Is a pelvic exam necessary at 38 weeks?

[jill16]

Hi there, first pregnancy here, and just found out from my OBGYN yesterday that at my next appointment (38 weeks), she will be performing a pelvic exam, and weekly from here out. from what i have read, this seems unnecessary yet common; any thoughts? are there any advantages to having the exam? can i limit the number of times it is done? shoudl i just go along with it and get used to having people up in there, since i need to be prepared for the act of labor anyway?

i really don't want my membranes swept, and i am anxious about possibly introducing any extra bacteria. Thus far, aside from some edema, i have had a very low-key pregnancy - i've had no contractions yet, baby is on track size-wise, everything is running smoothly.

if i don't want to proceed, or would like to postpone the exams until later, any suggestions on how to politely decline?

HELP! this is really freaking me out!

[IAMommy]

I don't see what the point of that is. When I was pregnant with DS, my midwife didn't come anywhere close to that area until I had gone through transition in labor, and that was only because I wanted to know my dilation. We didn't do a pelvic until my three month follow up.
A skilled birth practitioner does not need to be up in there to know anything unless it is obvious that things aren't going well. Your behavior will give the OB all the info she needs to see where you are in labor.

I would simply tell her that the thought of vaginal exams makes you uncomfortable, and unless she believes that there is a problem, you would like to avoid them. Make it part of your birth plan that you want to avoid vaginal exams during labor as well.

I must say that I am unfamiliar with the routine procedures an OB does - I'm a homebirther and it is an altogether different experience.

[Cativari]

Not needed and if you're uncomfortable then say no.

[JorgieGirl]

Originally Posted by Cativari

Not needed and if you're uncomfortable then say no.

Ditto.

In fact, no matter how far along you are, they are rarely ever 'needed'. Go with your instinct, mama.

[womenswisdom]

I usually encourage my clients to ask what information the care provider believes they will acquire by doing whatever intervention the doc wants to do. Then see if that information is useful to you in making some kind of decision. Usually the answer to this for a VE is that they want to see how dilated/effaced you are. Which, unless there are extenuating circumstances, is really useless information, in that it doesn't tell you anything about when labor will start or (usually) how long labor will be. If s/he wants to find out position, you might consent to a VE (not that accurate) or an ultrasound if you felt it was important to know that information. But checking just to check? No, thank you.

You can decline all vaginal exams before AND during labor. No need to "get used to it". They don't need to have their hands in there. I'd really encourage you to think about when during pregnancy and labor you might feel a VE would be helpful and say "No" the rest of the time.

[NSmomtobe]

I didn't have one until 40 weeks and I specifically asked her not to sweep the membranes.

[emnic77]

Originally Posted by womenswisdom

I usually encourage my clients to ask what information the care provider believes they will acquire by doing whatever intervention the doc wants to do. Then see if that information is useful to you in making some kind of decision. Usually the answer to this for a VE is that they want to see how dilated/effaced you are. Which, unless there are extenuating circumstances, is really useless information, in that it doesn't tell you anything about when labor will start or (usually) how long labor will be. If s/he wants to find out position, you might consent to a VE (not that accurate) or an ultrasound if you felt it was important to know that information. But checking just to check? No, thank you.

You can decline all vaginal exams before AND during labor. No need to "get used to it". They don't need to have their hands in there. I'd really encourage you to think about when during pregnancy and labor you might feel a VE would be helpful and say "No" the rest of the time.

Ditto this. I can understand if there were concerns about preterm labor, but you are 38 weeks. There is absolutely no need besides curiosity, and besides, it tells you NOTHING. I walked around for over a month with my first at 3cm dilated and a bit effaced...she was 10 days post-dates. The information means nothing, and may even allow the OB to try to pressure you into induction ("well, you're already 3cm, if we just give you a bit of pitocin things will move right along!!"). Between that and the risk of introducing bacteria before birth, my opinion is that the risks far outweigh any benefit at 38+ weeks.

[finnegansmom]

I agree with what everyone has said. I only had one the whole time I was pregnant (including labor) with #2. I was 38 weeks and was having really strong contrax and thought maybe I was close, Nada.... LOL. I never had one again. I probably won't have any this time. I didn't have any in labor, I didn't need them - I knew I was clearly in labor and then I KNEW it was time to push...

[khaoskat]

All they ever did (except when I had tons of early contractions before 37 weeks) was to frustrate me with "no changes", "no progress", etc.

The nurse one time handed me the "blanket" and when the MW walked in it was sitting in the chair and I was still fully clothed. She said I didn't want any, because it was to stressful to hear how little to no progress I was to their magic indicator of labor.

[MacKinnon]

I had none before I arrived at the hospital in very active labor with DS (I arrived at a 9+)
so I had one. With DD I also had none until I arrived at the hospital and I think I was maybe checked three times, once when I arrived at a 4, once a little further on, I was at a 7, and once I began to feel pushy (I was complete). My midwives did not routinely do pelvic exams in late pregnancy. Ironically, it drove my friends and family the most nuts, just not understanding why I couldn't tell them, "I was x dilated and x effaced." It has always kind of baffled me the way this is common knowledge/shared info among virtual strangers in late pregnancy. My car seat clients (I'm a car seat tech) often share that with me- "oh- it will be any day now, I'm already 3cm dilated and 50% effaced!" Feel free to refuse!!

[lilylumos]

It is not. You will still have a baby whether you have a pelvic exam or not and it means totally NOTHING (for instance I know a woman that was 7cm dilated for weeks and a woman that was 1 cm and then had a baby later that night). It can also impede labor as it did with me, I was checked and was an 8...totally got all excited that labor was almost over and I was going to meet my baby soon...and went another 14 hours.

And if you decide to do it, be aware that some docs will strip your membranes without telling you during that exam.

[boheime]

"I do not consent to a vaginal exam." Rinse and repeat.

[mediumcrunch]

Nope, not necessary.
Just don't take your pants off and if she makes an issue politely decline and say that you just don't feel it is necessary and would rather wait until the information is needed to make decisions about your care vs. fulfilling curiousity.
She'll probably give you a song and dance about needing to know so if you go to L&D and they check you they can see if there is progress and assess if you are in labor. Not true. Just smile and decline.
Edited to add: There are PLENTY of OB's that do not do routine cervical checks in the last month. In the last 10 years I've only had them at all before labor to see if induction was reasonable.

[sweeetpea]

Information from a VE is simply a snapshot and totally meaningless as a predictor. If you do not want to have a VE, simply keep your clothes on, and say "no, thank you".

They may be somewhat flummoxed, because they probably don't have many people questioning their standard operating procedure, but they can deal with it, y'know?

[umsami]

Originally Posted by lilylumos

And if you decide to do it, be aware that some docs will strip your membranes without telling you during that exam.

:

Definitely tell your OB, that you do not want your membranes stripped. Also, sometimes they'll try a "vigorous" pelvic exam to get things started. Once again, unless you're facing an induction or something... you don't want these things. (Well, most people don't.)

[BlackSheepPDX]

What everyone else said: No.

[Natsuki]

No, don't do it. Here is when I would consent to a pelvic exam:

1. If i was post-dates and considering induction (or anytime induction was a consideration b/c I'd want to know my Bishop's Score)

2. If I was in labor and wanted to know my progress

3. Right before pushing to make sure I didn't have a cervical lip

Here's the thing - pelvic exams can HURT, they are terribly uncomfortable and invasive. They are not something wonderful or to look forward to.

When I did get pelvic exams last labor, I asked the nurse and midwife to check me standing up and squatting b/c I couldn't handle laying on my back in labor and that was a major improvement over previous VE's I've had.

There are some risks to VE's as well - physical pain and discomfort for the mother, mental discouragement if it's not what you hoped, introduction of infection/germs and if they decide to sweep membranes that could lead to accidental breaking of water.

The way to avoid a VE is to not take your clothes off - just say "I don't want one today" and don't take off your clothes. You will encounter surprise and pressure to do it, but hold your ground (and consider their response to your request as indicative of how they will respond to requests 'out of the norm' during labor).

[sunfish21]

I would also decline. Some women cnahge very quickly; others stay the same for weeks. It is not an indicator of anything. My SIL was told just over three weeks ago that she was "going to go" any day now....

[luv-my-boys]

If you are not comfortable with the procedure, decline it. She cant exactly take your pants off for you...and if she did thats a whole other issue

.

[chel]

I've had cervical issues, effaced 75% since 22w. My last VE was at 36w to see if being off bedrest from 34w has caused any change. I was told I wouldn't need another after that.
At my 37w appt the nurse handed me a sheet and I just told her the OB said I wouldn't be getting any more VE and the nurse was fine with that, I guess she figured if it was an issue the OB and I would work it out.