week vaginal exam, because I requested it (and was 4 cm — he was born 4 days later). My second pregnancy they never even offered.

  8. Wow. you guys have doctors and nurses that ask you permission? we dont have that where im from! whenever they want to do a vaginal check, i go into a room, they hand me a blanket and say “take off your pants and underwear so we can check you.” then about 2 weeks ago at my 25 week prenatal, they said “okay, take these papers over to centrex. your glucose test is today.” these are also the people who told me that no doctor will ever consider me birthing naturally, and said that i have “no choice” when it comes to having a c-section or consenting to newborn exams.

    • Run…. run far!

    • It’s not that doctors and nurses ask me for permission. I simply say NO when I don’t want it. If I were told to remove my pants and underwear, I wouldn’t do it. I’d ask why the check was necessary, and then decline.

    • If there is no medical indication that requires you to remove your pants during an appointment, then do yourself a huge favor and just keep them on. You can say no.

    • Same things happen here. It’s just assumed we consent by showing up.

    • Oh, I had the same thing happen at the practice I went to. Here’s how it went:

      MA: Here’s a sheet honey, from 36 weeks on they do weekly cervical checks.

      Me: Ok (takes sheet, sits down as MA leaves)

      CNM: Hey! How you feelin?

      Me: Good, I guess a few more Braxton-Hicks but nothing big. By the way your MA gave me this sheet and told me to take off my pants but I don’t need an exam so… I didn’t.

      CNM: Great, let’s listen to your baby for a minute.

  9. My mw/ob were very lazy… they didn’t even try to do exams of any sort towards the end except NST, which was not done by the end. The last 2 appointments I timed… 1.5 hours waiting… 3 minutes with the doctor

  10. Wow, my poor zombie baby! I had a VE and pap early in my pregnancy (around 4 months) and the next one was at 39+3 weeks (30 hours after my water broke :D ) The doctor never even suggested one at any appointment… I guess my doctor actually got one thing right!

  11. I have to consent? You keep using that word. I do not think it means what you think it means.

  12. So, can you measure my belly and check for the heartbeat? Awesome. Next, you ask me if I have any questions.

    Oh, you don’t like it when people tell you how to do your job? Then stop telling me how to do mine.

    And, NO, I don’t HAVE to consent to ANYTHING I don’t want. Thanks, bubye.

  13. My MW only did cervical checks if I asked, and I only asked when I was in labor to see how dilated I was. And even then, my MW kept telling me that it wasn’t any indicator about when I’d have my baby so there wasn’t a need for it except for my own piece of mind (which being at 3 cm for 3 days was no piece of mind for me). I’ll probably forgo cervical checks this time.

  14. thats funny cos the only time ive had someones fingers in my vagina is when i said they could, and when im pregnant seriously i will cut your hand off if you even suggest it! if i dont let my husband touch me then why the hell would i let you?

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