Questioning the Value of Vaginal Exams in Late Pregnancy | Fit Pregnancy

Questioning the Value of Vaginal Exams in Late Pregnancy

10.01.10: Should you tell your doctor/midwife to keep her hands to herself?

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Shannon absolutely hates, hates, hates vaginal exams.  She’s pregnant with baby number two, due next month and says she’s dreading the onslaught of fingers in her vagina that start in late pregnancy and don’t end until after the baby’s born.  Her question:  What happens if I just say, “no?”

Good question, Shannon. Short answer – “nothing.”  As long as you’re not having complications that suggest premature delivery, infection, premature rupture of membranes, heavy bleeding or some other big problem, you can tell your doctor, nurses and/or midwife to keep their fingers outta there.  Vaginal exams aren’t absolutely necessary.  In fact, they don’t usually tell us all that much.

Dita says she’s pregnant with her first baby and due in two weeks.  She had her cervix checked today and is already one-and-a-half centimeters dilated.  That means she’s going to start labor soon, right?  Sorry, Dita, not so much. Women often dilate a little during their last few weeks of pregnancy with absolutely no promise of imminent labor. 

My doctors started checking my cervix at 38 weeks, announced it could “go any day now,” and then I waited on pins and needles, expecting the other shoe to drop. I hung out for weeks at three-to-four centimeters dilated and still went over-due with a couple of my babies.

So why do we do vaginal exams at the end of pregnancy if they really don’t change anything?  Well, they’re routine, that’s why.  Some people just to know what’s goin’ on.  The problem is, many women hate them and they don’t really indicate when labor is going to start.  They’re just a progress report of what the cervix has done so far.

I spoke with Catherine Harth, MD, OB-GYN and Associate Professor of Obstetrics and Gynecology at the University of Chicago about the necessity of vaginal exams.  Harth said, “There are some situations where it’s useful to know if a patient’s cervix is favorable [getting ready to labor]. For example, if her water breaks, but she’s not contracting and her group B strep test was positive. We want to know what her cervix was like at her last doctor’s visit. If her cervix was already dilating, we might want her to come into the hospital for antibiotics sooner than later.  If it was still closed, we might not need to rush.”

Harth continued, “There’s been some debate in the medical literature though about the utility of doing cervical checks in the last weeks of pregnancy.  If the patient is healthy, we know the baby’s head is cephalic [presenting head first in the birth canal] and it’s not going to change how we manage her care, it’s not absolutely necessary. In my own case, I was 2-3 centimeters [dilated] two weeks before I was induced.  I had a favorable cervix and it made me feel optimistic that things were going to happen sooner and then they didn’t.”

Some women don’t mind the exam at all and they like the update.  Seriously, the cervix is kind of mysterious and any clues about what it’s doing in there, in the dark, wher is appreciated.  That cervix is the mastermind behind labor after all.  It kind of runs the show and it’s nice to be “in” on its plans.  Women might hear their cervix is softening and dilating and they feel hopeful the end is in sight. They feel like their body is doing what it’s supposed to.  

Unfortunately, the news isn’t always encouraging. You might feel discouraged and anxious If you’re a week overdue, your cervix is tightly closed and showing no signs of opening soon.  That’s what convinced me I was going to be pregnant forever. I went a little nuts over this news.

So what should Shannon do?  Tell your doctor what you told me:  “I hate, hate, hate vaginal exams.”  Chances are good he’ll say, “Oh, OK, well, ummm, no problem.  Let’s not do it.”  If he insists though, ask why he wants the information and how it might (or might not) change your care.

Then, make your own decision about it.  It’s just like your Mama told you: No one has the right to touch your vagina without your permission. Does your no-exam policy make your healthcare provider’s job more challenging?  Maybe. Maybe not. Health care is not a cookie-cutter operation.  We customize care to the individual and if my patient tells me to keep my hands to myself, that’s what I’ll do. I won’t mind one bit either because I respect a woman who takes charge of her own business. 

Now, Dita honey, maybe you’ll go into labor right away but don’t call the cab to drive you to the hospital yet.  One-and-a-half centimeters is only about as dilated as your fingertip.  Think about how big your baby’s head is and you’ll get an idea of where you are now and where you need to go.  It’s entirely normal to be a little bit dilated weeks before labor starts.  That said, I’m a firm believer in getting your hopes up and I know from experience no one’s ever been pregnant forever.  And whether labor starts tonight or in three weeks, it’s guaranteed, your baby will be born at exactly the right time, right on his birthday.

Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to labornurse@fitpregnancy.com and it may be answered in a future blog post.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.

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