Medical Intervention During Pregnancy & Labor: A Guide for Trauma-Impacted Mothers

As a patient, particularly one with a traumatic past, it is likely that you will find yourself wondering of your provider, “Why?” What is the reason for common medical interventions, and must they be done to you? Your provider may suggest or even require medical interventions that feel overwhelming, intrusive, or triggering. You may be left feeling vulnerable, exposed, and even violated. If your provider does not take full consideration of your history or past abuse and trauma, you will likely be drowned in a sea of interventions “for your own benefit.”

…but are they necessary? 

In most cases, providers are making decisions regarding interventions for you based on 1) their education; 2) their professional experience; and 3) what they believe will provide the most positive outcome for you and your baby. If your provider follows that rubric in making decisions, then, congratulations! You have found yourself a good provider and one that you can trust with your physical and mental safety. Unfortunately, providers such as these may feel few and far between, particularly when you, as a trauma-impacted patient, are searching for one that aligns with your birth goals and is sensitive to your particular needs and triggers. It is far more common for providers to lack trauma-informed care and propose interventions for their patients that are insensitive or unnecessary in the name of standardizing care or making “things easy.” 

This insensitivity and lack of personalized care in the medical industry often causes women and their families to feel unsafe in the presence of physicians, midwives, and other medical professionals who are in a position of “power” over their clients. For trauma-impacted women, being in a position of submission or feeling “powerless” can lead them to avoid medical care entirely for the sake of preserving their security and peace. 

Aside from basic interventions such as blood draws or urinalysis, one of the most debated and dreaded interventions for trauma survivors is a pelvic or vaginal exam. These terms are commonly used interchangeably, and many providers do so, although they technically refer to slightly different examinations. Pelvic exam is the umbrella term for any examination involving the pelvic region and reproductive organs, which includes pap smears and vaginal exams, two of the more standard interventions, among others; vaginal exams constitute physical and visual examination of your vagina and vaginal canal. Reasons for a pelvic exam include: 

• Pap Smear 

  — To test for cervical cancer. During a pap smear, cell samples from the cervix are collected and tested in a laboratory for pre-cancerous or cancerous cells. The intention for this test is to achieve early cancer detection and allow for more positive treatment outcomes. 

  — Detection of HPV, or Human Papilloma Virus, a common sexually transmitted infection. HPV increases the risk of cervical cancer. 

  — Monitor cervical cell health. 

• Vaginal Exam 

  — To determine fetal position. The provider can determine the position and location of the baby in the birth canal. This allows providers to evaluate for any possible position changes or labor complications. 

  — To assess labor progress. Based upon the condition of the cervix, providers can attempt to make determinations on progress and duration of labor. Providers will manually feel the “ripeness” of the cervix (softness of the tissue), the effacement of the cervix (thinning of the tissue), and the dilation of the cervix (opening of the cervix).   

Medical textbooks and providers commonly disregard the fact that labor and birth is a natural, physiological process that does not follow linear progression or specific markers. Birth is primal and innate. It cannot be accurately tracked nor measured; in fact, most women birth better when left to rely on their body’s natural internal cues and not upon the results of physical examinations. So, why are pelvic exams for the sake of cervical checks so common? That’s because Western medicine is cervix focused. It relies upon the internal markers and measures of a woman’s cervix to tell her how and when to birth. This is an inaccurate understanding of birth and human physiology. Simply because the cervix is ripe, effaced, or dilated, does not mean that labor will progress quickly or if it has progressed from the last cervical check. Labor cannot be accurately measured by the cervix. 

As your trauma-informed doula, I am here to tell you that there is another way. If they must be performed, (such as for fetal positioning checks/changes or at the mother’s request), pelvic exams do not need to be the brusque, insensitive, terrifying experience that they are with many providers. Below you will find a method that a trauma-informed care provider might use with a trauma survivor, particularly a survivor of sexual abuse, to perform a pelvic exam: 

Before the exam your provider should: 

• Provide you with resources about pelvic exams and how they might impact you as a sexual abuse survivor. 

• Be observant to any signs of physical or emotional distress that you might display (marked distrust, body tension, disassociation, fear, or crying). 

• Be cognizant of any abuse history you have revealed and be respectful and affirming. 

• Acknowledge the possibility of a pelvic exam being a trigger because of past abuse. It is crucial to explain to you how a pelvic exam could be linked in your mind to past abuse (exposure, touching of the genitals, vaginal insertion), and affirm your fears while also reminding you that this re-stimulation is done with care and respect for your physical needs and wellbeing. 

• Clearly describe the steps of a pelvic exam and answer any and all questions and concerns: 

  — You will lay comfortably on your back with your feet together and your knees a comfortable, natural distance apart. 

  — The provider will do a visual examination of your external genitalia. 

  — The provider will either a) insert two gloved and lubricated fingers inside of your vagina until they reach your cervix, or b) insert a warmed and lubricated device into your vagina called a speculum, which appears almost like a duck’s bill and serves to open and hold open the walls of your vaginal canal for an internal visual examination of your vagina and cervix. 

  — If examination of your uterus is necessary, the provider will apply gentle pressure on your abdomen to locate the top of the uterus. 

• Your provider should allow for consistent feedback from your before, during, and after the exam. They should be willing to move at your own pace and comfort level. 

• You should never feel pressured or ignored. Your feelings should be validated and listened to.  

Successfully completing a pelvic examination for a trauma survivor is a triumphant event! If you are unwilling or unable to complete an examination, remember that there are other options for you available during pregnancy, labor, and delivery. (Note: cervical cancer cannot be diagnosed without a cervical exam.) Your doctor or midwife can rely upon natural physiological signs displayed by you to determine labor progress. Remember: your cervix is not all of you. You are a whole person and you do not need to be judged solely by your cervix to determine if you are ready or able to birth in the manner you need. You can do this. You were made for this.

God be with you, sister.