Doula claims vaginal exams are “fingering” women

Sexual harassment and violence against women.

If you want to see how badly the midwifery philosophy of “normal” birth has been discredited, there’s no better place to look than the UK.

For over a decade the Royal College of Midwives, the midwifery trade union, promoted a Campaign for Normal Birth on the grounds that it would save money, save lives and improve patient satisfaction. It was a spectacular failure. Dozens, perhaps hundreds, of babies and mothers were injured or died preventable deaths because they were deprived of appropriate monitoring and necessary interventions. Maternity liability payments ballooned to nearly £2bn per year. As a result, the RCM was forced to shutter its Campaign.

Demonizing obstetricians by equating them with sexual predators.

The RCM has yet to take responsibility for the fact that they wasted both lives and money promoting their ideological agenda. They did acknowledge that not only did they fail to improve patient satisfaction, they made women feel worse. RCM head Cathy Warwick admitted it had ‘created the wrong idea’:

‘There was a danger that if you just talk about normal births, and particularly if you call it a campaign, it … sounds as if you’re only interested in women who have a vaginal birth without intervention,’ she told The Times.

‘What we don’t want to do is in any way contribute to any sense that a woman has failed because she hasn’t had a normal birth. Unfortunately that seems to be how some women feel.’

The Campaign for Normal Birth was a spectacular failure on every level but that has not prompted much soul searching from prominent midwives. Indeed, the opposite has been happening; in their frustration they have been becoming, if possibly, more ideologically rigid.

In particular they’ve escalated their language, referring to obstetrical care in terms designed to vilify providers who disagree and incite the natural childbirth faithful. We’ve become used to their cries of “birth rape” that simultaneously demean survivors of actual rape, and maternity providers who are trying to save lives. The latest vulgarity is the attempt to equate vaginal exams with sexual assault.

According to doula Maddie McMahon:

Midwives shld be debating the pros and cons of routine VEs and exploring the evidence, or lack of, for regularly fossicking around in a normal labour. I’m just a woman telling you that you need a damn good reason to finger me. Just telling me I’m Xcm is not a good enough reason.

What is fingering?

Fingering is the use of fingers or hands to sexually stimulate the vulva, vagina or the anus. It may be done for sexual arousal or foreplay, mutual masturbation, or constitute the entire sexual encounter.

Why use vulgar sexual language to describe an obstetric exam?

1. To demonize maternity providers, particularly obstetricians, by equating them with sexual predators.

2. To discredit obstetrics as sexual predation.

3. To shock and gain attention.

4. To rile up natural childbirth advocates.

5. To vent frustration that women do not want what natural childbirth advocates believe they should want.

Why is so much rage directed toward a minor obstetric exam done to determine how labor is progressing?

Because checking cervical dilatation holds the same place in maternity care as taking a temperature does in general medical care. Just as taking a temperature allows a provider to find a fever and then address the problem, doing a vaginal exam allows a provider to diagnose a dysfunctional labor and then address the problem.

According to the paleo-fantasy of natural birth, women are “designed” to give birth, birth in nature is nearly always perfect and interventions in labor deface the pristine nature of “unhindered” birth. The facts are that women aren’t designed, birth in nature has high rates of perinatal and maternal mortality and unhindered birth is often a recipe for a painful death.

No matter! If you don’t take a temperature, you can’t find a fever. If you don’t do a vaginal exam you can’t diagnose labor dysfunction and if you don’t know about it you won’t do anything. Evidently doing nothing is the goal of UK midwifery care.

Which begs the question: if the entire point of UK midwifery care is to do nothing as often as possible, why have midwives?

They don’t lower the cost of care so they aren’t protecting NHS finances.

They don’t save more lives than obstetricians so they aren’t protecting babies’ and mothers’ lives.

And many women are extremely dissatisfied with the care they provide so they aren’t protecting women from psychological birth trauma.

What are they protecting?

They’re protecting birth! Never mind that is not a priority of women. It’s a priority of UK midwives and doulas and regrettably, they seem to think their priorities are the only ones that matter.

  • Zornorph

    What’s the difference between the Urologist and his nurse? The nurse pricks your finger and the urologist fingers your prick!

  • rational thinker

    Sometimes using shock value is the only way to get attention especially when trying to promote bullshit. I am somewhat surprised because arent some of the ncb crowd supporters of bringing the sex back into childbirth rhetoric.Who could forget this quote by a ncb guru:

    “It helps the mother to relax around her puss if you
    massage her there using a liberal amount of baby oil to lubricate the
    skin. Sometimes touching her very gently on or around her button
    (clitoris) will enable her to relax even more. I keep both hands there
    and busy all the time while crowning … doing whatever seems most
    necessary.

    Sometimes I see that a husband is afraid to touch his
    wife’s tits because of the midwife’s presence, so I touch them, get in
    there and squeeze them, talk about how nice they are, and make him
    welcome.” – Ina May Gaskin

    • Griffin

      Every time I read this quote, I feel like gagging. Ugh.

      • sdsures

        I just threw up. 🙁

  • Glia

    I found them quite painful, particularly since I also had a Foley bulb placed, and they were tugging at that at the same time. I eventually asked if we could delay the next check until after I got my epidural, and they agreed, despite that it was several hours before the ane made it around to me.

  • RudyTooty

    As a health care provider who checks patients’ cervices, I am mindful that this can be an incredibly painful and invasive and emotionally challenging examination for people.

    And I have to weigh the value of the information I will get vs the pain caused – if the cervix is sky-high and posterior – and I can barely get one fingertip around the lip of it – and the patient is crawling up the bed in pain – I may not have an accurate exam, but I can safety assume that it’s EARLY ON IN LABOR, or that some cervical ripening is indicated. In a case like that one, I value NOT causing discomfort and making some assumptions about cervical status rather than further inflicting pain.

    The entire clinical context needs to come into the decision to be aggressive about performing a cervical exam, and how zealous to be about getting an accurate exam. Sometimes ‘high, thick, posterior’ is enough for me. That’s enough information.

    If the cervical exam is being performed to assess for a prolapsed cord… that requires more zealousness… sometimes we do things that are painful, but necessary.

    No, it’s not like taking a temperature at all.

    [And I am in no way defending the doula’s insane perspective that nurses and physicians are fingering patients. She can go jump in a lake!]

  • Heidi

    When I was 12 weeks pregnant, an OB treated my friable cervix and that was the worst thing ever! I felt like I was going to pass out for the next hour, became very woozy, and while I thought I was about over morning sickness at this point, I threw up sometime after. I don’t remember the cervical checks themselves being particularly painful but getting my water broken was also not pleasant. I had very respectful OBs and nurse and was always informed and asked before checks though.

  • Madtowngirl

    I only had one cervical check, because my baby came early and I had a C-section, but yes, I found it painful. I also find pelvic exams to be generally pretty uncomfortable, and I have to really coach myself through them. My providers have always tried to make it gentle, but I think it’s just my anatomy. Pain tolerance also varies from person to person, and some of us can’t tolerate as much as others. So no, you’re not weird or anything for finding them painful.

    This time around, I get my cervix checked by transvaginal ultrasound, lol! I actually find it less painful. Maybe it’s the probe? I dunno.

    • sdsures

      Ugh, I’ve had a couple transvaginal ultrasounds.

  • sdsures

    Are more women statistically being diagnosed with vulvodynia or vaginismus these days? Either can make vaginal exams and pap smears excruciating-to-impossible to perform.

  • rational thinker

    I found them a little uncomfortable in my first labor but I guess it depends on the situation. Why did they let you labor for four days shouldnt you have had a section after one day with failure to progress.

    • Kate

      I was induced a week before due date because of pre-existing high blood pressure. I wasn’t dilated at all when I went in, so the first two days were just getting things started. They broke my water on day two, then it was just two days of slowly progressing hell. I got to 9cm but baby wouldn’t come out, he was turned at just the wrong angle. The hospital I went to prides itself on low c-section rate, and they knew I wanted to do vaginal birth if possible. But by day four I was begging for the surgery! My little guy is worth it, but boy was it a difficult road!

  • mabelcruet

    I can sort of see what she’s grasping at-I think she’s attempting to say that there needs to be good information provided to the woman about the procedure and it’s purpose, and consent needs to be given on that basis. A family member had ‘difficult patient’ written in her notes (that she later got an apology for) because she refused to have blood samples taken unless the nurse could tell her what they wanted to test for, she wanted more explanation. So I think MacMahon is saying information and consent are paramount, which any decent health care provider knows anyway, but she’s saying it in a ridiculously coarse and hyperbolic way for shock value.

    • Kim Thomas

      You’re right – women do need to be informed, and consent does need to be given. I work with women suffering from postnatal PTSD, and one of the things that they tell us time and time again is that they felt violated when an internal examination was performed on them without consent. Some of those women have had previous experience of rape and sexual assault, and an internal exam performed without consent can bring back painful and vivid reminders of the attack. One woman who had previously been raped told us that her experience of the way she was treated in labour was worse than the rape. So I really wouldn’t be dismissive of women who talk about “birth rape” – that really is how it feels for a lot of women.

  • PV exams don’t have to be painful, even though sometimes, even when trying to be gentle, they are. The whole region is very sensitive. What I’ve found is that [1] more exams are done in teaching hospitals, for obvious reasons, [2] patients often ask for more exams than midwives need to do, because they want to feel they haven’t been “suffering” without progress. [3] A really experienced midwife can usually dispense with some exams, but there are many situations where a midwife or doctor would be negligent if an exam WASN’T done. I’ve found that, if explained properly, the patient usually is much more cooperative.

    • sdsures

      Explanation goes a LONG way in alleviating patients’ anxiety.

  • Ravens Starr

    What is “fossicking”?

    • Chi

      It means fumbling around and searching. It’s original use was to describe someone who pokes around in abandoned gold mines to see if they can find any the original miners missed.

      • StephanieJR

        You learn something new every day.

      • sdsures

        Is it a British English expression? I’ve lived in the UK for 10 years and this is the first time I’ve heard it.

        • Chi

          Actually it’s an Australia/NZ (oh and Cornwall apparently) expression, which is probably why you haven’t heard it.

          • sdsures

            There – that’s a thing I know now. 🙂

  • Spamamander ctrl-alt-right-del

    Funny how they immediately jump to “any touch around the reproductive organs is sexual” when they are screaming that breasts aren’t sexual at the same time. When I was in labor I didn’t think anything in that region was vaguely related to sex- except maybe never having it again. If a man has a prostate exam, is that automatically rape?

    Update on my co-worker who used Sherry Lee Dress for her midwifery care- she had a healthy baby girl last night. Sounds like everything went well. I’m relieved as all get out.

    • Lucie

      They were also extolling the benefits of applying warm compresses directly to the va-jay-jay last week – which to me sounds like something that has far more potential to become borderline sexual, and feels a lot more ‘intimate’ which would be a problem for me. So it does seem odd that a doula should be making the same criticism of a procedure that seems far more clinical and distanced.

      I guess we all have different boundaries, but I think it’s telling that she chose a type of examination that is associated with ‘medical’ birth, as this was clearly what she really intended to attack. I thought that the response from the OU midwife (about how the alternative is looking up someone’s butt crack for a notoriously elusive colouration or something, so would she really prefer to undergo THAT?) was hilarious.

  • Mel

    Well, if the issue is that vaginal checks are such an issue, switch the standard method of childbirth from vaginal birth to C-sections at 39 weeks.

    Problem solved.

    What do you mean that’s birth rape, too? Can’t win for trying with this group.

    • Lucie

      Lol. As many women on that thread pointed out, they couldn’t get a VE for love nor money during their own labours, and found it incredibly frustrating that nobody wanted to keep them informed on how they were progressing. Pretty sure I’d feel the same way – there’s nothing worse than not knowing how much further you’ve got to go on something.

      • sdsures

        “Pretty sure I’d feel the same way – there’s nothing worse than not knowing how much further you’ve got to go on something.”

        I agree, but childbirth is somehow seen as more predictable in terms of “when will it be over?”. You don’t have that marker of temporal certainty with other procedures.

  • MaineJen

    The only time it ever hurt for me was when I was checked by a medical student who obviously hadn’t done very many before. YOUCH. Otherwise, they were uncomfortable but not painful. But I didn’t have to endure it for 4 days either…

  • KeeperOfTheBooks

    I did, but I have a really high and posterior cervix at normal times anyhow, so I wasn’t shocked that they really hurt. Oddly enough, my OB was the only man who examined me (all the rest were female nurses and a resident), and his exams were the only ones that didn’t hurt. So, perhaps partly cervical placement, and partly just not being as gentle as they could be? I’m sorry you had that happen to you. 🙁

    • Kate

      Same here, the one male OB who examined me didn’t hurt – it had to be the longer fingers! Crazy. Thanks for confirming I’m not the only one who had this experience.

      • demodocus

        my guy has short, stubby fingers, which I viewed with resignation. He did his best to be gentle.

  • fiftyfifty1

    We Pushed our Campaign for Normal Birth on women and then they feel like failures when they don’t have Normal Births. What?! How could this be?! This was NEVER our intention, “yet unfortunately that seems to be how some women feel.”
    Cathy Warwick, what a liar she is!

    • Lucie

      Yes. That quote said it all and is basically the problem in a nutshell.

    • The Bofa on the Sofa

      They don’t get that just in calling it “Normal Birth” means that everything else is “abnormal.” And, you know, people don’t like being characterized as “abnormal.”

      I’ve said this before – they are the ones who make the big distinction between “normal” and not. Doctors, otoh, see a c-section as a completely normal procedure. The Campaign should take their lessons from them.

      • fiftyfifty1

        “They don’t get that just calling it ‘Normal Birth’ means that everything else is ‘abnormal.’ And, you know, people don’t like being characterized as ‘abnormal.'”

        No, I don’t believe for a minute that they “don’t get it.” They do it intentionally to manipulate, but in such a way that they can deny it later. There is just no way that they stumbled into calling it a Campaign for Normal Birth. The playbook on how to shame women using the language of “normal” was laid out explicitly by Diane Wiessinger in her “Watch Your Language” essay, and has been used ever since by midwives and lactivists.

      • swbarnes2

        Not only do the patients not like being labeled “abnormal”, I think it’s clear that the British midwives don’t like labeling women’s birth “abnormal” either, which is why they resist handing off care to doctors, even when they medically need to.

  • CodeWench

    I sort of feel bad for MacMahon that her sexual experiences are apparently so unsatisfactory that she cannot differentiate between someone attempting to pleasure her and someone performing a medical exam.

  • swbarnes2

    Another crunchy ‘practitioner’ who claims that only the techniques she personally understands or carries out are worth doing.

  • Heidi

    But, wait, I thought sexual play was so important to birth and us non-natural child birthers are just a bunch of prudes who are too uptight to give our husbands blowjobs and have midwives fondle our breasts and rub our “buttons” during labor.

    • That guy is so lucky he didn’t get bitten when her teeth clamped down suddenly due to an unexpected labor pain.

      • Heidi

        Um, I wanna say the husband’s name was Wysong? Am i misremembering that?

        • Heidi
          • sdsures

            Dear gawd…

          • Eater of Worlds

            It’s not his real name. He decided to take on that nature name. https://en.wikipedia.org/wiki/Currawong It’s a kind of bird. I don’t think he took it simply because of “hey, nice bird, back to nature hippie name” but there are stories about the bird https://dharawalstories.files.wordpress.com/2015/05/diruwun3-9mb.pdf

            These people were really into hippie culture. They didn’t even seem to mind that the whole family had lice, repeatedly. They weren’t going to use chemicals to get rid of them. But the mother sold wool products, stuff she knit/crocheted. During active lice infestations. She had a huge realization and change of mind about how bad mainstream culture was when her kid had leukemia, they had to move to be near the hospital, had to sell their dream home (or stop renting it, I don’t remember) to rent something near the hospital and she was shocked at how nice people were and how helpful they were outside of her super hippie community. She’s toned down considerably since these days. The kid with leukemia was one of the twins she had from the BJ 2 day twin birth.

        • Eater of Worlds

          Wysong is a pet food, that’s probably what made you think that combined with the -ong ending of Currawong.

      • Heidi
        • Heidi

          “P.P.S. If you’re one of the hater minions, come to get titillated about the sentence “taking Currawong off into the back room for a quick fix of sex and semen”, after having visited the anti-life, anti-diversity, anti-everything pages that are so fixated on their smutty assumptions that Currawong and I were having sex whilst I had ‘an umbilical cord hanging out of me’………I was trying to be polite by putting it like I did above, but if you really want the graphic details………me and Currawong went into the back room and I gave him a blow job, because as midwives have known for a very long time, there’s an agent in sperm that brings on labour.” I’m pretty sure this isn’t the first time I’ve copy/pasted this, but it never gets old.

          • demodocus

            Probably because the last thing on most people’s minds while you/your spouse is in labor is a bj from the laborer? Nah, can’t be that.

          • Heidi

            I didn’t offer my husband a blowjob during labor, and we were in the hospital and all that, too, but I can just never imagine my husband would be in the mood while I was in labor. I like to think meeting our child was enough excitement and stimulation on that day. I was definitely not in the mood to be on the giving end anyway. Yes, I’d have rather gotten an IV of pig semen. (And yeah, I know pitocin isn’t pig jizz. . .) LOL.

      • Heidi

        One of her son’s had/has? leukemia, and the family did opt for non-alternative medicine and sought conventional, evidence-based treatment. So that is great!

        • I actually followed the link to their new blog, and it’s actually the baby from the story. The stuck second twin. Poor thing. But not only did they agree to do conventional chemo, but the outpouring of love they got from the Hospital and the Suburban community seem to be challenging the mom’s negative associations with the mainstream world, and she’s taking it in stride. Good for them.

  • The Bofa on the Sofa

    I’m surprised you were able to write this post about “fingering” without referring to Ina May.

  • TsuDhoNimh

    Good grief … the usual check for cervical dilation is quick and about as sexy as teaching someone how to correctly insert a diaphragm or a “moon time cup”.