Vaginal exams are an expected part of prenatal and labor care, offered as early as 35 weeks to many expectant moms. However, mothers may not realize the risks. Vaginal exams may seem a harmless procedure, but they can actually have a serious impact on the process of labor.
There are a few pieces of information that can be gained from a vaginal exam. By feeling the cervix, a care provider can tell if the cervix has changed position (posterior or anterior), effaced (thinned) or dilated (opened).
If a woman is dilated, sometimes a care provider will be able to tell a few things about the baby, such as how low the baby’s head rests in the pelvis (station) and the baby’s position (posterior, ascyclitic, etc.), depending on how much they are able to feel. All of this information can be interesting and sometimes it can be useful, but it is not always necessary.
Usually, vaginal exams are offered as a way to check a woman’s progress in labor. While it may be beneficial to know the status of the cervix before making major changes or decisions in labor, it is often done even if the result will make no change in the immediate course of action.
In labor, the need to track progress hourly or every couple of hours stems from the “Friedman’s Curve” standard. In 1955, Dr. Friedman observed the lengths of time women in labor dilated and averaged them, calling that the average pace of labor.
There were many reasons the study was flawed, including interventions manipulating the speed of labor such as sedatives, pitocin and forceps. But many care providers still hold to that standard of average and feel the need to interfere if a laboring woman’s pattern does not match it.
This is important because “failure to progress” is one of the top reasons cited for cesareans. At this point, one in three women in the U.S. give birth by c-section. Every care provider’s time limit varies, but the only way to reach this diagnosis is by performing vaginal exams.
For all the information that can be gathered, vaginal exams DO NOT reveal when a baby will be born. What care providers who see birth uninterrupted know, is that every labor pattern is different. It is not unusual for a woman to need ten hours to dilate four centimeters, nor to dilate four centimeters in ten minutes.
Normal pushing times vary greatly. There are so many factors that affect dilation including the mother’s position, interventions, the baby’s position, the atmosphere in the room, the mother’s fears or hesitations.
In fact, unwanted vaginal exams can actually slow a woman’s progress! This is because a vaginal exam — the process and the result — can have an emotional effect on a mother.
When a pregnant woman goes in for her 38-week appointment, and hears she is already dilated to 2 centimeters, she may become convinced she is going to have her baby any minute. She may start her maternity leave early or book her mom’s flight and truthfully, it could still be a month before her baby is born.
The vaginal exam can create an unrealistic expectations. The opposite is also true. A mom at 41 weeks may hear she is not dilated and could stress that her labor will never start, then actually go into spontaneous labor the next day.
What can happen instead, in similar cases, is at that appointment the mother is offered an induction to bring labor on. For a first time mom, induction doubles her chance of a c-section.
If a mother is opposed to scheduling an induction before her due date (or even within the two week time frame after her due date that ACOG deems a normal range for pregnancy), knowing her cervical status at prenatal appointment may have no benefit.
In labor, a woman may be using movement or water and coping well, but then struggle when she’s asked to lay on her back in the bed for vaginal exams. Vaginal exams tend to be uncomfortable, so if this is frequent, it can really interrupt her focus.
For women who have a history of trauma or abuse, exams given by unfamiliar staff members can be emotionally difficult. Sometimes, the water bag is broken either intentionally or accidentally during vaginal exams.
Once the water breaks, vaginal exams should be limited because each one is an opportunity to bring bacteria from the outside in, and is a risk factor for infection.
There are times vaginal exams can be appropriate and helpful. Many care providers prefer to check the cervix before a mom begins pushing to confirm it is completely dilated. Sometimes a mom may even ask to have the water bag broken if she needs relief from pressure of a bulging bag and cervical status can be assessed then.
If a mother is laboring without interventions, there are many signs that indicate how her labor is progressing, such as her demeanor, noises and movement. If a woman is medicated, vaginal exams may be more relied upon to determine her labor progress and how to assist her.
Pregnant women need to know:
• You always have a choice about vaginal exams, prenatally and during labor.
• Your consent should always be given before a vaginal exam.
• You can ask that a vaginal exam be delayed, at least through a contraction.
• You can ask not to know what information the staff concludes from a vaginal exam, if you think it might be discouraging or if no change is necessary.
• You can also ask for a vaginal exam if you’d like to know any piece of information that can be obtained.
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