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Natural Birth
Refusing a physical exam at first appt?
Has anyone done this? I have my first appointment Tuesday, and I'm just worried about the reaction from the Doc. I'm terrified of doctors, and have never managed to have a full-out exam - just one very quick, very painful pap smear. I know my limits, and know that I will just freak out if I have to have an exam with a doctor I've never met before. Getting pressure to do it just makes it worse. I don't know that I'll ever really be "comfortable", but I'm worried the doctor will criticize me and my desire to have a natural birth if I can't even have a physical exam. Thoughts? Anyone else refused an exam at the first appointment?
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Re: Refusing a physical exam at first appt?
I have not done so, but I would imagine any doctor with an ounce of compassion and care would understand if you simply explained to them that due to past experiences, you have a little bit of a fear/are uncomfortable with having a physical exam with a doctor on the first visit. Explain that you'll be more comfortable doing it at the next appointment. Hopefully he or she will be very sympathetic and will talk you through your fears and help you to be more comfortable. If they brush you off, are rude, or pressure you without trying to help you, I'd find a new care provider asap.
That said, it is pretty standard to have a full physical exam at your first prenatal appointment. Would you be comfortable if you got a "good vibe" from the physician during the first part of the appointment, explained your situation, and then they were able to talk to you, talk you through it, explaining everything and giving you time to be comfortable? That's something to consider, as well. Also remember that if the physician is male, there is almost always a female nurse who will be in there with you, and hopefully she can help calm your nerves as well.
I agree with telling the doc about your fear and leaving at the first sign of belittling. I do this with my needle phobia. Severe needle phobia. I've warned doctors, nurses, and phlebotomists and have it noted in my chart. I continue to go to those practices that really do understand and have left practices that have not all shown me that kind of compassion. I managed to go through a whole pregnancy of blood draws and a heplock and never once cried, vomited, passed out, or flat refused a test over needle phobia.
Ask around and see who is a really good and gentle doctor or midwife (whoever your preference is). You might also look into relaxation techniques you can employ during any exam...you'll still need to use them.
It is a good idea to get over that fear in general. Never mind for pregnancy or if it gets complicated, but your overall health. Once you have a few good experiences under your belt, you can remember those and it will be easier.
You've only ever had one pap smear because you're terrified of doctors? Have you talked to a professional about this? I'm not trying to sound snarky but pregnancy involves a lot of medical appointments and potentially a lot of exams and procedures, sometimes pretty invasive and painful ones. I would hate to see you struggling your whole pregnancy and going into your delivery with this kind of anxiety or fear.
I haven't had any internal exams yet this pregnancy but I'd just had a pap smear and pelvic exam two months before I got pregnant. Otherwise I probably would have had one at the first appointment.
Yeah, I have to agree with this. I would be concerned how your pregnancy is going to go if you have a fear of doctors. Even midwives, who are more hands off, still typically do certain exams and procedures. I would find a therapist and talk through some of this, or it is going to be a long pregnancy.
I had a pap smear my second appt, and my group b strep at 36 weeks, but no other internals.
Which is why I suggested counseling if it's a true phobia. As someone who's dealt with a fair amount of anxiety, I know that you can't reason or will them away. But I don't want to see you struggling your whole pregnancy if someone can help you, kwim?
Or if you think it's the kind of thing you'll get past once you've had the initial exam and "broken the ice" so to speak, even better. But if you're giving birth in a hospital and having the typical experience most American women have, there's going to be a lot of people sticking their hands up you and you need to think about how that will affect you if you get really stressed about a pap smear. You might benefit from taking a childbirth class that specializes in relaxation techniques like Hypnobirthing too. GL.
This definitely. I wonder if your fear stems from the fact that your first pap smear was so painful. I completely understand that. I've had some pretty brutal doctors when it comes to pap smears and I've always switched - there's no need to give them a second chance if they can't even manage to be gentle. In fact, before I got pregnant with DS, I was having some reproductive issues. The practice I was at gave me an internal exam and it hurt so bad I was on the table sobbing and said, "this hurts." The doctor replied, "really? It shouldn't." I thought, "Seriously? That's you're response? I agree that it shouldn't hurt. But it does. So maybe you could adjust your technique?!" UGH. So I switched and the first thing I told my new doctor was to be gentle and I explained my previous experience. He did a cervical exam and even a transvaginal ultrasound to try and diagnose what was going on with me and there was no pain whatsoever. World of difference! So be sure and discuss your fears and misgivings with your provider. A quality doctor will care about you completely - and by that I mean he cares about the entire you, including your emotions and fears. You shouldn't be just another uterus to him/her. If you feel that you are "just another uterus" then definitely switch providers. No woman should put up with that.
Also, a lot of women have fears surrounding OB care when they've been sexually abused in their past. If this is where your fear/phobia is coming from, then please get counseling. Pregnancy and child birth can be very traumatic when you've had sexual abuse in your past due to all the invasive exams, etc. that go on and professional help really can do wonders for you in healing from your trauma. As a survivor of sexual abuse myself, I want you to know that pregnancy and child birth can be enjoyable when you've gotten to a place of healing.
i completely empathize. i have a terrible needle phobia. my mother tried putting me in counseling for it when i was a teenager, but that was just really traumatic too. so i live with it and do the best i can. while i don't have a phobia specific to internal exams, my needle phobia has led me to be very uncomfortable with doctors in general, and i agree with pp that i've had to shop around to find doctors that i'm in any way comfortable with. i've had some pretty terrible experiences with doctors/nurses who lacked compassion.
for my first appointment with my mw this time, i was very upfront about my phobia and discomfort with internal examinations. she offered to do the blood test at the beginning of the visit to get it out of the way so i wouldn't be dreading it the entire visit. as for the internal, she left it up to me whether to have it at that visit or not. i chose to get it out of the way too, but i think it wouldn't have been a big deal to postpone to a later visit.
during my first pregnancy, i declined all internals after the first one; my mws were very understanding. during labor i didn't have my dilation checked until i was ready to push. this time around, i may decline even that.
I thought the recommendation was 18 (or maybe 21) or sexually active, whichever comes first, for the pap smear? Regardless, I am sorry you have such fear of doctors, and my answer wasn't supposed to be mean that you should just get over it, but rather that maybe you should talk to someone, because pregnancy, unless you do an UC, is not a hands off event. And I say that as someone who had my son in a country where it is much, much more hands off than the US, and who is going to m/w here who are low intervention. I hope it goes well for you!
Ditto Iris. If you're fearing a pap smear, you have bigger problems down the road. The first appointment exam is very quick. But that's the least of your worries. If you need any kind of early ultrasounds, like I did, it will involve a transvaginal wand. It sounds as exciting as it is. And have a lot of new people checking you out. I can't speak from the labor side of things because I had an emergency c/s with no labor but there will be a lot of people up in your business by the end of things, especially during labor.
Talk to a counselor about this. I'm sure you've heard of the fear-tension-pain cycle in labor. If you are fearful about being checked, it can have negative effects on your desire for a natural or even vaginal birth.
pps gave good advice. I wanted to add in my experience. I've been getting paps/internal exams for probably more years than you've been alive
(seriously...24 years? man, I feel old.) Anyway, my first few experiences were with insensitive male ob/gyns. I was afraid, didn't know much about my body, hadn't yet had sex, and they were not at all gentle or sensitive to me. I have not seen a male ob/gyn in more than 14 years. I'm sure there are great male ob/gyns out there, but I'd rather see a woman. When I got pg with DS, I switched to midwives and have been seeing them for the past ~4 years. They are by far the most gentle and understanding. They seem to be more concerned with my total well-being vs any obs I've seen who zero in on two parts of my body and seem to ignore everything else (including fears/emotional state). So, in addition to seeking help to deal with your phobia, I'd recommend looking into a midwifery practice instead of an ob, if you have that option. If there are no midwives in your area, maybe try to see a female ob vs a male. I'd also recommend reading something like Taking Charge of Your Fertility if you haven't. This is something I wish I had done *years* ago. Would it make you feel more comfortable if DH/your mom/a close girlfriend was there with you during the exam? I'd imagine most obs & midwives would be fine with this.
In my experience with pregnancy with DS, I honestly don't remember getting an actual internal exam until I got to the hospital in full on labor, though I'm sure I had a full exam not long before getting pregnant. The GBS test was a super quick swab and even the two internals I had in labor were very quick - feel the cervix and get out - kind of exams.
Have you looked into getting a midwife? I HATE doctors. I spent WAY too much time in the hospital as a kid and in addition to a vaso-vagal syncope reaction to needles, I'm not keen on the whole condescension and impersonal poking and prodding that typically takes place at a doctor's office or hospital. Depending on where you live, a home birth might be an option. And certainly if you live anywhere outside of the US (and I'm talking other industrialized nations, not just third world countries), it's the norm, and in some places with far lower risks of infant and maternal mortality.
I too had my first pap at 22 when I got married. The first one, I didn't feel comfortable with that OBGYN practice. I never went back there. When it came time for me to do it again the following year, I asked some ladies in my office if they recommended a practice. Two of my coworkers both recommended the same practice and the same nurse practitioner. I booked an appt with that nurse practitioner and it has been smooth sailing since. I always request that same nurse practitioner.
Try asking your coworkers or friends for recs.