During pregnancy, you’re likely to have a number of prenatal check ups with your care provider.
These check ups are to monitor your health and wellbeing, as well as to check on the growth and development of your baby.
Some doctors and midwives offer pelvic examinations as part of their prenatal care.
Although there are reasons why a vaginal examination might be necessary during pregnancy, it’s still an intervention, and every woman should know the risks and benefits before having one.
If you've talked to experienced mothers, you might assume prenatal vaginal exams are a normal and necessary part of care. While there are cases where vaginal exams can be helpful prior to labour, in a healthy term pregnancy they don’t usually provide any necessary information.
How Is A Pelvic Exam Performed?
When you have a pelvic examination, you remove your lower clothing and lie on the table. The care provider places a gloved index and middle finger into the vagina and assesses the cervix. This can feel uncomfortable, or even painful, and some women find the examination distressing.
The care provider feels how soft or ripe the cervix is, and whether there’s any thinning (effacement) or opening (dilation) of the cervix. The position of the cervix is also assessed – whether it’s posterior (facing toward the tailbone) or anterior (toward the front). Other details may be noted, such as how far into the pelvis the baby has descended, if at all, and which way the baby is facing (presentation).
Why Are Pelvic Exams Offered?
In most cases, an examination – to do a pap smear and other tests – will be performed early in pregnancy. If there are no complications during pregnancy, usually there will be no further exams until around 36 weeks. After this time, it’s common for practitioners (especially in the US) to do exams at every visit during the rest of the pregnancy. The rationale for this is to check for changes to the cervix and to determine whether labour is imminent.
Some practitioners want to do a vaginal examination at every prenatal visit during pregnancy. Unless there are compelling medical reasons, this isn’t necessary.
Medical Reasons For a Pelvic Exam During Pregnancy
- History of infertility
- Gynaecological problems
- Painful intercourse
- Suspicion of cervical problems, such as scarring or premature labour
- The need to check how favourable cervix is, if induction is necessary.
Can A Pelvic Exam Indicate When I Will Go Into Labour?
One of the things an assessment of your cervix cannot do is determine the day and time you will go into labour. In fact, research has discovered there’s a particular substance, secreted by your baby’s lungs, which triggers labour. So your cervix is definitely not a good indicator of what might happen in the future.
A cervix that is soft and dilated today doesn’t suggest that tomorrow or the next day it will ripen or dilate more. Often pregnant women can be slightly dilated (1-2cms) for weeks before labour actually begins.
Cervical dilation is dependent on factors that are beyond our control. Many women experience a long prelabour and a fast active labour – where the early labour has done a lot of the work of ripening and softening the cervix, and dilation is fast. Other women might have many hours of labour before the cervix is dilated. A cervix that’s high, tight and closed one day might start to thin and dilate the next.
Are There Risks In Pelvic Exams?
Although the care provider is using a sterile glove, there’s a chance of bacteria from the vagina being pushed up into the cervix. This increases the risk of infection of the membranes of the amniotic sac, which is a serious complication.
There’s also the risk of stimulating the cervix and rupturing the membranes (PROM). If you are not due, or your baby is not ready to be born, this can lead to more interventions during labour, such as augmentation of contractions, continuous fetal monitoring, induction, or even c-section.
There are also psychological aspects of pelvic exams. Many women who are told they are so many centimetres dilated, with a soft, ripe cervix, expect to go into labour immediately. Yet days pass and they’re still pregnant. This expectancy and disappointment can lead them to give consent to, or request, an induction.
What If My Care Provider Tells Me I Must Have A Pelvic Exam?
If your care provider insists on a pelvic exam, it’s important to know why. Ask for the specific reason for the exam, what it aims to find out, and how it will alter anything for your pregnancy or birth.
If you aren’t convinced there’s a good reason for a pelvic exam, then you are within your rights to decline it, or to request a second opinion.
If you decide to go ahead with the exam, make sure your bladder is empty, and that you are warm, comfortable and properly covered. Your privacy must be ensured and no extra staff should be present unless you wish. Breathe deeply and relax your pelvic floor muscles to limit discomfort.
Having a pelvic examination during pregnancy should be something you decide only after having all the facts. You should understand why the exam is being suggested, what your care provider hopes to find out, and how this information will help. The procedure must be explained to you and your informed consent must be obtained.
Recommended Reading: What Causes Labour To Start? and “Sorry You're Not In Labour” – How To Deal With Those Words.