Hi ladies,

I was just wondering if you can help me?! I've got 6 weeks to go before baby #3 arrives with our second home waterbirth, but my doctor who will be attending the birth (my family physician, not an OB) is talking about internal exams and a pap smear over these last few weeks, which I do not want to have.

After having my first 2 children in the UK, no internal exams are done at all during pregnancy until you are in active labour and pap smears won't be done throughout pregnancy until the baby is at least 3 months old. I already had a smear test done at my 13 week appointment and don't see why I need another, and would really prefer my womanly baby-making bits to be left alone!!

I have an excellent relationship with my doctor, but is it ok for me here in the US to refuse what he wants to do?? After only 18 months over here I'm still quite unsure of how the medical system works!! The care he has given, time he has taken with me and support to meet my wishes so far has been great but I really don't want to risk damaging the trust I have in him so close to the baby arriving. I DO NOT want all that stuff doing. I know my baby will be here very soon, and I'm just fine with that. I have no need to know if I'm starting to dilate already or if the baby's head is engaged yet... it'll all happen when the baby's ready!!

Any help and advice on how to go about this is much appreciated!! Thanks ladies!!

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Replies to This Discussion

You can absolutely refuse any treatment or procedure you do not want. Especially if the doctor isn't even an OB. I wouldn't let a family doctor perform any OB/GYN exams on me.
Absolutely! You don't have to do anything you don't want done. Just tell him you don't want the exams done.
Jane, I think it's wonderful that you have a Dr. who is willing to attend your home birth. In my limited knowledge, that is unheard of in the US, so good job on your part in finding one! If you have a good relationship with the Dr. then simply explain to him how you feel and what your plans are. You can explain to him that you have experienced labor in the UK without the internal exams and that they are unnecessary, and ask him to respect that. Internal exams are the way doctors use to determine how labor is going, how much you've progressed, and to gauge how soon the baby might be coming. I can see how it could be VERY difficult for a physician to feel comfortable simply watching labor without doing something to intervene, even something as simple as an internal exam. He may not know how else to handle labor if you don't allow him to check you cervix. That said, you don't have to humor him simply because he wants to do it. You know what you want, so stick to it, but be nice about it :)

In addition, a pap smear is routinely done once a year, so there should be no need whatsoever for that. You can ask the Dr. to wait until your 6 week checkup or until 1 year from your last screening if you want. As long as your past screenings have been normal there should be no problem with waiting. I've been told that I can safely go 2 years between screenings because I've always had normal results. I hope this is helpful.

In the US we have the absolute right to informed consent/refusal. This means that you have the right to know 1) the reason and risks for any procedure/treatment any medical professional recommends 2) the right to know any alternative treatments available and the risks of those treatments/procedures 3) the risks/possible outcomes of doing nothing at all and 4) the ABSOLUTE right to consent to or refuse any recommended treatment/procedure (for you and/or your baby). Be careful about signing forms at the drs office/hospital. These are often "Blanket Consent Forms" which give advance permission for the dr to do anything he/she deems medically necessary. This often makes the drs be less forthcoming with info if they know you have already signed this form and it reduces your rights later if you want to assert that you were denied the right to informed consent. Put a big X through the form and write the following statement along with your initials "I wish to practice my right to informed consent/refusal for each individual treatment/procedure." Then sign the form.

As for the Pap Smear. Are you sure that its not a test for Group B Strep (GBS) instead of a regular pap smear? A GBS test is fairly routine even among HB Midwives. Although, it is also a personal choice to have it and you can certainly refuse it if you choose. Internal exams are also routine, although less so among MW. And you can simply tell him you don't want any internal exams.

If he is a dr that is willing to do a HB (very rare for the US) then i am sure he will be respectful and understanding of your wishes.
Thank you all so much for your replies!! The more I find out about homebirth over here, the more lucky I realise I am to have a doctor who will attend my homebirth. After having my second child at home, there was no way I could go back to being in hospital, and finding someone who could provide the care my husband and I wanted was crucial before we even tried to get pregnant, especially over here. We're 40 minutes outside of Chicago and delighted to have found a group of 7 family doctors called Homefirst, all of whom will attend homebirths!! Unfortunately Illinois is one of the few states left where there are still real issues with midwives attending homebirths, nevermind doctors, so I know we are very lucky to have found them after spending hours trawling the internet!!!

My next appointment is next Tuesday at 35 weeks so I will talk to him then, though I'm sure you all understand that I still feel a little uncomfortable about having that conversation! It doesn't bother me at all that it would be him doing the exams - I just don't feel that they're necessary in the first place! I'm a month away from being 34 and have never seen an OB/GYN, not even through my 2 previous pregnancies as healthcare in the UK is very different. Practice nurses are qualified to do pap smears - I don't know anyone back home who's had a doctor do one, and internal exams (if needed) would be done by your family doctor who would then have to refer you to a OB/GYN if there were problems/concerns. You can not get an appointment with them straight away like you can over here - you always need to be referred.

Thanks again for all your help and advice! I'll let you know how next week goes!



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