Vaginal Examinations – 7 Things You Should Know

Vaginal Examinations - 7 Things You Should Know

Vaginal examinations (VEs) are considered by most hospitals as an essential maternity care practice and procedure.

They are conducted to assess a birthing woman’s ‘progress’ during labour. Most women will be given a vaginal examination on admission, and then every four hours routinely.

Vaginal examinations can be seen as less harmful than induction or episiotomies. Women are given the idea that a vaginal examination is a useful way for her carergivers to make informed decisions about how to support her during her labour.

Yet most women are not aware that this ‘simple’ procedure can have a negative impact on how they labour.

A Cochrane review on the use of partograms (chart plotting labour progress) concluded there was no evidence to support or reject the use of routine vaginal examinations in labour. There was also no evidence that routine vaginal examinations in labour improve outcomes for mothers or babies.

Here are 7 things you should know about vaginal examinations:

#1: Are Vaginal Examinations Necessary?

Clinical guidelines on vaginal examinations indicate that your caregiver should only suggest one if it will benefit you in making decisions about your care.

Vaginal examinations when you arrive at hospital aren’t necessary. Most hospitals advise not going to hospital too early, as you could be sent home until labour is established. If you stay you are at increased risk of interventions. Without saying it outright, this is a big admission that you will be ‘on the clock’ and if your labour doesn’t progress according to hospital policy timeframes, you may end up having interventions to speed labour up.

#2: Informed Consent

As with all medical procedures, you must be asked for your consent to have a vaginal examination every time. Before you decide if you will consent or refuse a vaginal examination, your doctor/midwife should:

  • Tell you why they want to check your cervix
  • Inform you what is involved and what it may feel like
  • Reassure you that the vaginal examination can be stopped at any time
  • Let you know someone can be with you
  • Ensure your privacy is maintained

In most cases, women are asked if the midwife or doctor can do a vaginal examination to check how far long in labour they are. This is not asking for informed consent. Read this article for more information on when doctors don’t listen.

#3: Vaginal Examinations Don’t Predict The Future

What your cervix is doing at the time of a vaginal examination is not a predictor of future dilation, nor when you will birth your baby. While telling women that they should relax and go with labour, the underlying message is that labour needs to conform to a particular expected timeframe, rather than accepting all women labour in their unique way. A woman who is 4cms may dilate completely in less than an hour, when others may dilate very slowly until 7cms, then complete dilation in a hurry. Measurements do not indicate how labour will unfold. Also, cervical dilation does not occur in a round, uniform circle fashion.

#4: Vaginal Examinations Can Interrupt Labour

During labour, your body produces oxytocin, which causes contractions and dilates the cervix. During this stage of labour, you need a calm, private and safe environment, with supportive carergivers, so that you can access the part of your brain that allows labour to progress normally for you.

If you become distressed or upset, your body will produce noradrenaline, which counteracts oxytocin, effectively slowing down or stalling labour. VEs can be painful and invasive, at the very least disappointing when you have been labouring for some time and hear a number that doesn’t equate to progress in your head. In these situations, your fight or flight response can be stimulated, slowing or stalling your contractions – even reversing cervical dilation.

#5: Vaginal Examinations Increase The Risk Of Infection

Every time a VE is done, there is the potential for bacteria to be pushed up the vagina and toward the cervix. This is especially a concern if the amniotic sac has released, as there is no protection for your baby against potential infections. It is not uncommon for membranes to be ruptured during a VE, which then brings other risk factors into play, such as cord prolapse.

#6: The ‘Feedback’ You Get Following A Vaginal Examination Can Be Discouraging

Most of the information you read during pregnancy discusses labour in terms of dilation – when you are 4cms you are in established labour, when you are 8cms you are approaching transition, full dilation will happen at 10cms. Of course cervical dilation is the first goal of labour, but measuring it constantly promotes the pervasive view that your body can’t be trusted to dilate without being checked on.

Hearing ‘you are only 4cms’ might be devastating for a woman who has laboured for 7 hours, and she may feel she can’t continue without interventions. Hearing a number when you have done crazy maths in your head that you should be X cms by X time can feel very discouraging.

#7: A Vaginal Examination Is An Invasive Procedure

After all someone, most likely a relative stranger, is inserting their fingers inside your vagina and feeling around. They can invoke many feelings, such as pain, discomfort, embarrassment, vulnerability, lack of control, violation. VEs can trigger past negative memories, especially for women who have been victims of sexual abuse.

Women who chose not to have vaginal examination often have a history of abuse and it takes a lot of courage and trust to share their past with their caregiver. They are placed in a position of extreme vulnerability when confronted with the prospect of having a VE and are often distressed because being compliant triggers off memories of previous assaults.

Disturbingly, stories are emerging from women who have experienced being denied admission to a birth suite or access to natural pain relief (bath, shower etc.) until they have a VE to prove they are actually in labour.

Even if a woman agrees because she wants to use the birth pool or doesn’t feel safe leaving the hospital, this is coercion and not informed consent. We start treading into dangerous waters when women are undergoing medical procedures in order to gain access to support and assistance during their most vulnerable hours of labour.

Vaginal examinations are only hospital policy and are counterintuitive to the ideal of natural birth. Midwives and doctors can observe a woman’s behaviour and be assured that labour is progressing as it should for that particular woman. It is worth noting that staff are only required to offer VEs according to their hospital’s policies, not to do one without consent. If you wish to avoid VEs, ensure you discuss this with your caregiver and support people before labour begins. Consider a doula to be with you during labour, to ensure you are well supported and have all the information you need to make informed decisions.

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Last Updated: March 9, 2016

CONTRIBUTOR

Sam McCulloch enjoys talking so much about birth that she decided to become a birth educator and doula, supporting parents in making informed choices about their birth experience. In her spare time she watches Downton Abbey and has numerous creative projects on the go. She is mother to three beautiful little humans.


5 comments

  1. VEs are important to give an idea about progressing during labour but they are painful after episiotomy because of stitches .

    1. That is what most are led to believe but if you read the article you will see the evidence against this common view. There are many non-invasive ways a care provider can monitor progress that don’t carry the same risks as VE’s.

  2. From a healthcare worker standpoint, an admission VE is extremely important, as it guides the care the patient will receive. She has come to my facility requesting care, now I must assess her to provide it. Is she 3cm and we carry on? Or is she 8 and on her 3rd child and I need to get her chosen provider at her bedside for delivery? They may not be in the building.
    Also, what part is presenting?
    The day a patient arrives with fetal heart tones down due to a prolapsed cord is a horrifing day, indeed. If there is a missed opportunity to help a baby in need due to the discomfort of an admission VE….
    After my initial wellbeing assessment, it really makes little difference to me. I just document declined and provider informed.

    1. If there is reason to suspect a problem, then I think it would be warranted. But unfortunately, healthcare workers do not see enough normal, physiological births. You can learn so much from observing women during a normal labour. I really wish it was part of their training to see homebirths. These women learn, learn, learn and trust, trust, trust. They work so well with their bodies. I think because there is no continuity of care in hospital, this makes the observation impossible, therefore the need to resort to tools and measures.

  3. I have found this article very helpful as I went through a long and protracted 3 day labour and was subjected to numerous painful vaginal examinations which i believe hindered my progress and traumatised me. My waters broke on a Tuesday morning but I only dilated 2cms in 3 days, I was inserted with 2 induction tablets that did not dilate my cervix but brought on contractions, so I was in pain but not dilating. to add to my extreme discomfort, the doctor conducting the examination had really fat fingers and was not gentle, it was a horrible experience and after 3 nights in hospital they finally injected me with oxcitocin and I delivered within the hour.

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