Internal exams in last few weeks: yay or nay?

[interbang]

Quick question:

I'm at 37 weeks.

My mw has only done one internal exam, when she thought the kid might be breech. (It wasn't).

Now, she says I have the option of internal exams during our weekly visits. She didn't seem committed to them one way or another, so I'm wondering, what's the value of them at this point? I mean, does it help me or her? Does it help with labor?

I'd rather not do them, unless she gives me a good reason, or unless I hear some good reasons from you all on this board.

Right now, my feeling is that I'll either be in labor or not, and I'm sure once contrax get going, I'll be more open to the internal exam thing..

[iamama]

I thought the internal exams were the most uncomfortable part of the whole pregnancy. I would pass on them. I think they just want to see if you are dialated or not. If your curious you can see about learning how to check your own cervix.

BTW Congradulations and wishing you all the best for your home water birth..you go girl!

[StacyL]

I haven't had any internal exams, and won't have any - no point really, IMO.

[plantmommy]

A woman can be dilated to a 4 for weeks and not go into labor, or go from no dilation at all to fully dilated in a few hours. So what's the point?

I should say, in defense of my midwives, that neither of them ever made an internal the least bit painful. As a matter of fact, with my last pregnancy my midwife did a cervical massage with epo in an attempt to stir things up a bit (I was 41 weeks and nothing going on, and very impatient and miserable!) and it wasn't even uncomfortable.

Still, I see no reason for internals in most cases.

[bu's mama]

I don't know this for sure, but I think my ob broke my water doing an internal (I didn't know any better at the time).

I had an appointment 3 weeks before my due date at around 8 at night. When I woke up the next morning at around 7 my water was broken & I had no contractions. I saw the mw in the office & put off going to the hospital until that evening - still with no contractions & wound up getting pitocin & an epidural.

Not the way I had planned. But like I said, now I know better.

[JenInMpls]

My mw is very gentle and I have her do an internal at my visits because I am always curious about the state of my cervix and I can't reach it myself!!!

I have requested on my birth wish list that internals be kept to a minimum and only between contractions.

[cottonwood]

Well, like you said, they can be done to check for specific things. I had one done about a week previous to my second birth because I was worried the baby was breech and wanted to know for sure (without having to go in for an ultrasound.) But I see no point in doing them just to check for dilation, in pregnancy or labor, as dilation simply is not an accurate indicator of when one will go into labor, or how close to birth one is. And it can be discouraging, painful, and inhibiting to the labor process besides.

[msrog]

I vote NAY! I suspect if I had gotten the internal that the midwife wanted to do last Monday, my birth story would have turned out quite differently. I am wondering if I was already 4 or 5 cms dilated and didn't know it...? If so, and she discovered this, I would most likely have been instructed to go to the hospital. I can see it now: Let's get this labor moving, let's break your water, "gee, your labor has stalled... Better resort to pitocin with an epidural... Oh, I'm sorry, and so surprised, but we will have to have a c section..."

[HeatherB]

I've also asked to skip any, at least at this point. The only thing I really want to know is that my body is working and progressing towards this birth, and that I can find out on my own. I don't need specific measurements, just to know something's going on. I really dreaded and hated exams with an OB during my last pregnancy. Blech. Awful. Can't imagine a MW would be anything like that bad (and she'd probably tell you she was considering stripping your membranes BEFORE she started doing it!), but it's still not something I'd do just for the fun of it. As the PPs said, there's really not much to gain from one. I guess you can find out how much work you've already done, and therefore that there's less to do later, but that's about it.

I expect to get to a point in labor where I'll want or need to know what's happening, just for the encouragement of knowing my body's working well. Up till then, and unless there's some good indicator that we need to do otherwise, I'll skip the exams. My MW says she likes to do one near term, then maybe one when she arrives and before pushing. But she's been very open to letting me pick just when and if that happens. It's just so easy to get caught up on numbers when there are SO many other things going on than just dilation and effacement.

[plantmommy]

Your OB started stripping your membranes without TELLING YOU first?!

:

[KittyUK]

Our mw's here don't do internals until you are in labour. So I won't be getting any. I'm now 37 weeks and prefer not to know. I think psychologically if I knew I wasn't at all dilated, it might get my spirits down. At least not knowing, i can dream

[Mom2baldie]

I am only 36.5 weeks and havent had any exams or anything so far. I dont know if my midwife even does them before labor starts. If she offers I will most likely decline just because I dont need the stress of being disappointed if Im only 1 cm or getting nervous/excited/anxious if Im 3 or 4 cms...

I know that dilation has nothing to do with when you will actually begin labor but I also know myself and I would start obsessing about it!

[Peppamint]

I'm not a September momma, but I wanted to mention my experience. I walked around at 4cm, 90% effaced with a bulging bag of waters for three weeks (ds was born the day before his EDD). Add in lots of prodromal labor and I spent a lot of time trying to figure out if it was about to turn into active labor.

Next time we'll hold off on internals unless we feel there's a need. I was way too hopeful and it turns out I don't really go into what feels like active labor until I'm well past 8cm.

[mum2tori]

My OB is very gentle. And thankfully would never consider doing something like stripping my membranes without my consent!! : : That's just wrong. I don't mind the internals, he doesn't start doing them until after 36+ weeks unless there was a concern for pre-term labor. And if I didn't want them, he's fine with that.

The only time an internal has hurt was when the nurse at 'check in' did one with Jack. She started talking to someone else at the same time and didn't realize that I was in a full on contraction when she tried to start. She immediately stopped and was so apologtic. :LOL She paid closer attention after that. She also discovered I was already at 7cm and they needed to move me to L&D NOW. :LOL I had been at 3cm about 25 minutes before.

[HeatherB]

Originally Posted by plantmommy

Your OB started stripping your membranes without TELLING YOU first?!

:

Yep. : is right! One of those "let me check you... and here, I'll just *yank,pull,OWW* stretch things a little." I very nearly got up from that table before I even figured out what was going on! It didn't help that after she did that twice (different days) I ended up with some fluid leaking (not waters breaking, but who knew?) and started trying to get labor going full force. A lot of hard work pre-labor and a very, very long real labor is a very bad combination.

So... I'm definitely in favor of skipping unnecessary exams.

[JenInMpls]

Wow, Heather, in that situation I probably would have planted a foot square in the OB's chest. I can't even imagine my mw trying something like that. Then again, I think I have the gentlest midwife on the planet.

[cottonwood]

"I guess you can find out how much work you've already done, and therefore that there's less to do later, but that's about it."

Yeah, I've heard some women say that knowing that they were at 8 or 9 gave them extra strength to keep going. However, what if you (referring to general "you" ) get to 8 and then labor slows down or stops? Or what if you're at 9 and your body is trying to push the baby out and your midwife tells you to stop because you're not fully dilated? Or, what if the midwife finds a cervical lip? Or, what if you've been in labor for two days and find you're only a 2?

All of these scenarios are normal variations, but they're almost never treated as normal, they're treated with some sort of intervention instead, and undermine your confidence that your body knows what it's doing. So I guess it comes down to what your midwife and you would do with that information and if you're okay with that. If not -- I'd say to forego the exams entirely.

FWIW, the last scenario happened to me -- I didn't dilate at all for the first 50 or so hours of contractions (which was VERY discouraging, I know I would have handled it a lot better if I hadn't known that I wasn't dilating,) and then went from 0-10 in four hours!