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.