Vaginal Examinations are NOT a requirement of birth
Vaginal examinations are a tool used by HCPs in labour to assess a woman’s cervix. Sometimes they may give helpful information such as helping to identify a baby’s position, which may in turn influence the way you are supported there forwards (eg. You may be helped to try a different position to encourage a baby to rotate), or it may be useful to you if you are making a decision between 2 types of pain relief for instance.
However, your cervix is not a crystal ball and a vaginal examination cannot determine how long is left of your labour. You may be 2cm dilated and have a baby in your arms within the hour. You may be walking around 4cm dilated for 3 weeks without even knowing.
Several women in the birth-ed community have been told by their midwife, that in order to have their partner with them in labour they would be ‘required to accept a vaginal examination’.
I did some googling and found this..
‘Accept’. Verb. Consent to receive or undertake (something offered)
‘Require’. Verb. Specify as compulsory.
You CANNOT be ‘required’ to ‘accept’ anything. You can either ‘accept’ out of choice or ‘be required’. Not both. A requirement that you would not usually choose is to be coerced or forced. To limit access to a birth partner, (Pandemic or not), based on whether or not you will allow someone to perform a vaginal examination on your body is not only disrespectful and wrong, but against all codes of healthcare and most importantly, illegal.
Consider for a moment what a vaginal examination involves. Another person, perhaps whom we do not know, touching our body in possibly the most intimate way. There are a vast number of reasons as to why a woman may feel uncomfortable in accepting this. None of which she should need to disclose if she doesn’t want to. Which is why vaginal examinations ARE and ALWAYS WILL BE an OPTIONAL part of labour and birth.
You may well feel completely comfortable choosing to have them, and in almost all circumstances they are done gently & with the utmost discretion & respect. However, if you choose not to have one- ‘No’ should mean no.
images from the World Health Organisation
I have been in contact with birthrights this week & have shared their helpful response and resources below:
“Dear Megan,
Thank you very much for contacting Birthrights and thank you so much for all of the vital work that you are doing to support women in pregnancy and birth. We are alarmed to hear about this situation at the mentioned NHS Trusts and we very much appreciate you bringing it to our attention.
It sounds as though some of the midwifery staff at the Trusts have been wrongly informed about the legal position. We are discussing the way forward today and may well contact the Trusts directly on behalf of Birthrights.
We are glad to be able to share some further information with you and please do share it with all of the women and families you are supporting.
The legal position is that an individual does not have to consent to any medical treatment that they do not wish to have, and that includes vaginal examinations at any stage during labour and birth.
Consent that is given on the basis of a threat about being admitted to hospital and/or a threat about a partner being able to join, is not valid consent and the healthcare professional may be legally liable for battery and a breach of human rights if they proceed with a vaginal examination in such a situation. Consent should be properly sought for every medical procedure offered and it is only ever an offer of treatment. The law and good practice, as stated by the General Medical Council and NICE, amongst others, requires that all treatment or course of action should be discussed fully and consent sought. Women and individuals always have an absolute right to say no.
I attach our factsheet on Consenting to Treatment: https://www.birthrights.org.uk/factsheets/consenting-to-treatment/
and Human Rights in Maternity Care: https://www.birthrights.org.uk/factsheets/human-rights-in-maternity-care/both of which explain some of this in more detail.
You and the families you support might also find this recent British Medical Journal blog on vaginal examinations during the pandemic to be helpful: https://blogs.bmj.com/bmjsrh/2020/05/22/ve-consent-covid/
Maternity services cannot be dependent on a person accepting a vaginal examination. It would be untenable if the Trust were saying that no midwife in the Trust has the skill/ability to determine that a woman is in established labour other than by a vaginal examination.
I hope this is helpful Megan. Please do encourage women to write to us individually, either to make a complaint, or to have information about their rights in a current pregnancy. We would be glad to support them further.
Thank you for all of the work that you are doing to share accurate information about rights and options in childbirth and to offer ongoing support and services to so many women and families. “
For a greater understanding of your rights and choices in childbirth, our online hypnobirthing and antenatal course takes you through everything you need for a positive, supported and informed birth experience. (And it’s JUST £40).