The Myth of Vaginal Exams 6


Are routine vaginal exams in pregnancy necessary? I am here to tell you, emphatically, that no they are not!

Goblin Valley

As a midwife, I tend to cringe at the very nature of any intervention being routine or necessary for every client.Routine vaginal exams to assess your cervix during pregnancy are one of my biggest pet peeves.

Let’s examine why.

1. They are invasive: having a provider put their fingers inside your body, even when done with care and respect is invasive.

2. They are uncomfortable: having to lay on your back on an exam table, with your legs open, followed by the actual procedure that is also uncomfortable makes the whole situation undesirable and awkward to say the least! Now, sometimes as a health care provider, I have to do things that are uncomfortable or even temporarily painful. When that happens I better have a really good reason to do so;

A. the intervention better be necessary to guide my decision making process OR

B.to directly intervene for my clients safety and health.

Routine vaginal exams in pregnancy do not fit into either category.

For example, I have known a cervix to be long, firm and thick and have that client go on to have a baby several hours later. Conversely, I have known a cervix to be 3-4cm dilated, soft and stretchy and have that client not give birth for weeks. The point here is that your cervix is not a good fortune teller, it cannot accurately predict when you will have your baby. It is a snapshot in time and only tells us about that particular moment.  For all of these reasons, routine vaginal exams in pregnancy are not necessary. You will go into labor and birth your baby all without needing to have your cervix examined.

My practice has been open for 10 years and we have welcomed well over 2,000 babies to the world. All without routine vaginal exams during the pregnancy! With all that being said, there are some clients who will request an exam. If after a discussion about all of the above the client still desires one, we will oblige of course. In this case, it is their choice after informed consent and it can be empowering.

 

Are vaginal exams necessary in labor?

This answer is a little more complicated and does not have a strict black or white answer. Remember that these exams are invasive and uncomfortable. Then remember that with that type of intervention, your care provider should have a good reason.  Keeping these things in mind, there are times in labor when your provider may need additional information to guide your care and vaginal exams may be part of that plan. However, they should be performed respectfully, with permission and after an explanation of why it is necessary at that particular time.  I find it helpful to have the lights dimmed and to make sure the pregnant person is ok with all the people who are in the room. More people, whether other care providers or family members do not help and should be politely asked to leave.

That being said, it is also 100% possible to be in labor, give birth and never have a vaginal exam;

Claire had been woken up, the morning she turned 37 weeks, by the sensation of her water breaking.  The fluid was clear and the baby was moving well.  At the beginning of her pregnancy she had tested positive for GBS (group beta strep) in her urine, so she and her husband came in for an evaluation and a dose of IV antibiotics.  When they arrived, Claire was not yet having contractions.  Everything checked out good; her waters had definitely ruptured, the fluid was clear, baby and Claire were both doing great.  I started an IV and gave her a dose of penicillin.  Since she was not yet in labor I did not do a vaginal exam.  Claire and her husband then went back home to have some breakfast.  Four hours later, they returned to the birth center.  Again, everything checked out good and I gave Claire her next dose of antibiotics.  Because she was GBS positive, we talked about encouraging her labor to start.  Claire and her husband both agreed that they would like to get proactive.  I sent them home again, this time with some herbs.  I did not do a vaginal exam.

Another four hours passed, Claire and her husband returned, and they were joined by their 5 year old son and Claire’s mother.  It was obvious that things had shifted and Claire was starting to labor.  She was in that sweet foggy stage of early labor, when women seem to be floating above the world, mildly aware of what is going on around them but not being fully present either.  I gave her the next dose of antibiotics and we all settled in.  In a short time, Claire shifted again, moving into the active phase of labor.  It was lovely to watch.  She was supported wonderfully by her family and she easily let go to the process.  She moved well, walking around with the contractions and swaying with her husband.  Eventually, she asked to get in the birth pool.  Very shortly after sinking down into the water she began grunting at the top of her contractions and then proceeded to birth her sweet 7lb 2oz. baby boy into the world.

And all of this without one single vaginal exam!  A couple hours after the birth, Claire and I were talking about it.  She asked why I never did one and I told her that besides the fact that her waters were ruptured, I didn’t need to do one.  It was clear that her labor was progressing and I did not want to disrupt the flow of that progress.  Claire said that during her labor, she briefly wondered why I wasn’t checking her cervix but then reasoned that I knew what I was doing and let the thought pass.  It is important to remember that there are so many ways, other than a vaginal exam, to assess labor progression.

As a midwife, sharp eyes, clear ears and an open heart are just as valuable when serving our families.

To wrap it all up. Routine vaginal exams during pregnancy are not necessary, for some pregnant people they may be helpful but it should be their choice. Vaginal exams when you are in labor may be necessary and helpful for your provider to guide decisions about your care. In both cases, the exam should be done thoughtfully, with care and privately. When you are choosing a provider, it is very reasonable to ask them about their thoughts on this topic. How they answer will give you some insights into their overall philosophy.

Did you receive routine vaginal exams? If so, were they dine respectfully and with informed consent?

Image credit Aubre Tompkins, CNM


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6 thoughts on “The Myth of Vaginal Exams

  • Katrina G.

    Since I shared this on social media and I thought I’d stop by and share a thought here too!
    I had several invasive and painful vaginal exams with my first birth both from my provider and nursing staff. It was a terrible experience…that I considered getting an epidural just to not feel the VEs anymore rather than for the traditional reason for epidural. They were uncaring a rough. That was an all-around traumatic experience for both me and my son for many reasons.
    For the birth of my second child, my partner and I made LOTS of changes about the way we went forward preparing and planning. I’ll never forget the day I chatted with my midwife about the necessity of vaginal exams in my upcoming labor, she had been so supportive about all my wishes for birth, but I was certain there was going to be no way to avoid VE, much to my surprise, she responded, with “why would we randomly do unnecessary exams?!”, “if there comes to a point where we need to, then you’ll let me know, but until then, I’m hands off and this is all about doing what you need to do.” It was such a relief!!
    It was such a great, healing, and empowering birth for many reasons, and not doing a single vaginal exam definitely kept me in the flow and helped me to feel safe, so I could just go with my body and not have to worry about re-living the trauma of the first experience!
    Thank you for writing this blog with boldness to speak the evidence and clarity!!

    • aubrekate Post author

      Katrina,
      Thank you for sharing my piece and you are welcome. I strive to speak the truth even though sometimes it is not popular. I am grateful to hear of your healing and empowering experience with your second birth and am sorry, though unfortunately not surprised, to hear about your first experience. Stories like that are why I do what I do, both in practice and through my writing.

  • Fiona Hermann

    In NZ vaginal exams are never done in pregnancy by either midwives or OBGYN. Why would you?? It seems a very “American” thing. Unless it’s to gauge ripeness for IOL what’s the indication ?

    • aubrekate Post author

      Fiona, yes unfortunately in most “mainstream” American maternity care, vaginal exams are done routinely during the last few weeks of pregnancy. As a midwife, I feel strongly about this not being good practice and try to educate women in my community about it and empowering them to decline. I am glad to hear that this is rare in New Zealand!