Vaginal exams ~ when saying ‘no’ doesn’t mean anything.
Much maternity research focuses on whether one intervention or another increases or decreases what the practitioner has to manage (shoulder dystocia, c-section, haemorrhage, embolism, hysterectomy, etc). Generally speaking, the mother is relegated to some category of “risk” and tends to be blamed for whatever mayhem ensues.
Not often, but occasionally, she is asked for her perspective.
In a July 2025 study called “’I didn’t feel I could say no’: A qualitative study of pregnant women’s experiences of consent to vaginal examinations”, women who had recently given birth at an inner-city hospital in the UK that included vaginal exams were asked a series of questions about their experience.
Unsurprisingly, disregard for consent was their experience.
While vaginal exams are believed to be necessary for tracking the progress of labour in order to manage the labour, the labour ward, and their resources, we know that they are entirely non-predictive concerning time of delivery, vary from practitioner-to-practitioner, tend to be wrong 50% of the time (a guess might be better), and include the potential for introducing infection, breaking the amniotic sac, hurting the mother, humiliating her, or triggering a sexual assault response – whether current or from her past.
From the study:
Most women believed that they had no choice about having a VE, understanding it to be a non-negotiable part of their care
“it’s part of the process, so it’s one of the things you just suck up and do” (P11)
Most participants reported that they were not offered the opportunity to refuse a VE, nor were they made aware of alternative ways of assessing the progress of labour
Despite being ‘aware’ that VE(s) were a choice, some women reported feeling pressured to accept them and felt they had little or no control over the decision.
“It’s just a thing that’s going to happen next, so you just grin and bear it.” (P4)
“I didn’t feel like I could say no. It ended up being really painful. I just feel like I had to bear it until she was done.” (P16)
Participants in the study all accepted vaginal exams primarily because they didn’t feel empowered to question a ‘routine practice’. This lines up with previous evidence (cited in the study) that when a recommendation is conveyed with surety and no mention of alternatives, women will acquiesce. Practitioners also tend to gain easy acquiescence by using assertive language, conveying an expectation of compliance, and invoking the “necessity” of the proposed intervention. All coercive tactics.
The study goes on to suggest several reasons why consent is lacking when it comes to vaginal exams. And in line with the purpose of the study, the authors suggest ways to train practitioners in the laws of consent and to alter birth culture where consent is at the fore.
My personal take on this study is that we need to stop focusing on vaginal exams and retrain practitioners in the skills of looking at a woman, her face in particular, to assess labour progress and keep our hands to ourselves.
The benefit of not being a midwife and instead serving as a wise neighbour is that no woman who invites us is expected to endure or even offered this humiliation ritual. There is another way.
Vaginal exams can have their place when it’s clear that labour is becoming aberrant and more information could guide the mother in next steps. But that should be uncommon. So uncommon that the practitioner would clearly discuss the benefits and risks of gathering information through her vagina and would most certainly want her full consent.
I can dream.