By Maryanne W. Waweru l wawerumw@gmail.com
A vaginal examination (VE) is a routine medical procedure during labour to assess and monitor its progression. It basically entails a nurse/midwife/doctor inserting their fingers into the vagina of a pregnant woman who is in active labour, to feel the cervix and to estimate how dilated (opened) it is as they assess the progression of labour. Ideally, vaginal examinations are done at regular intervals of about 4 hours, to check whether the labour is progressing as expected.
In this article, I share a few Kenyan women’s experiences with vaginal examinations during childbirth. The purpose of this article is to improve nurses’, midwives’, doctors’, and other healthcare provider’s understanding of women’s experiences with this process, for improved maternal care.
So, what I did was to ask random mothers the following questions:
- Did you know that the VE would be done?
- Did the nurse/midwife/doctor explain it to you beforehand?
- How did you find the procedure to be?
- Was it done by one nurse/midwife/doctor, or by different people?
- How many times was it done?
- Was it done by a male or female nurse/midwife/doctor?
- Was it done in privacy?
- What would you like to tell nurses/midwives/doctors about the VE process?
The following are some of the responses I received. All the women delivered in hospital.
Mother A
My experience was very unpleasant. The first time, I was 3cm dilated when a male nurse examined me. After some hours a female nurse did it. Surprisingly, she told me I was 2cm dilated then asked me to go home and return when I was more dilated. I refused as I was scared about something going wrong at home. I felt safer in the hospital. A few hours later, a different female nurse examined me and said I was 5cm dilated. That gave me hope that baby was finally coming, but a few minutes later another nurse examined me and said I was 4cm dilated. I was confused. Did these people know what they were doing or were they just guessing? I hated how different nurses kept inserting their gloved fingers, making me feel embarrassed. Couldn’t it just be done by one person? However, being a first-time mother, I didn’t want to ask any questions as I feared their reprisal. Many hours later, the doctor came and told me that my labour was progressing poorly, and baby was getting tired. I was taken to the theatre for a caesarean section. Imagine after all that!
Mother B
As he prepared me for the VE, the male nurse told me it would be a bit uncomfortable which was true. I didn’t feel pain, but I felt a lot of discomfort. The same nurse is the one who checked me about four times. He was patient with me and explained what he was doing and why. I would urge nurses to prepare the woman beforehand so that she can be mentally prepared. It also helps her to relax, based on my personal experience. I would also tell them to be gentle while doing so as the patient is already dealing with a lot of anxiety and pain that comes with labour.
Mother C
I was a first-time mother and I remember being ushered into the labour room by a male nurse as he pointed to a bed with the instructions “panda hapo utoe nguo ya ndani na ulale ukiangalia juu”. I obeyed him and next thing, I saw him put on gloves and apply gel on them and without saying a word, inserted his fingers. The pain I felt by this intrusion was worse than the pain of labour itself. I was so unprepared. A little courtesy would have helped!
Mother D
My doctor had briefed me about it prior, so I was well prepared. The procedure was uncomfortable but not painful. It was done by a one specific nurse at different intervals, and later by my doctor. It was done in privacy as they drew the curtains surrounding my bed. What I would tell medics is to please be gentle as they do it, and inform the patient in advance so that they are prepared psychologically. It will help ease the discomfort.
Mother E
Mine was so painful! The nurses didn’t tell me what they were doing. They didn’t even introduce themselves at the very least. The first time it was a female nurse who did it, and I remember shouting at her to stop because of the pain I felt when she did so. The second time it was a male nurse who I will never forget. He inserted his fingers so deep that I yelled out in pain. He said he was trying to open my cervix to allow baby to pass through, but I wondered why he was being so rough while at it. I screamed out in so much pain until the supervising doctor came rushing and instructed him to be gentle because I was a first-time mother. It’s been six years and I think the reason I fear giving birth again is because of that process.
Mother F
For my first delivery, I hated it as it was done by different trainee nurses. I feel it would have been better if it were done by just one person who had experience but no, they all had to have a go at it because ‘they were learning’. Worse, it was done with them as a group so they were all standing there, observing my nakedness. I felt so invaded and violated. Thankfully, with my second child I knew better so I delayed going to the hospital such that by the time I got there, I was already 7cm dilated and this time it was done privately and by only one nurse.
Mother G
I didn’t like it. After being checked twice, when I saw the nurse coming again for the third time, I shouted at her not to do so because she was hurting me with her fingers. She left me alone as neither she nor any other nurse returned to check me again, only coming to do so when I started screaming that my baby was coming out.
Mother H
I never minded it because I was in labour and I just wanted to know how far the baby was. The female nurse told me that she was doing it to check how much my cervix had opened up. She did it twice and it wasn’t painful. It was done in privacy which was such a relief. I would like to tell nurses not to be harsh when handling women in labour. Just be polite and kind to them.
Mother I
I didn’t know about it. I was a first-time mother and the nurses would just come and insert their fingers –rotating between male and female nurses. They weren’t telling me what they were doing and I was afraid to ask. I found their actions to be invasive. At some point it was so bad that I refused for them to touch me because I was feeling harassed. When I refused, a female nurse slapped me and shouted at me to cooperate. I felt so bad.
Mother J
I never minded the procedure. I was a first-time mother and I had read about what to expect during labour and childbirth. The nurses never told me anything at the hospital when I was in labour, so thank God I had researched on my own. It was done four times by different nurses. Initially, it was done in private but after I was 8cm dilated, the nurses didn’t draw the curtains that surrounded my bed, so it was open for anyone to see, unfortunately. I went on to deliver my 4.2kg bouncing baby boy vaginally and didn’t get any stiches. The nurses congratulated me for being strong and listening to their instructions.
Mother K
The procedure left a bad taste in my mouth. I especially hated the gel they applied on their gloved fingers before inserting them. I think it had pepper in it because it would leave me feeling itchy, aching, and sore. Each time I saw the nurse approaching me I would just start crying because I knew what was coming and there was nothing I could do about it. It was such a bad experience for me.
Mother L
Being a first-time mother by then, I didn’t like it. It was done by a female nurse, and I wasn’t aware that she would insert her fingers down there. It was so painful until I told her that she was not well trained to do it. But she told me she had been a nurse for many years so there was nothing I was telling her. She added that this is what all pregnant women in labor go through, that I wasn’t the first one, and so I should just get used to it if I was to continue having babies. I wasn’t happy about her attitude. The nurses should be explaining to the mothers well and they should do the VE in a friendly manner.
Mother M
My experiences with all my three children were good. The nurses told me what they would do, and that I should relax if I did not want to feel pain. I relaxed and it was uncomfortable but not painful at all. They have all been done by female nurses, which is what I preferred.
Mother N
The labour pain was so intense until I didn’t feel the pain when the nurses did the vaginal examinations. It was done by both male and female and I didn’t mind whoever did it, I just wanted my baby to come. In fact, I was the one calling out for them to come check if I had dilated enough as I just wanted to be over and done with.
Those are just some of the responses I received, but from them you can deduce that:
- Many first-time mothers don’t know that VEs will be done on them
- The nurses/midwives/doctors need to explain the VE procedure to the women beforehand
- Knowing what to expect helps the women feel more relaxed, lessening the pain and discomfort
- They prefer that it’s done by one nurse if possible
- The women value privacy during the VE procedure
- Women in labour are afraid to ask medics questions or voice their concerns about any negative experience for fear being rebuked or punished
- The nurses/midwives/doctors need to be gentle as they do so
If you are a healthcare worker who helps women during childbirth, I hope this article has been of benefit to you as you help women achieve positive childbirth experiences.
If you are a first-time mother, I hope you know what to expect.
If you’d like to share your childbirth experience email me at: wawerumw@gmail.com
Do you have an opinion about this article? Comment down below.
Mummy Tales by Maryanne W. Waweru is a platform dedicated to empowering its readers on different aspects of womanhood and motherhood. Read more motherhood experiences of Kenyan moms here. Connect with Mummy Tales on: FACEBOOK l YOU TUBE l INSTAGRAM l TWITTER
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