During your pregnancy it’s a fair bet to say that a stranger will, at some point, request to examine your vagina. What fun! A vaginal examination is a relatively quick procedure where your midwife or other caregiver will insert their fingers into your vagina to feel your cervix. As with all things birth, whether you have them or not is entirely your choice. And as with most things there’s some real pros and cons either way.
Let’s have a look at the facts.
Number one on the con list is that someone is having a thorough rummage in your vagina. It’s a physically invasive procedure, sometimes painful, often disruptive to the flow of labour and can put you into a vulnerable state. Now, hopefully you’ll have some rapport built up with your caregiver by this point in the proceedings, but they’ll still be a relative stranger in the scheme of things and what’s more likely to send your adrenaline rising and oxytocin plummeting than being put in that situation? And as we know, you need a good supply of oxytocin – the love hormone – in labour to keep your uterus contracting nice and efficiently; when something happens that makes us uncomfortable, stressed or fearful, the amygdala part of your brain triggers your fight or flight response which releases a burst of adrenalin, inhibiting both oxytocin and the endorphins which are acting as your body’s natural painkillers.
Vaginal examinations are physical, and so present an infection risk. Perhaps not a huge risk in the western world where caregivers have access to plenty of soap, water and gloves, but a risk all the same. Bacteria can be pushed up the vagina, pass through the cervix and enter the uterus. The risk increases if the amniotic sack has displaced already, and some infections can be quite serious for babies in utero. Shockingly, in one study it was found that women who have had a vaginal examination in labour have 80% greater number of different bacteria in the cervix than those who hadn’t.
When a vaginal examination is carried out they can be useful storytellers to your caregiver, telling them important information, more on that below. However, they can also give you and your caregiver misleading tales. There are few rules in labour, no definitive timings, no guarantees that they will progress in exactly the way you have planned. So what happens if you’ve been in latent labour for hours and hours and get told you’re ‘only’ at 3 centimetres dilated? What if you’ve been in active labour for half an hour and you’re told you’re at 8 centimetres dilated? Do either of these things mean that your baby will be here at a specified time? Nope…in both situations baby could still be hours away from making their arrival, or they could be here within the hour. And yet your care pathway may very well be altered to fit the story that your caregiver believes your cervix is telling them. Not only that, but your own expectations can become hinged on the number you’re told and if the story doesn’t go the way you’re expecting then your flow of labour can be interrupted and throw you off kilter. If things happen more quickly or more slowly than you anticipated you could experience panic and fear, and fear leads to pain. And don’t forget distance measuring with only fingers for guides is subjective – if more than one person carries out the examination you could be in the position where measurements are miscalculated!
So what, then, are the pros from having a vaginal examination? Well they can give your caregiver information that they can use to build a picture of what’s happening in your labour. How far dilated you are alongside other factors can give an indication (but not a guarantee!) of how close to baby’s arrival you are.
Vaginal examinations can also tell your caregiver what position your cervix is in. As the cervix dilates it moves from a backwards facing position which protects baby, to a forward-facing position allowing an easy descent down the birth canal for baby.
The examination will also assist in ensuring you know your baby’s position. Again, this isn’t unique to vaginal examinations but in certain conditions such as malpresentation it’s important to have a clear picture of the situation so appropriate care can be given.
Vaginal examinations can be really useful if things aren’t progressing quite how you’d be expecting them to be. If they seem to be taking a wee while longer than expected to make their arrival an internal examination by a midwife can check their descent and position. This will tell them if baby’s position means they might need help to come along (such as asynclitic, breech or occiput posterior). It can also tell them if an intervention such as rupturing of the membranes would be appropriate to carry out. So where does this leave you and your choices? Vaginal examinations can be an important part of your care but should be used alongside other practices from your caregiver as a diagnostic tool. How judiciously they’re used is entirely up to you and your comfort level with them.