internal exams?

[laehmichal]

I am thinking of switching midwives, as the last practice I went to only delivers in the hospital, and we would like a home birth this time around. I really like the midwife my sister had, however, she recently told me this midwife only does 3 internal exams in a pregnancy. My sister was 10 days overdue and had significant swelling and high bp - ended up needing an induction for preeclampsia. I don't think an internal would really have made a difference as the midwife was monitoring her bp and swelling, sent her to the hospital when she needed to go, but is this common to not have those exams? Would they have made a difference in her situation? My midwives did them regularly during the pregnancy, especially at the end to check for dilation, etc. Just wondering what the norm is, welcome any opinions and experiences. Thanks!

[alegna]

Most homebirth midwives I know don't do ANY internals unless you want them.

-Angela

[VillageMom6]

Originally Posted by laehmichal

My midwives did them regularly during the pregnancy, especially at the end to check for dilation, etc.

I don't see the point of having them at the end of pregnancy to check for dilation. It's just to satisfy curiosity and it tells you nothing. Whether you're at 4cm or closed up tight, you could have your baby that night or in two weeks.

If I'm showing signs of preterm labor, then I'd agree to cervix checks. But otherwise I am declining all internal exams until I'm feeling the urge to push.

[hawthornehill]

most homebirth midwives don't do any unless you ask them.....

[AutumnAir]

Internal exams are almost always unnecessary IMO. And you're right in thinking that an internal would have made absolutely no difference to the diagnosis and treatment of your sister's pre-E.

There are a few select circumstances in which I would consent to an internal - but they are few and far between, and TBH I would feel much happier with a MW who didn't do them as 'routine' at all. There's no good reason to routinely do something invasive and uncomfortable to a pregnant mom, exposing her to risks of infection and the possibility of accidentally rupturing the membranes. My 0.02.

[emnic77]

I've never had an internal exam with my homebirth midwife (and I'm 41+ weeks right now). I had maybe 3 with my hospital midwife last birth. They are totally useless as a routine check. I walked around 3cm dilated for literally weeks with my first baby before she was born. Dilation checks at the end of pregnancy tell you nothing. There's just no need for them, they don't tell you anything at all.

[aloneinid]

I am halfway through my 3rd pregnancy and have only had one internal exam ever (at my request to check my uterus size in my first pregnancy- confirming dates). Checking dilation does nothing except, like a PP said, satisfy curiosity. I know a woman who was dilated to 7 for three weeks before delivering and many who were not dilated at all who delivered hours later. I would say that a midwife that doesn't do routine internal exams is exactly what I would look for in a HB midwife!

[tootersmom]

My OB doesn't even do them at all unless you're actively contracting.

[AFWife]

Originally Posted by VillageMom6

I don't see the point of having them at the end of pregnancy to check for dilation. It's just to satisfy curiosity and it tells you nothing. Whether you're at 4cm or closed up tight, you could have your baby that night or in two weeks.

If I'm showing signs of preterm labor, then I'd agree to cervix checks. But otherwise I am declining all internal exams until I'm feeling the urge to push.

This. The night my water broke I'd had an appt that morning and was dilated to 1cm...I was told, "See you in a week"

[luv-my-boys]

I have never had a HCP be total gun-ho about doing internals. In fact my last didnt even check me until PP to make sure I was healing. I really dont think its necessary and really isnt indicative about when you will go into labor unless you are having premature contractions or there are other concerns that an internal would be helpful. But solely for dialation, I personally would forgo it plus there is always a chance of introducing bacteria that I'd rather not chance

[Qbear'smama]

I had my daughter at a birthing centre and my midwife didn't do any internals except to let her student MW feel things like my bulging bag of waters (I agreed to this, of course) and when I was in active labour I had a little lip of cervix left that wouldn't budge and I had wanted her to check it out. I agree about internals not really serving a purpose and potentially introducing germs.

[MaerynPearl]

The only internal I got with my FP was the first one during my pap...

[BlackSheepPDX]

What everyone else has said. "Only" 3 internal exams is actually a LOT of internal exams if you know they aren't really telling you anything. And one of the many things they don't tell you anything about it Pre-E.

[laehmichal]

This has been really helpful. I just don't really know any different than standard, i guess ob procedure. I had 2 healthy, successful pregnancies already, and barring anything medically wrong this time, I have no intention of going back to that hospital. It was not a happy experience for me to be stuck there for several days, poked and prodded and never left alone to rest with my new little one. I just don't have much to base evaluating a homebirth midwife on, as I have never had the experience. So glad I can rely on all of yours!! Anything in particular I should look for?

[Earthy Mama]

I declined all internal exams. I had a pap the month before I got pg, so no need for even one.

[mediumcrunch]

The only internals during office visits I have had in the last oh, 10 years (with hospital based midwives and OB's) are the initial visit/well woman exam and one to check dilation/effacement when we are looking at induction. I haven't had providers that did internals 'just because' starting at 36 weeks since the mid 90's. I wish they were as inclined to keep their hands out during labor though.

[jennica]

I think a lot of people think that internal exams are telling us something, or doing something to help us out. But really, under normal circumstances, they don't do anything. They may tell us how far we are dilated, but what does that mean? Not much. With midwifery care you might find that they often don't routinely intervene unless the intervention has a purpose. Some times they think an intervention has a purpose, and you don't, therefore it's important to find a midwife who is on the same page as you. For example, I asked my midwife how many internal exams she normally does, and she answered none, which was exactly the response I was looking for.

[MacKinnon]

My CNM's that delivered at the hospital did NO internals during either of my pregnancies. The CNM's at the free standing birth center I'm delivering at this time do not do them either, unless you request them. On the contrary, I had a friend's CNM practice that did them after 36 weeks, and another friend's OB office that did them routinely at EVERY SINGLE prenatal, for everyone! The general belief, I've found, from most practioners who don't do them, is that it doesn't really show you anything. You can be at nothing and then go into labor that night, or be at 3cm for weeks and weeks. I did not want any, and have never had any checks "just because." I can't see how an internal would have effected anything with your sister. Pre-eclampsia and evaluation for dilation are not related.

[bjorker]

I'm 33 weeks and none of my midwives have rendered my pantsless as of yet, nor do they do much poking during labor unless I want them to. I think it's best to stay out without a good specific reason!

[Magali]

At 18 weeks I was at a first visit with a new doctor and she asked to check the size of my uterus. I felt so yucky and crampy afterward, because IMO it was 100% not needed. I have decided no more internal exams until I feel like pushing. I'm not really sure why I let her do it at all actually...