The Vaginal Exam During Labor: Is it Necessary?

The vaginal exam is an over-used procedure that is a disruption of the laboring woman's process.

The internal exam to check cervix dilation is one of the most common procedures done on a laboring woman. Its usefulness is rarely questioned.

What Information Does a Vaginal Exam Provide?

  • A vaginal exam is used to check the cervix dilation or how open the cervix is. During labor the cervix goes from closed to around 10cm (some woman probably open more and some open less).

    What many women don't know is that a few other things can also be discovered by doing a vaginal exam.

  • The first is effacement, or how thin the cervix is. Effacement is represented in percentages from 0-100%.

  • The second is the station of the baby or where the baby's presenting part (usually the head) is, in relation to the ischial spines of your pelvis.

    For example, a -4 means that the baby's head is still very high up in the pelvis, 0 means that the baby is level with your ischial spines(also called "engaged"), and a +1 or +2 which means the baby's head is coming down the birth canal.

  • Usually the position of the baby's head can be ascertained from an internal exam. Your caregiver should be able to tell you if the baby is facing posterior or anterior--towards your back or away from your back. Ideally, you want the baby to be facing your back.

If you have a vaginal exam done ask your caregiver for all four assessments.

All three of these things effacement, dilation, and the baby "engaging" begin to happen in the last weeks of pregnancy. Very often women don't know they are in labor until they are a few centimeters dilated.

Keep in mind, all of these measures are just estimates. Each person's fingers are a different size and everyone measures slightly differently. This is why the same woman can be checked by a doctor and then by a nurse and have varying results.

Often caregivers will report dilation this way, "You're between six and seven" or "you're a stretchy nine". Checking labor progress by a vaginal exam is not an exact science.

Cervix dilation can go very quickly or very slowly. For example you could be at a 3 and then suddenly progress to 10 within an hour. Or you could be at 8 or 9 and still have hours left to go. In other words, an internal check doesn't tell you how much time you have left to labor.

DIY Vaginal Exam

Imagine! YOU CAN DO YOUR OWN VAGINAL EXAM! (And most of your own prenatal care for that matter, but that is for another article) Some women are squeamish about this. But, trust me it is a good thing to become intimate with your body before you push a baby out of it!

Try this before you are in labor.

1) Reach up with two fingers into your vagina until you can't go any farther.

2) Spread your two fingers apart and you will be feeling the edges of your cervix. If you are not effacing and dilating it will feel more like the tip of your nose. If your cervix is starting to thin it will probably feel more like your lips.

3) If you can insert one finger into the middle of your cervix then that is approximately one centimeter, two fingers is two centimeters and so on. Ten centimeters (on my hand) is when my first finger and pinky finger are spread like a "y".

Get familiar with what your cervix feels like before labor and then you will be able to tell when it starts to change.

You can also have your husband or partner do this if you like.

Alternatives to the Vaginal Exam

An internal check doesn't really tell you much that can't be ascertained in other ways.

Behavioral Signs:

The behavior of the laboring woman/mother is the clue as to where you are at in labor. Experienced midwives will know the behavioral signs.

  • You can make a good guess as to where you are in labor without doing an internal exam. In early labor you can still focus on other things and do other things. You will be able to talk through contractions.

  • As labor progresses your focus starts to move more inward and you will usually just want to focus on your labor. During contractions you will not be able to talk.

  • Transition is when you begin to feel like it should all be over and done with. Some women say this is when they feel they can't go on or that they want pain meds. You might become indecisive, or frustrated and angry at those around you. You are not sure what position you want to be in and NOTHING FEELS GOOD and NOTHING IS HELPING.

  • You begin to feel like pushing but you're just not sure what to do or where to go this is ALL JUST SO INTENSE.

Physical signs:

  • A purple line between the buttocks. It goes higher up as the cervix dilation increases.

  • Contractions will be visibly stronger, the uterus will rise up farther.

  • A catch in the back of your throat and a feeling like you're throwing up except you're "throwing down". Your uterus, diaphragm, and whole body begin to push the baby down.

  • Feeling like your pelvis is going to BREAK IN HALF

You won't need anyone to tell you that you're about to have a baby! In fact if anyone talks to you at this point you might just FEEL LIKE SMACKING THEM or better yet you won't hear them anyway--you'll be so deep into your own internal process.

Negative Side Effects of the Vaginal Exam

  • It can be discouraging if you are not as far dilated as you hoped or it can give you false hope when in fact you may have hours to go.

  • If done during the end of pregnancy, it can give false hope for the same reasons. You can be dilated several centimeters and not go into labor for weeks or not be dilated at all and give birth within a few days.

  • It can be uncomfortable. Most caregivers will want you to lie on your back to do an internal exam. Aside from the discomfort of having a stranger's fingers stuck up your vagina, lying on your back in labor is NOT COMFORTABLE!

  • Vaginal exams increase the chance of infection especially after the amniotic sac has broken. Bacteria gets pushed up the birth canal with every exam.

  • It is possible to cause the amniotic sac to break prematurely.

  • It is an intrusion into your personal space. It pulls you out of your internal birthing process and intuitive knowing.

When a Vaginal Exam Might be Useful

  • Sometimes an internal check is useful when it is suspected that the baby is presenting in a less than optimal position--like breech or posterior or with a hand up by the head.

    If you know the baby is in one of these positions then you can take take steps to help the baby move to an easier position in which to be born.

  • Medicated births would be the exception as well. If a woman does not have a natural birth and has received an epidural or other drugs the normal behavioral signs of labor progressing are not evident.

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