Don't Blame Her for Not Enjoying Your Vaginal Exam
Oct 13, 2022
I had a phone call with a really lovely doula who wanted to debrief a recent birth she supported. The birth was long, she told me. The early labor lasted a day, and then the active labor another day. The first-time mother pushed with an epidural for 3.5 hours before her baby was born.
This doula wanted to know --- what went wrong?
Why did the birth take more than two days? What could she have done to help her client birth sooner and easier? This mother also experienced severe pain during vaginal exams. Perhaps, her doula posed, there was sexual trauma in her past? Perhaps that is why the birth took so long, perhaps that is why the vaginal exams were excruciating?
Perhaps.
And perhaps there wasn't sexual trauma in her past at all --- perhaps this present moment presented sexual trauma for the woman. Birth is a sexual, social experience, not simply a biomechanical one. She is birthing. She is in the extremely vulnerable and primal brain state of labor, and someone is inserting a hand into her vagina and up to her cervix (where she is already experiencing intense stretching or pressure sensations). She is not in control of that hand. If she is like most women birthing in-hospital, she may not know that she can withdraw consent, and instead believes that she is required to submit to this invasive assessment in spite of extreme discomfort or pain. (We teach in our Intentional Birth program how to set the stage for receiving a respectful and gentle vaginal exam---if you want one.) Even with the most respectful exam, she is immobilized on a bed in semi-control of her position, her tissues are naturally tightening against the foreign invasion, and all of this is occurring while the forces of birth are at work in her body and mind.
For birth to work as it is designed, a woman should feel safe and private. Oxytocin (which drives her uterine contractions) is the same love+connection hormone that surges in her body during sex. Pause, and tell me how your oxytocin would flow if a gloved stranger were to interrupt your bedroom proceedings to give you a vaginal exam? Why is this the norm during birth? (Hint: it's not for most out-of-hospital providers. Routine vaginal exams aren't evidence-based, and there are so many other ways of knowing how your birth is progressing).
My question is not “Why were vaginal exams painful for her?”
My questions is “Why would we expect vaginal exams to be comfortable and easy for any laboring woman?”
Why do we question what was wrong with this mother --- or what was hidden in her past --- instead of asking what is wrong with this assessment system, what is wrong with this present moment!
A similar question may be asked of the long yet perfectly normal birth. 24 hours of early labor is well within the range of normal. 3.5 hours of pushing is not extraordinary for a first-time mother, even without an epidural. Yet this mother and her doula were made to feel like something should be happening faster, like they should be fixing and doing and trying. To be sure, there are times when proactivity will spare the mother discomfort or exhaustion. For instance, some symptoms of this birth suggested an asynclitic descent of the baby's head, which can be helped by positioning and movement (activities we discuss at Intentional Birth). Even if so, babies almost always find their way with patience and with the instinctive movement of the mother. No one in the mother's space should make her feel as though she's taking too long, as though her body is not trustworthy.
This doula did a beautiful job being present for the mother, troubleshooting with her and encouraging her. I don't blame her for asking the questions, “What went wrong? What should I have done?” It took me many years to realize myself ---
It wasn't the mother. It wasn't the doula. It was the expectations of a system that cuts every birth from the same cloth to the same pattern.
There is a way out of this boxed thinking. So many birth workers have found it after long, hard experience (including some hospital providers!). We are ready to lovingly show you the short-cut to an empowered, mother-centered birth in our Intentional Birth program.
