Foregoing an internal your first visit - Page 2

[LaurenAnanas]

I'm wondering what everyone means by "internal."

At my first appt, my midwife inserted two gloved fingers and had her other hand outside above my pubic bone so that she could feel my uterus and check its size. There was no speculum, no "peeking," and no interest in my cervix. It took less than a minute.

Are you counting that as an internal exam? I don't see any reason to decline such an exam (unless you just didn't feel like having anyone's hands up there, which I can understand), especially since it seems to be a useful diagnostic tool/status check in early pregnancy.

[attachedmamaof3]

If anything of theirs is inside of your body, it's an internal.

To the PP: What do you think your MW was diagnosing with your internal? I'm curious. As far as the "status check", what exactly needs to be checked inside of your body that can't be done from the outside?

IME, any MW worth their salt can externally palpatate your uterus and get everything they need to know, even about the baby. There is simply no reason for an internal anything (during a normal pregnancy)....unless you request one. Even in labor.

(Again, unless you request one).

[gypsymomma4]

Now I am curious, It has never before occured to me to refuse an internal. Every doctor I have had has done them, I had them at least every other week during my pregnancy with my youngest, that was due to concerns about my cervix. I started PTL at about 20 weeks and spend the next 15 in bed, every time I tried to push the limits by walking around, or going up and down the stairs we were back in the hospital with more contractions, and more shortening and then dialiating of the cervix.

So my question, to those who may have more of a clue, could the internals have added to the problem?

This has been a nagging worry for awhile, as I suspect that the internal US, may be contributed to at least one, if not two of my losses.

My first appointment is next week, and I want to be careful, so if this is something that could be dangerous, and not just benign but not necessary, I would like to know.

[attachedmamaof3]

I wouldn't think that the internals contributed to your losses unless there was a germ issue (as in germs introduced to your vagina/birth canal via exam) or if they inadvertently stripped your membranes or something like that...(the latter is a long shot).

However, how did they determine PTL? Was it purely cervical?

[Katielady]

I had a whole saga about this at the very beginning of my pregnancy!

http://www.mothering.com/discussions...d.php?t=865751

In case you don't feel like reading the above thread, here's the summary: I refused this and other testing from my R.E. and ended up dumping him, and am still so happy about it. If my midwife wanted to feel the size of my uterus with a few fingers just inside, that would be OK with me I guess. I doubt she will, she's the most anti-testing midwife I've ever met. But stay away from my cervix!

[christigpa]

Originally Posted by olive&pimiento

I just want to add a couple of reasons that pelvic exams are done in the beginning of pregnancy, not because I have a particular opinion as to whether one should have one or not, but just for clarity.

I would say the main reason we do internals at the first visit are as follows:
-To check the size of your uterus. It helps indicate how far along you are. Some women do have period like bleeding in the beginning of pregnancy, which can confuse the dates. If a woman does not want an early dating u/s, is unsure of dates, etc., this can really help establish how far along the pregancy is.
-To check that the cervix is long and closed
-Check ovaries for cysts
-To check for any signs of infection

"Establish a baseline" was my OB's reasoning. No one was invading my cervix so there was no risk to LO.

[knittinmama]

Yes, I meant internal, which means that she is checking my uterus with gloves, etc.

I just didn't want the exam. What is the sense of telling my cervix is high and closed?

I don't even like having an internal during labor, and who doesn't! Forturnately I only had one with my DS.

[veg_goddess]

Originally Posted by olive&pimiento

I would say the main reason we do internals at the first visit are as follows:
-To check the size of your uterus. It helps indicate how far along you are. Some women do have period like bleeding in the beginning of pregnancy, which can confuse the dates. If a woman does not want an early dating u/s, is unsure of dates, etc., this can really help establish how far along the pregancy is.
-To check that the cervix is long and closed
-Check ovaries for cysts
-To check for any signs of infection

I may be leaving something out. I think that doing pelvimetry in the beginning of pregnancy is silly. The hormonal effects of pregnancy change the pelvis so much.

As a student midwife, I have worked with midwives who this is absolutely mandatory and get annoyed if women try to refuse and midwives who leave it up to the woman and midwives who don't even offer it. Just to offer my opinion, i really don't think it is necessary. as someone else mentioned, a skilled midwife can palpate the abdomen on the outside to measure the uterus. if the cervix easn't long and closed, most likely, you would be seeing some sort of blood...and, even if the cervix is long and closed, it might not be in a week or two. as far as ovarian cysts, if the woman is not having pain or swelling, then it usually is not a big deal in pregnancy and the cysts will sort themselves out. as far as infection goes, by a midwife doing internals, she increases the chance of something being introduced into the yoni causing an infection.

i guess for me, the bottom line is that, like everything in pregnancy and childbirth, women should always have informed choice on the subject. she should be ableto ask the question of why? and is it necessary? and expect an honest response.

[snowgirl]

I had an internal on my 1st visit last week(9weeks). I think it was because I was spotting and cramping most of this pregnancy. She wanted to look at my cervix and feel my uterus. I didn't think twice about it. I had an internal with my last pregnancy(different state) with my first visit(12 weeks), but I was due for a pap. I am guessing that unless there are any issues, there is really no reason and that is why some women obstain. Correct?

I am happy for this thread, but also starting feeling guilty that I had an internal without questioning it. This is something I have been going through ever since having dd about a lot of choices(vax, food, health care products,). Honestly, some days, I am so tired of trying to research everything to make the best choices, that I just have to let go and have some trust. I do think it is important to be informed. Anyone else feel the same way?

[Katielady]

Snowgirl, I don't think you should feel bad! It's not a black and white thing, like "all internals are bad, always!" It might be reasonable to do if you've been spotting or cramping. And I definitely think there's something to be said for trusting your practitioner. I trust my current one and would probably let her do an internal if she thought it was necessary.

I think the problem is when there's some routine protocol that docs or midwives want to follow and it's just arbitrary. When they want to do it because "that's what we do," and they get annoyed if you even ask questions about it, that's taking away the woman's right to make choices about what happens to her body.

[slinginhipmama]

Originally Posted by snowgirl

I had an internal on my 1st visit last week(9weeks). I think it was because I was spotting and cramping most of this pregnancy. She wanted to look at my cervix and feel my uterus. I didn't think twice about it. I had an internal with my last pregnancy(different state) with my first visit(12 weeks), but I was due for a pap. I am guessing that unless there are any issues, there is really no reason and that is why some women obstain. Correct?

I am happy for this thread, but also starting feeling guilty that I had an internal without questioning it. This is something I have been going through ever since having dd about a lot of choices(vax, food, health care products,). Honestly, some days, I am so tired of trying to research everything to make the best choices, that I just have to let go and have some trust. I do think it is important to be informed. Anyone else feel the same way?

I'm with you snowgirl! I too had an internal because I was scared, I had spotting and cramping and this totally reassured me.
As for trying to research and make the right choices, it is hard and I do believe you need to have some trust. I think we'd all go a bit batty, if we didn't (well, at least I would).

[gypsymomma4]

Thanks to all who have posted to this. I feel much more confident about discussing the necessity of an internal with the doc. on tuesday. While I want any and all reasurrance I can get, I don't want more interference than necessary either. I would love to think I can get through a whole preg, without medical interference, but I just don't have that kinda of confidence any more. In answer to attachedmamaof3's question about how they diagnosed the PTL, with my youngest. It was not just cervical, It started with spotting, backache, and contractions, My ob did an internal and found the cervix half the length it should be, and put me on terb, and bed rest to be monitored closely for two weeks, When there was not enough improvment at two weeks it was continued, It would look better as long as I stayed in bed, but as I said everytime I 'broke the rules' the contractions would start up again.

[attachedmamaof3]

I would not consider these examples to be a normal pregnancy and ABSOLUTELY would have requested and allowed cervical checks in those situations (of spotting/cramping and PTL).

Look, it's not a "hard and fast rule" that you don't do internals. Just that there needs to be some acknowledgement in the medical community that in reality they add NOTHING to a normal pregnancy and serve absolutely NO purpose. (Again, in a normal pregnancy).

[goodheartedmama]

I've never had a "routine" one during pregnancy. However, I've bled with each pregnancy, so I've had one each time to make sure my cervix was closed.