If you’re new here, you might want to catch up on the Why Didn’t Anyone Tell Me? series.
Hello, my name is Amy. I’m 37+ weeks along with my 4th baby. I do not know how far dilated I am. I do not know if I am effaced. I do not know the station of my baby. I do not know, because it doesn’t matter!
With much trepidation at my 32 week appointment, I finally gathered the courage to tell my new doctor about my strong aversion to vaginal exams. It went something like this:
Him: Any questions?
Me: Well, yes. {said in my best trying-to-be-confident while rambling voice} I’ve never had a vaginal exam done until I’m well into labor because from all my research I know they are almost always unnecessary and I see no reason to go through the discomfort all for false hope or false discouragement because I’ve known people to walk around at a 4 for a month and other people be completely closed one day and have the baby 12 hours later, and then there’s the risk of infection or inducing labor so you don’t need to do them, right?
Him: {grinning at my obvious discomfort} Actually, it’s refreshing to not have to convince a patient that vaginal exams are unnecessary. I don’t do them if you don’t want them done, because vaginal exams provide useless information. There is no need for them in most pregnancies.
Me: {internal happy dance}
I’m a never say never kind of girl, and I know that there are circumstances where a vaginal exam might provide necessary information… maybe you’re way overdue, you’re trying for a v-bac, you think you might be in early labor and you live hours from the hospital, etc. but in the vast majority of normal, healthy pregnancies, vaginal exams are not necessary or helpful.
The Myth of the Vaginal Exam in Pregnancy explains it much better than I do.
…The common belief is that by doing a vaginal exam one can tell that labor will begin soon. This is not the case…
…Many people try to use the information that is gathered from a vaginal exam to predict things like when labor will begin, or if the baby will fit through the pelvis. A vaginal exam simply cannot measure these things…
…Labor is not simply about a cervix that has dilated, softened, or anything else. A woman can be very dilated and not have her baby before her due date or even near her due date. I’ve personally had women who were 6 centimeters dilated for weeks before labor began. Then there is the sad woman who calls me to say that her cervix is high and tight, she’s been told that this baby isn’t coming for awhile, only to be at her side as she gives birth within 24 hours…
…Vaginal exams can increase the risks of infection, even when done carefully and with sterile gloves, etc. It pushes the normal bacteria found in the vagina upwards towards the cervix. There is also increased risk of rupturing the membranes. Some practitioners routinely do what is called stripping the membranes, which separates the bag of waters from the cervix. The thought behind this is that it will stimulate the production of prostaglandins to help labor begin by irritating the cervix, causing it to contract. This has not been shown to be effective for everyone and does have the aforementioned risks…
(click over for the full article)
It’s your body, your baby, your birth. For me, I’m thinking if it’s not helpful… if it’s not necessary… if there are risks… well then, just back away from my cervix!
Are vaginal exams routine with your prenatal care? Has anyone ever told you they aren’t a must-do?
Linked to Works for Me Wednesday
ROFL!!! I had to read this just for the title! I know for a fact my ob would lie – tell women they were farther along than they were because he thought that is what they wanted to hear. I don’t like to be checked any more than is necessary either!
Love it! There were so many things I didn’t know with my first two. I was much wiser with the second two.
HOW REFRESHING!!!! It is so nice to hear from someone who feels the same way! I am 36 weeks along with baby #5 – we’re doing a homebirth this time with some fabulous midwives. And, what a gem of a doctor you have there – it must have made you feel 100X better when he answered you like that!
Love it! If you’re curious, you can check yourself. Most women can reach- checking cervical position is a common part of NFP.
I totally agree with you! What I don’t know if how great I’ll be at convincing my OB of that as it gets closer to delivery, but I’m going to try. What I have been able to do during my pre-term labor checks (we’ve had some scares & I’m a high-risk pregnancy) is get them to only do the finger part of the exam and not the speculum part. Hopefully this will cut down on risk of infection.
My midwife didn’t do exams unless I asked. Although she did acknowledge that doing one was helpful to her in that it gave her the, ahem, “lay of the land” before she had to deal with stitching me up.
In my case, I was induced after spending two weeks dilating from 4 to 6 without any sign of real labor coming on and an ob itching to send me for a C-section.
My 2nd daughter was born very quickly and I had a great midwife…and no internal exams til after baby was born.
You know, I never thought they weren’t mandatory! Of course, they shouldn’t be!
I remember with my daughter, I bled after each exam. It hurt and scared me!
I’m glad you found a doctor who has the same thoughts about it as you do!
Wow with my first baby I was admitted at 27 weeks and it was clear from the first moment I was there I would not be having a natural delivery, so i never had an exam. BUT up until then I thought “how freaky my doc has never done an exam, am I getting sub par care?” Of course I never mentioned it because I didn’t really want an exam. Isn’t it crazy what our perception of what is “normal and expected.” I wonder why docs don’t just say up front it’s useless in most circumstances…I’d have gone to each OB appt much less anxious!!!
I just had to click on this link from WFMW. Just to see what it was about.
Thanks for sharing. I had one exam I think, and now I cannot remember why. I chose a midwife though and we did all exams at her Birth Center. I even had my Princess there. We were home within three hours in our own bed. I loved it. All natural, no drugs. 
Blessings!
LaVonne
Like so many others, I always assumed those exams were just “par for the course”. That said, I walked around 3 cm dilated and 90% effaced for over a month with my first. I even had some silly restrictions as a result for a couple weeks because of the “chance I could go too early”. He was born 1 week past his due date.
Now… my second arrived at 24 weeks and, yes, they did check me when I started bleeding heavily. I don’t fault them for that and I’m glad they did. I was checked once with my third- right before the surgery. Love this post and what it might do to help so many women avoid unnecessary discomfort OR getting their hopes way up! (Oh, also, it annoys me that more babies are induced if women’s bodies haven’t “progressed” enough on their own… it happens differently for every woman! But don’t get me started on inductions… 
)
i started cringing when i read the conversation with your Dr. literally, my body tensed from my knees up to my abs. because with both pregnancies i had exams late in the game to check for dilation & station etc. and they were THE MOST PAINFUL exams ever. in both instances, however, i went into labor less than 24 hours later…coincidence? i don’t know. i do know that i recall the exam to check for labor being more painful than labor itself.
great post. i’m due in 2 weeks and supoose to be checked next week. I might now tell him I dont want to be checked. If i’m dilated, it will probably get my hopes up. i’m already very anxious to have him born.
Thanks for the great post
Hahaha! Love it Amy. With my first pregnancy it was the norm to get a vaginal exam at every visit past 30 weeks. Not fun when you start going every two weeks.
However, with my second pregnancy I was surprised when my doctor didn’t do one until the appointment before I went into labor. Every doctor and midwife is different, but I prefer when they don’t need to get all up in your business all the time. 
My water broke with my first at 38 weeks. About 12 hours after I was checked. Yes, he was ‘full term’, but I would have like it more if he came on his own time – not booted out like a tenant that didn’t pay rent!
I never got checked with my second.
What a blessing to work with a doctor who is that honest with you! Praying for a safe delivery!
I had both my girls at home & wasn’t checked till I was in active labor.With my last, my midwife arrived & after checking me said I was fully dilated & the baby was just inside! She was born 10 min. later!
Great post! For our birth preferences list (preferences seem to be easier for docs to follow than plans), we asked that after an initial check when we got to the hospital that we not have vaginal exams unless we asked for them.
I figure that then it becomes more of a game of how long can I wait to find out, supported by DH and our doula, then being disappointed or getting put on a clock based on dilation.
I could handle saying that to my doctor, but my mom couldn’t. If I don’t call her within 30 minutes of leaving an appointment to report my “progress” those last four weeks of pregnancy, she comes unglued. She also is sure to talk to me twice a day for the last two weeks of pregnancy, to see if anything else is happening. I can’t imagine telling her that I wasn’t going to have any vaginal exams until I was in transition/ready to push…or none at all!
My doctor does NOT routinely do exams. I am the envy of my childbirth class.
Shockingly, I had an entire pregnancy, birth and postpartum without anyone ever sticking anything in my vagina….
Ick! I hated those suckers!
Too late for me….I’m a million years old now!
My babies are teen/college age! Bummer!
Goodluck to you though!
We had our hospital tour a couple of weeks ago and they told us that they do one check when we arrive and if we aren’t at 4 cm, they’ll tell us to walk a few laps around the hospital and come back later. Other than that, they don’t do exams unless we ask for them (or we run into complications). I literally felt the tension leave body when I heard that.
It’s so refreshing to read an honest treatment of this topic, both about how it makes you feel and about whether these exams are truly necessary. I had a couple in my last month of pregnancy, and they really didn’t bother me; I was on a downward spiral of ever-worsening complications, and we needed to know whether my body was prepping for labor so we could decide between induction and C-section.
What I HATED were the exams during labor. I understand why the nurses did them, but I still don’t think they were completely necessary (at least, not all of them). But sometimes you pick your battles–we let it slide to gain concessions in other areas that were more important to us.
I never had to worry about getting a vaginal exam done because I had placenta previa, so I couldn’t have one. My doc emphasized to me that if I went into labor or had any bleeding, I should go to the ER and tell them to give me an Ultrasound, NOT a vaginal exam.
My doc also only examined my belly once, and I think that was at about 36 weeks. I thought that was strange, but I guess since I had so many Ultrasounds because of PP, it wasn’t really necessary to feel me up much.
Great post, Amy! I love your provocative title and the way you approached this topic.
I had my first baby with an OB as a caregiver – and I was checked every week from 36 weeks on (maybe even before then). Agonizingly, I was also checked numerous times during labor (painful!).
With baby #2, I chose a midwife as a caregiver…and they never checked at all during my prenatal care…and only once when I was in labor. Needless to say, my second experience was so much better.
I’m glad that you’re sharing this information so first time moms can make informed decisions.
I never really thought about this before – I went to a midwife practice where the internal exams were kept to a minimum. I think I had ONE during pregnancy and one right before birth… now that I’ve read this I am wondering if next time I can ask them just not to do one at all – I’m not sure what they would think!
I hate the vaginal exams! At 37 weeks when I was having consistent contractions I was sure that I was going into labor. I had three different nurses come in and give me a vaginal exam to tell me that I was dilated to 2 cm. Then my doctor comes in and does a vaginal exam to say, “your closed, you can go home!” I was very upset! They gave me a pain shot and sent me home. I was still having contractions and I’m 38 weeks. I’m walking, having sex, etc. trying to get this baby to come out but still no dilation! I don’t know what’s wrong with me! I’m in continuous pain though!
Oh, you poor thing.
I hope you get some relief soon, and that your sweet baby will be cozied up in your arms!
With my third and most recent baby (born a week ago), I didn’t have a single internal exam. In retrospect I should have allowed one in the final 45 minutes of labor to make sure I was fully dilated, because I wasn’t quite (they think) and my son came down quickly and ended up dragging my cervix partially outside my body. The round ligament pain that’s resulted in during recovery is NOT fun. If I’d waited another 10 minutes I could have saved myself most of the pain I’ve had in the last few days here. But I saw no reason to have any earlier than that, nor do I now. I did check myself on occasion, especially if I was having any cramping late in pregnancy but too soon for baby to come (like around 35 weeks or so). Baby was born on his due date.
Ouch ouch ouch! I never had one, even in labor, with my third, because my labor was so (comparatively) easy. I was walking around one minute and pushing the next. It was wild! (And that’s when I knew how NICE it was to labor with the bag of water intact!)
Thank you so much for this article! I always get so stressed before vaginal exams, to the point where I’m sweating buckets waiting for the doctor. I had pretty good experiences using a regular OB for my first two, but if/when I’m pregnant again I definitely want to look into using a midwife!
I think so many people just “expect” them when they’re really quite avoidable.
I just clicked over from Simple Organized Living. I think your post is another interesting point in the difference in care provided in Canada vs the US. I am pregnant with my fourth baby and the only exams I ever have done in the office are at 36 weeks when my GBS swab is done. I think that is the case pretty much across-the-board here. And as a labor and delivery nurse I can tell you that there are far less interventions here than there (although of course often still far too many). I am always so intrigued by all the differences right across the border between two first world countries.
Great post, by the way.
That comment may make some ladies want to cross the border for delivery.