eXams in Labor
Be Empowered Birth Series
What is a vaginal exam?
A vaginal exam may be conducted throughout pregnancy and during labor. The purpose of vaginal exams range from conducting testing in early pregnancy, such as a pap smear to checking your cervix prior to labor, as well as most commonly checking your progress in labor.
During a vaginal exam your healthcare provider will put on sterile gloves and insert their fingers to check your cervix. Prior to having any vaginal exam, your provider or nurse should communicate what to expect, what they will be doing, and ensure that they have your consent—each time. During these exams they are checking to see how much your cervix has dilated and thinned out, they may also be checking to see what position your baby's head is in.
Depending on your place of birth your provider may desire to provide vaginal exam every continuously throughout labor to see how you are progressing. Whereas for other providers, they may not desire to do a vaginal exam during labor as often and notice the outward signs of a mother's place in labor.
The two most common times during labor for a vaginal exam can be upon arrival at your birth location and near pushing. Remember, when and how frequent of vaginal exams is your choice and to best make those choices, let’s review the benefits and risks of vaginal exams.
What should you consider prior to vaginal exams?
One of the biggest risks often discussed with vaginal exams includes the more frequent exams, the greater the risk for infection or rupture of membranes.
Emotional risks could be discouragement if you are not as far as long as you anticipated in labor, as well as if you are having exams in pregnancy, but the cervix had not had any changes prior to the onset of labor.
Exams in labor could also be triggering for women who have experienced sexual abuse.
Some hospitals won't admit you to the labor and delivery floor until they have determined that you are in labor. They will typically check you when you arrive at the hospital and then check you a few hours later to see if you have dilated any further. If you have progressed they will admit you and if not they typically send you home to labor for a bit longer before returning.
Knowing what position you baby is in can help your birth team know what the best position for you to labor in is. For instance if the baby is coming down OP (head down but facing the Mother's front instead of her back) there are several different positions Mom can get in to give the baby room to turn to OA position (head down but facing mother's back).
Knowing your dilation can help your birth team to establish a pattern of labor.
If you are wanting an epidural but want to hold off on it until you are at a certain point in labor an exam could help you determine if you are ready for an epidural or if you want to hold off for a bit longer.
Some providers won't let women labor in the tub until they have dilated to a certain point so an exam can be helpful in this instance too.
It can also be helpful in determining when it is time to push. You could be dilated to 10 cm but have a tiny lip of the cervix left and that makes pushing a baby out a bit more challenging.
If you would like vaginal exams or your provider would like to conduct them, it is important to note that WHO recommends vaginal examination at intervals of 4 hours but goes on to say in that same article that "there is currently no direct evidence on the most appropriate frequency of vaginal examinations to prevent infections"
Be sure and talk to your healthcare provider about the best options for you and your baby. Whether you choose to have vaginal exams in labor or opt out of them, begin to open the communication lines with your provider on your preferences.