Why is an internal exam so bad?!

[Smoke Jaguar]

FWIW I never once had or was offered an internal until I was in labour. So I don't know why you think that it's routine? I have seen MANY different OB's and MW over the course of all 3 pregnancies (more than I can count) and it wasn't even mentioned.

Mel's right - internals haven't been 'routine' for quite some time across the profession. I've only heard of some 'old schoolers' who still do internals and present them as 'routine' or even expected to patients. Your 'people' are probably concerned that this might be how an internal has been presented to you, too, because there is no medical necessity for it otherwise.

[Taurean]

Mel's right - internals haven't been 'routine' for quite some time across the profession. I've only heard of some 'old schoolers' who still do internals and present them as 'routine' or even expected to patients. Your 'people' are probably concerned that this might be how an internal has been presented to you, too, because there is no medical necessity for it otherwise.

Maybe it is more common in the OB world then as most of my friends have seen private OB's for their pregnancies. This could explain why my two midwife friends questioned it but it still doesn't answer why they think it is so bad that I have asked for the internal - not the OB. I honestly think it is just another case of my midwife friends V's the OB. I've copped it quite a bit, especially from one of them, throughout my pregnancy. It's just driving me a little nuts as I really like my OB and am very pleased with my choice of care.

[Toomanytoomany]

Here are my thoughts on internals for no clinical reason:

1. They don't give you any useful information. You may walk around effaced and 3cm for weeks - it doesn't mean anything. You can be long and closed on Friday night and in full labour on Monday morning. It really doesn't mean anything. You might be elated to find out you are a bit dilated, but then still be here three weeks later. That is terribly depressing.

2. It has risks. When you are dtd with your partner, it doesn't generally involve lots of poking around inside the cervix. Before labour, your cervix is quite posterior and this protects it from some of the excesses of intercourse. There is a small risk of infection with an internal, a risk of premature rupture of membranes, and as someone said, it can also be the beginning of a cascade of interventions (even if that is just, "Well, you are really ready to go, why don't we break your waters if you aren't in labour by your due date?").

3. If you are already having a lot of Braxton Hicks, an internal can stir things up uncomfortably, even for days afterwards, leaving you mentally and physically more exhausted, not to mention kicking you into that high gear "is this it????" mentality that makes the end of pregnancy so difficult!

4. It brings medical management of your pregnancy and labour just that little bit more to the fore. For many women, it's really important to avoid that, to keep the mindset that the body is doing what it needs to do, and doesn't need checking or measuring or feeling up by a third party to make sure it's performing correctly.

(As an aside, I always get a bit frustrated when I hear about doctors doing internal palpations to "check up whether anything is happening" when a woman is threatening premature labour... way to stir things up if they are happening, or increase the risk of a PROM in the case of an inevitable labour. Use a speculum exam to check for dilation or an ultrasound, for goodness' sake!)

[Taurean]

TMTM - some good points, thanks. It would have made a lot more sense if my friend had phoned me with this sort of info instead of just texting me and questioning me over and over and simply saying 'what would I know, I'm only a midwife' but without actually giving me any reason for the 'don't do it' comments.

Thanks everyone. It's been a very interesting discussion in the end! I will chat to my OB about it at my next appointment and I may just no do it. I know he'll be supportive of that given I was the one who suggested it in the first place.

[Toomanytoomany]

TMTM - some good points, thanks. It would have made a lot more sense if my friend had phoned me with this sort of info instead of just texting me and questioning me over and over and simply saying 'what would I know, I'm only a midwife' but without actually giving me any reason for the 'don't do it' comments.
.

Oh, I'm sure!! Lecturing doesn't do anyone any good. She could have said, "I have some thoughts on this if you feel like discussing it," and you could have responded had you wanted to.

[Taurean]

Oh, I'm sure!! Lecturing doesn't do anyone any good. She could have said, "I have some thoughts on this if you feel like discussing it," and you could have responded had you wanted to.

Exactly! I love her to bits but she has been like that throughout my pregnancy. She really doesn't like OB's and is constantly questioning everything mine does - like weighing me. Her comment when I mentioned my weight gain once was 'Oh your OB must be really old fashioned, nobody weighs pregnant women anymore'. It drives me mad!

I knew I could rely on the BB girls for the feedback I was looking for.

[Visitor8]

I didn't get weighed either with Ashton or Chase lol

I think that is also not needed.

I think your friend has lots of valid points. Can you sit down with her and chat without the lecture?

[bon]

Her comment when I mentioned my weight gain once was 'Oh your OB must be really old fashioned, nobody weighs pregnant women anymore'.

My midwife actually asked me to weigh myself at my last appointment. They don't make it routine as such, but they like to know your starting weight and get you to weigh yourself a couple of times during the pregnancy just to make sure everything is ok, and you are not putting on too much or too little. That way it gives them an idea as to whether you might need more info on nutrition etc.

Anyway, I think the thing with internals during pregnancy is that they have gone the same way as episiotomies and shaving of the pubic area - once upon a time they were done routinely, but in recent years of evidence-based practice, it has been shown that they are mostly unnecessary and in some instances are even harmful. Basically, in the majority of cases there is no benefit by having one, so they are not done.

[cherie26]

At the end of the day it is your decision. I have been going through the same as you and am up most nights with prelabour since 30 weeks and I am now 37 weeks (contractions get to 3 mins apart then stop!). It is exhausting and I have decided along with my ob to induce so he will be doing an internal at my app on friday.
Same thing happened with my last pregnancy and he checked me every app from 34 weeks and I was induced at 38 weeks by which time I was already 6cm dilated.

Goodluck with the rest of your pregnancy and relax.

[Sagres]

I guess from my experience internals give you information, and I'm a bit pressed to see how getting information is a bad thing. A lot of discussion here has been about being disappointed. I find this point a bit weird....I do lots of things to find out more information. When I had high blood pressure during pregnancy I had urine and blood tests, and I was very disappointed with the results. But I'm a big girl, I dealt with it, I much preferred to know and be disappointed than not know. If you are in a similar frame of mind I don't see why it should be a problem.

So with my situation, I was in labour and had an internal at about 2:30am and was 2-3cms. At about 3:30am I opted for some pain relief (epi) as I was not coping and I was likely to be in labour for a long time yet. An internal at 4am revealed I was 10cm. The point being it I had of had an internal and got the information about how my labour was going at 3:30 I would have not had an epi at that point in time. I thought what I was feeling was 2-3cm type pain and there was no way that I could see myself doing that for several more hours, when what I was experiencing was actually transition and something I could have dealt with if I had of known pushing could be a few minutes away.

I think you've hit the nail on the head with the midwife vs. ob point, I think your midwife friends are taking the context they want to from your situation to push their own agenda and ignoring the facts i.e. you requested it and are happy for it to occur. I have absolutely no problem with some one giving me information about my options but if in the process they are being unsupportive and unhelpful - well that's not helping me and I'm probably not going to be as receptive to their point of view.

[AliB]

This is a really interesting thread, I too had wondered why 'internals' were in the 'avoid' category.

I'm not quite sure that I understand what an internal is... I had imagined that it was just knees up, speculum and bright light. But Toomanytoomany referred to 'internal palpations' - that sounds a bit more major. What exactly is done, either pre-labour or during labour?

Thanks

[Cassius2]

i think the gist of the thread is about internals conducted outside of labour. it is becoming increasingly common for ppl to get internals done in the final weeks of pg as an indicator of progress. so for example if a woman feels that she has been having heaps of pre-labour and is feeling really exhausted and frustrated because of it (totally normal!) then she may request an internal to see if there has been any change to her cervix that may indicate progress (ie effacement and/or dialation).

some issues that can (CAN) stem from this is that before labour is established the cervix can undergo heaps of changes (you can have an internal done one day to see that you are 1cm dialated, then at the next appt have 0cm dialation). and this is okay...you're not in labour yet and your body is still prepping itself. the only problem there is with this information may the psychological/emotional one. the woman MAY feel let down (by her body, by the exhaustion etc) and become demoralised or increasingly stressed. BUT on the other hand, if a woman feels that she can cope with the knowlege that things may not look favourable 'down there' then i dont really see it as being an issue to request an internal. that said, i dont really think that it is necessary to have an internal as par for the course (ie if it is a standard policy by the OB). it is a woman's choice to have/not have one.

as for internals in labour: once in labour the nature of internals is different. it can be an effective tool (if a labouring woman wishes) to guage how her labour is progressing. of course, it can also be used as a demoralising moment when you have laboured for 4 hours and 'only' dialated 1cm (for example). HOWEVER, again, if you are OKAY with the knowlege that things may not have progressed as fast/smoothly then i dont really see having an internal as a big issue (UNLESS of course you know that the time of labour has been put 'on the clock' by the hospital/OB...then i would delaying for as long as possible LOL!).

I for one had 2 internals in labour. one about an hour in (i was 4cms dialated) and then again about 6 hours later (and i was 6.5cms). i found this a good gauge for me and i wasnt at all bothered that in that time i had 'only' dialated a smallish amount. labour was established the contractions were good and strong. and an hour later i was fully dialated (didnt need an internal to know that...bubba had def started her descent! LOL).

the only thing that really threw me as a first-timer was the realisation of HOW MUCH internals in labour HURT. it was so going against the forces of nature to have someone's hand shoved UP while everything was wanting to come DOWN. especially mid contraction...OUCH lol! but like all things you can get through it...or tell them to get lost and get out LOL!

HTH

[Inanna]

I guess from my experience internals give you information, and I'm a bit pressed to see how getting information is a bad thing. A lot of discussion here has been about being disappointed. I find this point a bit weird....I do lots of things to find out more information. When I had high blood pressure during pregnancy I had urine and blood tests, and I was very disappointed with the results. But I'm a big girl, I dealt with it, I much preferred to know and be disappointed than not know. If you are in a similar frame of mind I don't see why it should be a problem.

So with my situation, I was in labour and had an internal at about 2:30am and was 2-3cms. At about 3:30am I opted for some pain relief (epi) as I was not coping and I was likely to be in labour for a long time yet. An internal at 4am revealed I was 10cm. The point being it I had of had an internal and got the information about how my labour was going at 3:30 I would have not had an epi at that point in time. I thought what I was feeling was 2-3cm type pain and there was no way that I could see myself doing that for several more hours, when what I was experiencing was actually transition and something I could have dealt with if I had of known pushing could be a few minutes away.

I think you've hit the nail on the head with the midwife vs. ob point, I think your midwife friends are taking the context they want to from your situation to push their own agenda and ignoring the facts i.e. you requested it and are happy for it to occur. I have absolutely no problem with some one giving me information about my options but if in the process they are being unsupportive and unhelpful - well that's not helping me and I'm probably not going to be as receptive to their point of view.

Sagres evidence based practise tells me that internals don't tell a lot - so respectfully I disagree with your comment. TMTM made excvellent points in her post. A Woman can be ripe and ready and dilated for many days before labour begins.
I have seen a Woman go from zilch to 10 in an hour ( & also myself in a little over an hour!).

The reason why your friends were so outspoken is because it is contrary to evidence based practise. It is not wise practise as it sets up Women for disappointment and failure. PLEASE do not underestimate how those feelings can impact on your body. Your head gives birth before your Hoo Haa. If your head is saying: "I am not working properly, all this contraxcting is not getting anywhere, what if I can't do this..." You are set up for failure.

THAT is evidence based!

Something that has been overlooked is that birth is abaout trust. Birth is intrinsically related to trust. Without Trust Birth is hard. Trust in care provider, body, support network, in life...

With a finger poked into a vagina you can measure a cervix with some estimate. That only tells a teeny part of the story. Your body is telling you much more than your obstetricians finger. Your body is telling you that it is working hard. That it is exercising that beautiful muscular organ that holds your precious baby. Love your body for that! Thank your body for that!

Get back into the earthiness of this process and Trust.

I understand what your friends are saying - maybe they could have said it better but what they are outraged at is that it is not (most of the time) a positive thing to have a look see...

Trust that beautiful body my darling...

[Lolli]

In my experince, internals are very painful and extremely uncomfortable. Far worse than any pap test I ever had- the only thing that competes in terms of discomfort was an internal u/s.

I had quite a few of them in pre labour with ds, and quite a few more in labour, due to complications. I've asked my mw for as few as is neccassary this time round, hopefully none at all. I felt they were almost used against me in my last labour- i could tell them the pain was getting worse, contractions were closer, things were heating up- but they wouldn't believe me until the internal confirmed it (an internal was used to decide whether I could call dh or not, ffs). It undermined my confidence in my own body and mind.

Just my two cents hun From your perspective, I can see why you were ticked off at the response you got from your mates- i would have been too.

[bon]

I don't think the issue is internals during labour, it's internals done during pregnancy. If you ask for one and want one before you have gone into labour, that's a bit different to a doctor telling you you need to have one because it is routine or just something that they have always done. But either way, they are mostly unnecessary. In labour it's different - they can be very handy to give an indicator of how things are progressing, and if you want pain relief they will often do one just to make sure you are not too far along to have it. But even then, you don't have to have one at all if you don't want to. I prefer as few as possible. I think I had two last birth, but the midwife was very good and they really didn't hurt.

Ali - a standard internal exam (as I have experienced it anyway) is just a doctor or midwife inserting a couple of fingers into your vagina and feeling the cervix to see whether it has dilated, and if so by how much. I guess a speculum could be used, but the only time I have ever had a speculum in there is for a pap smear.

[Sagres]

Yes, sorry my example was a bit misleading because it was about internals during labour. But by the same token I can imagine a situation were I would find the information gained from an internal before labour useful in decision making e.g. if I was very overdue and considering induction I would find the information about whether my body had spontaneously started the process or not (and the implications this has on the chances of a successful induction) useful in my decision making process.

[Vixstar]

It's my body and my baby so why does everyone have to judge my decision?

Damn right it is your decision. I know it is hard to understand and really grates a nerve too I guess. People judge because it is what they would not do......without giving any consideration to you/your feelings.

On a diff topic, my MIL makes snide remarks etc about my son going to preschool (she is anti-preschool) and about him doing swimming lessons (she thinks he will drown). I will never gain her support because I am doing what she does not like/believe in.

Also, my GF of mine had internals and said it felt pleasant as she was having pre-labour pains etc from 38 weeks also (she then went a week over!)...i had internals as part of a normal labour and hated it.......some obgyns are gentle and some not I guess!

Hang in there hun!

Take care,
xxxx

[AliB]

Ali - a standard internal exam (as I have experienced it anyway) is just a doctor or midwife inserting a couple of fingers into your vagina and feeling the cervix to see whether it has dilated, and if so by how much. I guess a speculum could be used, but the only time I have ever had a speculum in there is for a pap smear.

Thanks, I didn't realise they used fingers. I now understand why it would be ouchy - I HATE the feeling of having my cervix touched Oh well all stuff I need to get used to I suppose ;P