Having a vaginal examination in labour can be offered as part of your routine care but what are they for and do you have to them?
1. what is a vaginal examination?
Internal examinations can be offered as part of your care in labour to assess your cervix and the progress of your labour. An examination can also be used to check the position of your baby as well as whether your baby is moving down through the pelvis.
Usually performed by a midwife, who uses her fingers to feel the cervix for softness and dilatation, a vaginal examination is offered when you arrive at the hospital and, once you are booked on, every 4 hours.
2. are vaginal examinations needed?
The measurement is used as a way to establish your labour status and to work out how long labour will be. Maternity unit policies are framed around the results of vaginal examinations as this measurement can be used to book a labouring women into hospital and it can be used to give an epidural or to use a birthing pool.
However, there is an argument that it is not an effective method of assessing labour and women should be observed, listened to, supported and reassured.
However it is a snapshot of your cervix at the moment of the examination, it doesn’t indicate what the cervix is going to do next.
3. are vaginal examinations accurate?
They can’t tell the future and how dilated you are can change pretty quickly. I have worked with women who are 9cm dilated and labour still lasted for hours, while others have been ‘only 2cm’ and they give birth a short time later.
An internal check can be useful if a midwife suspects that labour is being impacted by the position of your baby but this needs to be explained well so you feel informed and supported.
4. what are your options about having vaginal examinations in labour?
Some women don’t want any internal examinations at all, while other women don’t want any unnecessary, routine exams. It can be seen as the authority of labour progress but there is no precise measurement for this and midwives can have an idea of what’s happening with your labour from your behaviour – movement, sounds & conversation and alertness.
You can request an internal if you want to know how far into labour you are but it’s also important to remember that this measurement is only one piece of the picture.
In pregnancy it might be possible to speak to your maternity unit to set up an agreement with an advocate who can support your choice not to have internal examinations. Check if your local hospital offers this as it can be an effective way to receive support, which minimises stress in labour.
You can say no to an internal at any time and many of the women I have spoken to have felt that the routine 4-hourly examinations weren’t necessary and they caused interruption and discomfort.
“I felt like I didn’t have a choice, it was part of the process and that was that.”
“I only had one, it was uncomfortable but my midwife was quick. My labour was fast so I never had to make decisions about more.”
“I hadn’t planned on having any but I agreed to one when we got to the hospital as I felt quite ‘pushy’ – I was 9cm, although it was still another 4 hours until I gave birth.”
“I’ve had three babies and the examinations were never offered as a choice, they were always presented as an essential next step.”
“I feel like I was really fortunate – when we got to the hospital, my partner explained that I wasn’t up to any internals so my midwife gave me some time and observed me before booking me in. And the midwife who was with me throughout labour was happy not to offer them. It was really positive.”
My thoughts on having vaginal examinations…
They can have a place in labour but they are intrusive and not always easy for women to experience. Women are more aware of their rights and they are thinking about is appropriate for them in labour.
I understand why they can be needed – to provide a piece of the big picture – but I’m not keen on all the emphasis being focused on them, especially around how far dilated a woman is. During a straight-forward labour, they can interrupt the flow of labour and the headspace of a labouring woman. And, as someone who dilates quickly, I know that internals aren’t an accurate assessment of how labour is progressing and how it will continue.
As a birth doula, I aim to focus on my client so I observe her behaviour, what she says and how she moves. Every woman is different but there are some similarities and, with 1:1 care, I have the time to focus on my clients and her needs. I can also reassure her, encourage her to keep going and offer her options.
My tips are to:
- know more about labour and birth, what makes it work, what can be disruptive and how unique it can be
- know more about care during labour so you know what to expect and what your options are
- talk it through and work out a realistic plan for you
- you can speak to your midwife
- include this in your birth plan
I am on hand with in-person and Zoom consultations to help you prepare for labour and birth – please feel free to send me a message below with your questions.
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Copyright: Janine Smith