Pelvic exam in first trimester

[MamaAcorn]

Just wondering if a pelvic exam is necessary during the first trimester and what exactly it accomplishes? I had one at 12 weeks with DS without thinking twice about it at a large OB group. It was a bad experience that caused much pain and bleding for three days, though still a completely healthy pregnancy. I have midwife from the start this time around, and she told me that I'd have the pelvic exam at 10 weeks, this Friday. I"m dreading it so much! I asked why it was necessary, and her response was to test for STDs, do a PAP, and assess my uterus size to match dates. I've had a normal PAP in the last year, know positively that I don't have any STDs, and I'm positive about my LMP and conception date. Can I decline the pelvic exam all together? I just feel so protective of that area now that there's a growing baby in there!

Thanks!
Pam

[pamamidwife]

I don't think they're necessary. I don't do PAPs at all in pregnancy, but I guess if I was working with a higher risk population, it might be nice to do an STD check if the mom wanted.

With PAPs, and some may disagree, there is so much cervical change happening during pregnancy that you're more likely to get an abnormal, test-again-later result. So, it's nicer to wait until 6-8 weeks postpartum.

[lorijds]

If the pap is due, we usually go ahead and do it in the first trimester, along with STD swabbing, if mom wants. We haven't ever had any problem of a mom having a miscarriage or any problems after the pap.

One thing is that we always wait until the second appointment. I think it is a terrible howdy-do....hello, I'm your midwife, welcome to the practice, now strip down and let me poke around a bit.

On our first visit, we always just go over the client's health and personal history,and draw lab work.

One thing our midwives like to do is measure the cervix. It has happened a coupel of times that a mom has a naturally short cervix. Then, if mom has any problems later on, and a VE is performed that finds a short cervix, it is noted on the chart already whether that is normal for the mom, or whether some change has occured. It has kept a couple of moms away from that "threatened preterm labor" label.

And actually, since we do well woman exams, too, we now note the length of cervix on every woman of childbearing age, so that it doesn't come into question later. I know that cervical length can change, depending upon where one is in one's cycle. But I still think it is good to note (along with where she is in her cycle), for possible future reference.

Pelvimetry (measuring the pelvic outlet, and checking what "type" of pelvis you have) is somewhat helpful. But, unless something incredibly odd is noted, it isn't extremely informative either. Until labor, no one knows how much your pelvis will relax and open up. So much depends on such variable factors---baby's position, mom's position and activity, etc.

If you don't want the exam, it isn't so important that you MUST have it. Just refuse politely. It shouldn't be a big deal. For some moms, we would rather know it is a big deal, and avoid it all together. Just tell your provider how you feel -- you aren't at risk for STDs, you are sure of your dates, you are current on your paps, and you simply don't want anyone else in there at this time--plus, your pelvis is "proven" in that you have already had a child. I would rather have one of our clients refuse the exam, knowing that she was "feeling protective of that space." If she is feeling that protective, that is a good sign, to me, that she is going to take great care of herself, for her baby.

Congratulations on your pregnancy!

Lori

[TurboClaudia]

Decline it politely.

And isn't there a new recommendation about pap tests that if you haven't had an abnormal result in the past x number of years, an annual one isn't necessarily recommended? My brain is too fuzzy to do a search on this one right now...

warmly,
claudia