Why You Should Keep Your Hands To Yourself
Answer: “Vaginal exams.” Jeopardy question: “What is one thing a doula does not do?” Most of us hear these reasons in our doula trainings : doulas are not experienced at it; it introduces germs; it is a medical diagnosis (liability); or that it “muddies the waters” between the doula’s role and that of other medical professionals. There are doulas and other birth professionals who feel that doing vaginal exams at home in early labor is an advantage. When I first started as a labor assistant in the mid-1980’s it was assumed that I would someday provide vaginal exams and other clinical skills. We thought being able to offer more medical information to the mother would be empowering. After years of personal experience and research, I now theorize that it is more empowering for the mothers and more powerful for the doulas to avoid doing vaginal exams. Here’s why:
1. Everyone else wants to put their fingers in her vagina. Triage nurses, doctors, residents, midwives, midwifery residents, nursing students, you name it. Even though I would likely be using these skills at her home to gauge when to go to the hospital, I don’t have to add my name to the list. Doing vaginal exams doesn’t help me be a better doula. I just become another person who is entering the private spaces of her body.
2. It changes the balance of power in the client doula relationship away from an act of service. As a doula my role is to empower and support this mother one hundred percent. If she wants something I help her to get it; if she doesn’t want something I help her to say “no”. My role is to help her believe in herself. As a professional doula, I have no agenda other than to support her and her loved ones. As women we are equals and I am there to serve her as she labors and births her child.
Once I put my hand inside of her we are no longer equals – she doesn’t put her hand in my vagina. The social roles between us have shifted. In her mind who I am symbolically has changed. I used to be there to serve her and now I have touched her intimately and evaluated her! This shifts the power balance between us so that I have more power than she does – I have personal private knowledge of her she does not have of me (and very likely will never have of me). Our support relationship is no longer the same.
3. With that one act, the doula role shifts from support to evaluation. I am judging her body. I am giving her information about herself that we don’t believe she has any other way. I am subtly communicating that I don’t trust her to know where she is in labor. Her intuitive knowledge of her own body and labor isn’t good enough – we need to check the cervix just to be sure.
4. The doula misses the opportunity to empower the mother. When you aren’t doing the evaluating, you need to rely on the mother’s internal messages. She lives in her own body, for goodness’ sake, which is something most people tend to forget. You can call it intuition or receptivity to subtle nerve pathways perceived by the brain. The mother has access to what is going on in her body and as a doula I can assist her to listen to these messages. If we can help her to identify what she is experiencing and feeling, she can discern for herself what she wants to do. When we model early on: “It’s your body, what do you feel? What do you want to do?”, it starts a pattern that can carry on throughout her labor.
5. Not relying on vaginal exams means that the doula hones other observational skills. Patterns of breathing, skin color changes, cartilage and bone changes, even the usual bloody show and contraction patterns can all tell us where the mother is in labor. Combined with her own internal messages we can present her with information so she can decide. We can also observe signs of progressing labor, dehydration, or other concerns which might lead us to think that going to the hospital or birth center is a good idea.
As doulas, our very presence is an effort to put the mother at the center of her own birth experience. Our role of unconditional support is special and no one else can offer what the doula does. Rather than being a limitation, avoiding vaginal exams empowers both the mother and the doula. Why endanger that when the price can be so high?
**Having said that, there are some mothers that really want at home labor support that includes vaginal exams. That is why we have monitrices who possess both clinical skills and labor support skills and are covered by midwifery or nursing standards of care – even as students. There are also midwives who will teach the mother’s intimate life partner to get to know her cervix during pregnancy so they can feel for labor changes. But the expectations that are brought to the midwifery relationship and nursing relationship are different than with professional doula support.