I’ve been introspective over the last few days, ever since I realized that much as I trust my midwife, I’m not ready to let her touch my vagina, and may never be. And even I have had to convince myself that that’s ok.
This may sound strange to many people, especially in the US where birth is highly medicalized. Even in less medicalized circles, the vagina is still a central focus of pregnancy, labor and birth. Except in the rapidly growing number of countries where c-sections make up a majority of births… A whole separate topic…
But although the vagina is the passage through which the baby comes, it’s just one part of the entire process, a full-body, full-mind dance whose complexity is not completely understood. Just read Sarah Buckley’s recent publication on the intricate hormonal changes of late pregnancy and birth.
Assessing cervical dilation is the most common reason women allow OBs and midwives to touch their vaginas. I could write a whole blog post about why dilation isn’t always the best way to judge labor progress, and I could write another post about how the action of judging progress, even if it were reliable and accurate, isn’t helpful or necessary in many labors. Luckily, someone already has: https://sarahvine.wordpress.com/2010/03/07/how-dilated-am-i-assessing-dilation-without-an-internal-exam/ and http://midwifethinking.com/2011/09/14/the-assessment-of-progress/.
There are other reasons people put their hands there. An asynclitic head position, or otherwise problematic lie can be diagnosed and even ameliorated by an experienced practitioner. Sometimes a nuchal arm is preventing descent and can simply be moved out of the way. Breech maneuvers are sometimes necessary to deliver a trapped fetal head. And hands can prevent tears, particularly in a speedy or uncontrolled delivery.
Back to me… I started to get very nervous when I considered my upcoming prenatal appointment during which I am supposed to have the screening lab test for Group B Strep. It’s a simple swab of the vagina, done with a q-tip, and some providers swab the anal area as well. The closer the appointment got, the more anxious I felt. My history doesn’t allow me to just let a medical person touch me there – it seemed ludicrous in retrospect that I had been assuming that 34 weeks of pregnancy would have erased that trauma. It also started to seem ludicrous that simply being comfortable with someone and having developed trust over those 34 weeks would likewise eliminate the re-triggering potential. It didn’t. The trust is there now – but the old triggers are still there too.
I do want to be screened for GBS. I want the opportunity to make a decision about antibiotics for me and the newborn if I should screen positive. I then found out that many midwives and even some OBs have their clients self-swab if they choose to. And I realized through this thought process how insanely important it is to me that I have the choice to do it myself. I’ll be asking to do the swab myself, and if my midwife is opposed to it for some reason, we’ll have to have a long talk about why.
Nothing is absolute and I love my midwife for helping me realize that too. She is perfectly happy to respect my boundaries and also gently brought to my attention possible situations where I might want her hands on, like some I mentioned above.
My real epiphany came when I started thinking about a potential hospital transfer. The most important thing to me is that no one touch me there, including as I am catching my baby. My husband thinks it’s a little unrealistic to expect that my wishes would be respected in a hospital, but I actually trust my backup OB and have heard from at least one other person that he is trustworthy. My midwife also has privileges.
Perhaps it is unrealistic, but I do imagine being able to create a protective buffer zone around me; I have my “affirmations” and statements at the tip of my tongue; I have my hospital birth plan – really need to print those – and I have something I didn’t have before this whole GBS freak-out. I have conviction. I have the conviction that there are very few reasons to let someone into my vagina, and that it’s a part of my body that I can plan to protect, that I am absolutely allowed to NOT ALLOW anyone into.
I have the conviction that preventing myself from being triggered or re-traumatized is worth it, is worth going to the trouble to get something that so few birthing women think they can have, or want. I have the conviction that it’s OK for this to be of paramount importance, and that it’s also OK for others to think that’s absurd. I have the conviction that if a situation arises where a midwife or OB’s hands on my vagina would be in my interest, that I myself can make the decision in the moment. I have the conviction that barring an emergency, this is something I can accomplish no matter whether I give birth at home or in a hospital. And that gives me immense comfort.