What if you choose to NOT have vaginal exams (VE) in labor? What are the alternatives?
We could argue that knowing the dilation of the cervix is important ---or stand by the position that it offers no real value. VE's often answer the common question, "How dilated am I?". And with that, we must address the fact that the cervix does not open/dilate at a linear rate. Therefore, the VE offers no indication of how long your labor will last or how fast it will progress. VE will only reveal what the cervix is doing at the time of the examination. It cannot provide information about what the cervix was doing before, or what it will do in the future.
Note: there are occasions where it is useful to have a "baseline" assessment of the cervical dilation, effacement, fetal station, and position ---but that's just an assessment and does not need checking every few hours. In fact, the more exams you have increases the risk of getting a bacterial infection or accidentally having your membranes ruptured. And let's just address that they are just freaking uncomfortable!
Also, any and every time someone wants to perform a VE they should inform you of what, if any decision or changes in your care would be made about the information gained. You get to offer consent, or decline to "be checked", every time.
For those who choose to decline the offer of a VE, and "Yes, you can decline", there are a number of other ways to estimate how labor is progressing. 1) Watch and listen! Every human being/body labors differently but they are some commonalities. A birthing persons' behavior is revealing of what stage of labor they are in. Midwives are experts at this assessment because we know what normal labor looks like, sounds like, smells like, and feels like just by talking to you, watching, and listening! This is especially valid when you have had continuity of care -someone that stays with you continuously. The value of continuous care inarguably offers the best assessment of a person's progress in labor. 2) The purple line: In some people (not all), a purplish line can be seen, starting from the anus and developing up between the buttocks (toward the sacrum). This line can approximate cervical dilation ---about 1cm of line equals about 1cm of dilation of the cervix (Shepherd, Cheyne, Kennedy, McIntosh, Styles, & Niven, 2010). Note: this is not always the case - some people have the line and it does not relate to dilation. This, like anything else, can be used in conjunction with other signs and symptoms (like watching and listening) as many factors together tell the story of how labor is progressing. 3) Hot legs: as the body progresses through labor, the extra blood needed by the uterus pulls blood away from the extremities. This can lead to the legs getting progressively colder (from the foot to the knee). Anectodetly, it is said that when the colder part is at the mid-calf, this equates to roughly 5cm of cervical dilation. This assessment is best used with unmedicated labor (no epidural or pain relief), and no water immersion (for obvious reasons).
Further reading (and references) about Vaginal Exams http://aims.org.uk/Journal/Vol22No1/VEsDiagnostic.htm
https://evidencebasedbirth.com/evidence-on-prenatal-vaginal-exams/ http://midwifethinking.com/2011/09/14/the-assessment-of-progress/ https://midwifethinking.com/2015/05/02/vaginal-examinations-a-symptom-of-a-cervix-centric-birth-culture/
Shepherd, A., Cheyne, H., Kennedy, S., McIntosh, C., Styles, M., & Niven, C. (2010). The purple line as a measure of labour progress: a longitudinal study. BMC pregnancy and childbirth, 10, 54. https://doi.org/10.1186/1471-2393-10-54 https://www.rcm.org.uk/sites/default/files/Assessing%20Progress%20in%20Labour.pdf
Shelly DeMeo (Varelli) Kneading Time Holistic Therapy & Birth Services www.kneadingtimeholistictherapy.com