Pelvic Exams--how many, and when, and why?

[Kam]

I have had two relatively uneventful vaginal births, and a pelvic exam at the beginning of this pregnancy with my current midwives "to assess position."

My homebirth midwives are proposing another pelvic exam at my 40-week visit, and again in labor. I would like to decline both, simply because it seems a potential source of infection for no good reason. But I may be missing an important reason for these, and would not want to refuse something that may improve the midwives' ability to work. I'm hoping for the greatest degree of autonomy possible with their support and help standing by.

When do you do pelvic exams? And for what purpose? Ruling out prolapse or malposition?

Thanks for any help you can offer!

[Trinitty]

Hi there!

That's a good question... I was wondering the same things.

I haven't had any yet; I'm at 23.5 weeks.

I don't want any at all.... I find them invasive (that's MY vagina, thanks!) and figure they are mostly not needed.

I've said to my midwife that I want to be left alone to do my own thing.... I want them there to keep an eye on me, check the heart beat and encourage me if I need it.... but other than that, just let me do what feels right.

My midwife has mentioned that if I don't want her to "check me" then she won't.... but of course, if there's a problem, failure to progress, cord prolapse, a FOOT!, or some other complication all of that squeamishness on my part will quickly be put aside.

But, I figure that a good 80% of females must be able to birth just fine without hands and fingers feeling around up there, otherwise, our species wouldn't be here today.... so I'm going to get them to stand back and let me do my thing unless or until they think something really needs attention.

I hope you have a couple of the pros respond to your post, as I'm curious myself!

Trin.

[CarolynnMarilynn]

In a normal pregnancy, vaginal exams aren't needed. I offer a pap and swabs, but other than that would not do a vaginal exam unless requested. Some clients wish exams after their 'due date' for stretch and sweeps, but other than that I don't do them. In labour, exams can helps determine if a woman is progressing, but there are other signs I can use if the mom prefers no exam. If a woman has been pushing for quite some time without a baby's head visible, she requests an epidural, she requests her waters be broken, or it looks like her labour requires augmentation, there is no need to perform an exam. After the birth, I will ask to look at her perineum to assess for damage and to see if stitches are required. At the end of her care at 6 weeks I offer a pap and swabs if she needs one. I have had some clients where I have never done an exam at all as I didn't do one in pregnancy and her baby's birth is imminent when I arrive. I know there are other styles out there.

[SublimeBirthGirl]

I'm not a midwife. I'm a CBE and trained as a doula. I think the birth world would be a better place if hands never entered the vagina. no exams without a profound medical reason (i.e., a medically indicated induction, trying to determine whether to start w/ Cervidil or Pit perhaps).

[Charmie981]

I don't do them unless a client requests one in labor or she has been pushing for 30+ minutes with no visible progress. It is not uncommon for a client of mine to have no VEs at all during her entire labor and birth.

IIn my first pregnancy/birth with an OB at a hospital, I had enough VEs to last 10 lifetimes and decided I did NOT want that again. I managed not to have one during my entire second pregnancy until I was in labor. I preferred to labor until I needed to push and then push and NEVER have a VE, but my midwife insisted that she needed "to know I was in labor" (the contractions that were 3-5 minutes apart and 60+ seconds long weren't enough, I guess).

At this point in my life, I wouldn't go to a midwife who required, insisted or pushed for a VE even in labor.

[Sijae]

I've had 2 midwife-attended homebirths and one UC. With the midwives, I never had any VE's during pregnancy and only one dilation check right before pushing in each labor. If I used a miwife again I would not have any VE's at all including in labor.

Laura

[Kam]

Thanks for your thoughts and experience. I have been going back and forth on this, and continue to do so. Uggh. I guess there's no way to know what will feel right until the moment!