Consent for cervical exams during labor

This sign is a PDF download you can save on your phone or computer and print. Print out a copy and take this with you in your hospital bag. 

printable door sign reminding care team to ask permission

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Let’s talk about consent for cervical exams or any vaginal exam during labor. I’m going to divide this blog into two sections: for women and for women’s health professionals.
 
For women
 
You have full rights to bodily autonomy. You have the right to consent (give permission) regarding who has access to your vagina. That consent does not end when a woman gets pregnant. Yes, part of women’s health care is taking care of our reproductive system and sometimes that requires the care of a professional to examine, assess, diagnose, etc. We choose when to go to the gynecologist and when we get an exam. We also have the right to say stop if it is painful or uncomfortable.
 
Now let’s talk about labor. The way to confirm a woman is in labor is to check for cervical dilation. This is done through a vaginal exam. Your progress in labor will also be assessed by checking cervical dilation. Here’s what you need to know. You still have the right to say yes or no. You still have the right to consent. Don’t let anyone tell you otherwise. Health professionals and hospitals do not hold authority over your body. You can say no. You can say wait. You can say stop. You can say yes to one person and no to another. These are patient rights. Every woman giving birth in America has this right. You need to know that. You don’t have to ask permission to say no. If someone does say no and an exam is forced, that is sexual assault.
 
For many labor and delivery nurses, doing cervical exams are a routine part of the job. This is something they do every shift. I know these nurses and doctors are talking more and more about consent and how to be more respectful when approaching this care, and I know many of them never got any training on how to have this conversation. They may be in the routine of saying they’re going to check a patient. It is not a bad thing to openly communicate with your care team. Here are some things you can do.

• Print this attached sign and hang it on the door or by the computer.
• When it comes time for the nurse to check, say “I’d like to talk about consent first.”
• When you get admitted to the hospital and each shift as you get a new nurse, you can have this conversation. “I require consent before every vaginal exam.” This is not a bad conversation to have. It’s not negative. It’s not confrontational. It’s your body and you’re entitled to remind other people of your right to consent. This is a patient right.

 
If someone coerces you or tries to force you,

• If you’re in an office setting, leave. Do not go back. Fire them and let them know why. Report it.
• If you’re in the hospital or birthing center, you can say that you do not consent. You can remind them that you have the right to decide who you’re comfortable with being there and when.
• You can ask for a different nurse and tell the nurse manager why you are uncomfortable.
• You can file a complaint with the facility.

 
To prevent further issues (if this has become an issue), you can wear pants until it’s time to deliver. You can keep a support person with you at all times who will sit in front of you until you give permission. You can talk to a patient advocate.
 
It’s not normal for exams to be forced or coerced, but it does happen. I don’t want you to go into the situation expecting it or being afraid of it. I want you to be aware that you have the right to consent and to know how to communicate your boundaries.
 
 
For women’s health professionals
 
I hear you talking about consent for this and I applaud you for improving care. I know this is an awkward part of your job. I know that patient rights and things like consent or declining anything is not something they teach much on in college and it may not be something they talk about at your facility. Here are some pointers.
 
Of course, never do an exam without saying something first. Instead of saying you’re going to check them now, ask them if you can check them and maybe mention the reason why. Instead of gloving up first and then mentioning it, get permission before going for the gloves.
 
Remind her of her rights. Affirm her authority over her body and right to consent. If she is okay with an exam right now, once you’re ready tell her “Let me know when you’re ready for me to start.” This simple sentence gives the patient more control.
 
I know the last thing you want is to make someone feel violated or like she has no choice but to let you do something she is uncomfortable with. I know your heart is to take good care of people. Patient rights is something we’re talking more about nowadays. And how wonderful that is when you think of what women’s health care or any hospital care was like over the last century. We’ve come a long way. Talking about consent is something we need to normalize.
 
You can also use this flyer on your unit. Take it to your management and talk about doing some training or practice on consent.

Maternal-infant Wellness Education
with Leanna Mae

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