Friday, April 1, 2011
Obstetric Lie #93- "I Need You To Take Off Your Pants"
Few things make a nice girl feel more vulnerable than being stripped down and spread eagle with her feet in some stirrups. Add to this that you are probably with a man who is not your lover and considerably pregnant and we have the makings for a modern maternity system that step by step degrades, dehumanizes, and objectifies women.
We are of course talking about the vaginal exam. Oh, but not just ANY vaginal exam, the obstetric lie we will discuss today is the PREGNANCY vaginal exam. It is embarrassing, largely unnecessary, uncomfortable, potentially dangerous, demeaning and yet......rarely questioned and routinely done. (We will save the LABOR vaginal exam for another day.)
Maybe you are thinking, "Has this angry mommy blogger lost her mind? Why is she talking about something that everybody does? Isn't that necessary?" One of the amazing and pervasive things about these obstetric lies is that most of them are so deeply ingrained into our pregnancy/birthing experience that we don't even question them. They are just routine - a part of our introduction to the mythical, secret, and supposedly painful world of childbearing.
Well, the pregnancy vaginal exam isn't really necessary. Really - it isn't. I am not making this up nor have I gone crazy. There isn't a lot of need for you to have somebody touch your cervix while you are in labor, much less a month before your supposed "due date". (My gosh, when do these myths end? There are just so many!)
The pregnancy vaginal exam is particularly disturbing to me though because it subtly lays the groundwork for a deep physical mistrust of our own body. (This thing could just start opening up at any moment without warning!) AND it also sends a clear message about the importance of experts to measure your progress and ability to give birth. (You might not be able to do this! The female body is frequently broken!)
Much more than just a simple procedure, the vaginal exam teaches the woman preparing for birth some lessons that the obstetric model of care is eager to have her learn:
1) You need to do things that make you uncomfortable and that are embarrassing.
2) Experts know more about your body than you do-you can't even see what is going on inside your secret dark recesses.
3) Things could go wrong at any moment. Your body and your birth is an accident waiting to happen, thus the exam.
4) Do what the experts tell you to, even (or especially) if they make no sense and you have no idea why they are being done.
5) You are NOT in control. We are. (The vaginal exam is a clear display of power, particularly MALE power. The only reason we don't really recognize this anymore is because it is so common place we have forgotten to question it. Would you EVER do this for no good reason? These are your very private parts, usually reserved for your closest companion OR to detect disease OR for some type of internal surgery. Yes, doctors sometimes need to look into our bodies to determine the 'need' for internal surgery. Is it any wonder that this is a routine part of our maternity care in a country where the surgical birth is at a raging high?)
The book Birth As An American Rite of Passage is incredibly and deeply perceptive as it picks apart the reasons behind so many obstetric rituals. Of the vaginal exam, Robbie Davis-Floyd says, "Frequent cervical checks drive home to the laboring woman the physical significance of the messages about time, about the suspected defectiveness of her own body, and about her lack of status and power relative to the hospital staff..." (pg 112)
Maybe you are thinking, "Well, maybe, but what harm is really done? I don't want to make waves at my appointments. I can go with the flow and still have a great birth."
Let me tell you about two real live women that I knew.
The first was a first time mom. She got the routine exams. About four weeks before her due date her doctor found her to be about four centimeters dilated. He didn't do anything except mention that she would most likely have her baby early. (Who doesn't want to hear that when they are 38 weeks right?!) But we know that dilation, though it does give us some interesting information, does not tell us without a doubt when the baby will come. This mama had the same exam and was told the same thing for the next four weeks. Yes, she went all the way to her due date and had a perfectly healthy and wonderful baby. At forty weeks. Despite the emotional turmoil that this caused, this mama was fine. I would not however disregard the effects on an already emotional pregnant woman though when it comes to false expectations for her labor and birth.
Our second mama was also a first time mom. She did not however get so lucky and escape with only some emotional upset. I talked to her while pregnant. She was excited and really hoping for a natural birth but didn't have time for a birth class. She also had routine vaginal exams and a few weeks before her due date was found to be four centimeters dilated. This sent the staff into an immediate panic! She could have the baby at any moment! We wouldn't want it to just fall out on a bus or something! So, of course, they started an induction right then and there. Pitocin followed by this and that and an epidural and... out of the blue a baby that needs to be saved from the labor via a c-section. Mama is not planning to VBAC. She believes that the system saved her baby.
I wouldn't dare make fun of a mother who believes this. It may seem like I am reading into things a bit much, but follow my logic here for a minute. This c-section did not just come out of nowhere. It did not even start with the epidural or the pitocin or the induction. This c-section started with the systematic dehumanization of the mother through an unnecessary procedure; the pregnancy vaginal exam.
There is a reason women believe in the system and it is because the system is very convincing. These unnecessary surgeries don't often just happen out of the nowhere. They grow out of a specific methodology that begins the PREGNANCY (not just the birth) by looking at it as though it is pathological. There are procedures throughout the pregnancy that send powerful messages about your ability to work as a female and about who really knows what is best for you and your baby. The vaginal exam is only one of many, but because of the nature of the exam (nudity, supine position, another more powerful person inserting their hand into your body) it is particularly convincing and powerful.
This is a simple enough thing to change ladies. We need only decline this procedure or find care providers who do not routinely do it. Keep your pants on. Therein lies great power.
(Of course, as with any obstetric test or procedure, there are times when it is necessary. Do your research, find somebody you can trust, and have faith in your birth.)