Are internal exams necessary during pregnancy (especially early on)? - Mothering Forums

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#1 of 27 Old 03-16-2012, 06:21 PM - Thread Starter
 
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I will be going in for my 1st prenatal visit next week, when I'll be 11 weeks. I called the office today to find out what to expect and they told they would be doing blood work, urinalysis, vital stats, a pelvic exam and a pap. I already know that I'd like to refuse the pap, but I'm wondering about the necessity of a pelvic exam. With my last pregnancy I saw a midwife and didn't have any. If it's important I'll do it, but I'm unclear as to what the benefit is....?

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#2 of 27 Old 03-16-2012, 07:36 PM
 
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I was due for my pap anyway at my 8w appointment and had it done. I didn't even spot even though I usually do and was worried I would. They also test for chlamydia and gonorrhea as a matter of course, because these stds can affect the fetus. You should be able to refuse any tests and exams that you want to, however.


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#3 of 27 Old 03-16-2012, 08:53 PM
 
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No, it is not necessary. Just another reason not to use an ob! (cough cough) lol.


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#4 of 27 Old 03-16-2012, 11:14 PM
 
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Nope. The only internal exams I've had were at my request in the final stages of labor (I seem to lose my confidence during transition). 


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#5 of 27 Old 03-17-2012, 07:53 AM
 
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Any testing for chlamydia and gonorrhoea can also be done with a urine test, so you really don't need the pelvic exam. And, if you've already been tested for those things at a previous pap, you don't need to do it again.

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#6 of 27 Old 03-17-2012, 10:27 AM
 
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I had my yearly exam back in October, so I'm not due for another one, and I know I don't have any STD's because hubby and I are exclusive with each other, and have had standard testing at our yearly check ups anyway as a part of the typical screen they do. 

 

I am going to refuse my pelvic exam and pap at my first appointment on Monday (6 weeks) and will let them know I don't want one until I'm around 20 weeks, earliest. 

 

I have had a lot of miscarriages, and one was right after my pelvic exam at 12 weeks, so I really want to be overly cautious.  I didn't have any problem with pelvics with my two daughters, but given my miscarriage history and the fact that you just can't always know what causes it in one woman/pregnancy or another, I just want to be cautious for my own peace of mind.

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#7 of 27 Old 03-17-2012, 12:47 PM
 
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I asked my midwife at my last appointment why pelvic exams might be necessary during pregnancy. She answered that they really weren't necessary until labor. I then asked WHY did my OB give me a pelvic exam at every single visit during my last pregnancy? First she questioned "Really? Even early on?" When I answered her in the affirmative, she said: "Because he's a pervert." We kind of laughed about it, and she said that she honestly couldn't think of a single reason why he would be sticking his hands in me at every appointment.


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#8 of 27 Old 03-17-2012, 01:33 PM
 
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Quote:

Originally Posted by MamaInTheDesert View Post

I asked my midwife at my last appointment why pelvic exams might be necessary during pregnancy. She answered that they really weren't necessary until labor. I then asked WHY did my OB give me a pelvic exam at every single visit during my last pregnancy? First she questioned "Really? Even early on?" When I answered her in the affirmative, she said: "Because he's a pervert." We kind of laughed about it, and she said that she honestly couldn't think of a single reason why he would be sticking his hands in me at every appointment.


It's kinda my personal theory (based on nothing other than my outlook/experiences so don't flame me too much) that some drs. like to get patient really used to cooperation/taking orders/letting whatever be done to them.

 

I live in a really high c/sec rate country, pretty much no natural birth, etc... went to do a 12 week NT ultrasound and they wanted to do transvaginal... everything I read read about NT in US is abdominal... I fought with the tech and he insisted that I was wrong. (I am normal weight so that wasn't an issue) He finally agreed to abdominal, but said he would not sign his name to the NT part... well I guess he got a good enough pic anyway because in the end he did... 

 

I think it is just a tactic here for women to get used to take off your pants and do what you are told, get used to that early and then you will be ready for the birth.

 

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#9 of 27 Old 03-18-2012, 06:53 AM
 
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I'm an apprentice at a birth center. We don't do pelvic exams in early pregnancy. We are willing to do them near the end if a mom asks for one, but she usually has to be the one who brings it up.


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#10 of 27 Old 03-18-2012, 07:14 AM
 
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I had my first baby with an OB, and she did not do a pelvic exam till labor. I was due for pap while pregnant, but she said she prefered to do it after pregnancy; that was fine by me, because I was afraid of any kind of spotting. My second was with midwives, and again I had no pelvic exams till labor, and a yearly some months postpartum. I think pelvic exams during pregnancy, especially so early on, are unnecessary and intrusive...

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#11 of 27 Old 03-18-2012, 09:01 AM
 
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Have to say - its really good to hear so many stories of pregnancy centers/ midwives / etc who don't do pelvics until much much later. :)

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#12 of 27 Old 03-19-2012, 12:26 PM
 
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I got my Pap literally the day before I conceived last time, so I didn't need one once I was pregnant. I went through that entire pregnancy without any internal exams at all. The labor was precipitous, so there was no time for checks during labor, and I don't know if I would've had any anyway. I'm not planning on having any this time unless something is wrong.

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#13 of 27 Old 03-19-2012, 01:11 PM
 
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I didnt have any internal exams at all my last pg, until i was in active labor and wanted to know how far i was, bc i wanted to get into the birth pool.  Not necessary at all to have internals early on!


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#14 of 27 Old 03-20-2012, 08:36 PM
 
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There is no need to do "curiosity checks".  I will not do one before 39 weeks unless there is a REASON to check--they hurt and I think may be a cause of preterm birth---I mean---when you have sex the penis is not actually TRYING to get into the cervix and see what is going on---not natural.

 

Most moms want to be checked at 39 weeks (most want earlier but I explain that there is no need and the exam is not meeting any baby needs).

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#15 of 27 Old 03-21-2012, 04:20 PM
 
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I am so glad this question was asked!  I had a pelvic exam at every visit during my last pregnancy.  Besides being painful, it's so demeaning to be talking to your doc in that stupid paper gown.  Going with midwives this time.

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#16 of 27 Old 03-21-2012, 05:06 PM
 
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i never had an internal exam during my pregnancy,,, just one time towards the end, I was 1cm dilated and DD came the next morning :)


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#17 of 27 Old 03-22-2012, 09:56 AM
 
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I had a pap with my first appointment since it had been a really long time since I had one, so I was fine with that. I haven't had any other internal exams though and I had an appointment yesterday, I am 39 weeks today :)

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#18 of 27 Old 03-22-2012, 02:33 PM
 
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I'm glad to read this.  I went to the only hospital in my town that has midwives when I first found out I was pregnant, and the midwife who saw me pretty much demanded that I have a pap smear.  I refused and told her that I didn't want to do anything internal, that I had been spotting a little, and I didn't want to exacerbate that.  She became angry and said that something must be wrong with me for me to refuse treatment, that I must have had some sort of abuse (which I needed to tell her about even though I just met her), and that they couldn't do an ultrasound on me without it being internal, so there was nothing she could do for me.  It was absolutely awful.  :(  Needless to say, I didn't continue my care there...  In fact, I walked out sobbing.  I found a great homebirth midwife who hasn't even asked to do anything internal yet, and I'm 24 weeks.  I guess I am telling you all this to let you know that there are bullies out there about internal checks, and if you encounter one, RUN!  If you truly don't feel comfortable with internal checks, you don't have to have them.  Good luck, ladies!


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#19 of 27 Old 03-23-2012, 09:09 AM
 
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I'm also not clear on the point of internal exams during pregnancy. I do know that some providers like to do a pap smear at the beginning, though I'm unclear as to why - if they find cancerous/precancerous changes, I don't think they can treat it without terminating the pregnancy or putting it in serious jeopardy. My midwife says she doesn't do internal exams unless asked, that she prefers to do a pap after the baby comes. I *did* have an internal exam at my first visit, but it was at my request because I was afraid I might have some sort of infection, based on my symptoms. Since then, nothing.


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#20 of 27 Old 03-23-2012, 09:39 AM
 
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I don't know if it's standard care where I am or not, I was due for a Pap for my first appointment as a follow-up after an abnormal+treatment in the spring. I agree with Monkey - I don't know why they do the pap, as my doc explained she wouldn't do anything else (biopsy or treatment) if it came back abnormal, so it seems kind of pointless. But it eased my mind to have a normal pap so I was glad I had it. Since then, no other internal exams, and I don't expect any until I get close to my EDD (I'm 29 weeks). 


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#21 of 27 Old 03-25-2012, 03:55 PM
 
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So...an OB CAN be found who doesn't do an exam if you don't want one!!!  

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#22 of 27 Old 03-25-2012, 04:05 PM
 
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I usually do a Pap with cultures at 12 weeks so that if a woman spots or miscarries in the first trimester there is no finger pointing.  Pap is according to guidleines.  If she is up-to-date--I don't do a pelvic.

 

I offer pelvic at 39 weeks in an uncomplicated pregnancy---and most women are more curious than I am---I can wait until they present in labor--they are generally itching to see if anything is happening.

 

The notion that we make women strip so we can feel all powerful is --to me--abhorrent---I have NEVER in 30 years EVER heard an OB talk this way---I was shocked to see such a statement.

 

When a woman comes in thinking she has a vaginal infection ---how do you suggest I examine her---the old tongue depressor down the throat isn't going to help.  Oh  are gastroenterologists who do colonoscopies being perverse or is ti just the vagina?

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#23 of 27 Old 03-25-2012, 04:50 PM
 
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Obdoc,  

I made one of the statements you were shocked to see. I am not in the US. Can you tell me why transvaginal u/s would be standard for every woman doing a NT u/s at 12 weeks? I can understand if they did not get a good image and needed to try after abdominal, but for everyone? The country I am in has a 44% c/s rate, one of the highest in the world. (There is a context for my opinion, maybe it is totally wrong, but it is based off of what I have seen here, personally and through relatives/friends).

 

Why would internal exams be needed at every appt?

 

Of course if a patient is complaining about vaginal infection, well you would have to check that out. I think the better analogy is do vaginal exam for a sore throat. 

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#24 of 27 Old 03-25-2012, 05:27 PM
 
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the difference in imaging at 10 -12 weeks for NT check is quite dramatic----and if you are a little "fluffy" it makes a huge difference.  "Claritin clear" as I say.

 

Of course doing a NT check is not routine---many here say they would never do anything about the result so they don't want the test done.

 

There is no need for routine exam at each visit--I personally think that digging around at the cervix is unnatural and can cause premature labor---it is posterior to prevent the penis from banging it around so why should a finger do it?---leave it alone!!! 

 

My prematurity rate is half of my peers in the same locale.

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#25 of 27 Old 03-25-2012, 05:58 PM
 
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I was 12 weeks 3 days, but none of the 3 ob/gyns or 1 mw I saw cared anything about my charting, I ended up just lying about my LMP after a while. At the time I was 5'6" and about 140 lbs. It's not just me, it's how all n/t us are done here, (and routine here for private care along with other exams which aren't "standard" in US), but I'm not even US, so sorry, this is a bit off topic anyway, there is a totally different "birthing culture" here, (80%+ c/s rate for private hospital).

 

Obdoc, I hope you stick around, I saw you were frustrated in other threads today too, it is good to have other perspectives around here too, I think there have been in the past but I haven't seen many obs recently. 

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#26 of 27 Old 03-26-2012, 12:51 AM
 
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I don't know if I should even respond since this is not the popular opinion here but I do have to share my story in case it helps just one person and their baby.  In my case early internal exams were extremely beneficial.   Without I would have had a 2nd trimester MC and thankfully steps were taken to prevent that from happening.  I cannot imagine the heartbreak if I or my OB had just assumed all would be fine and then lost my baby.  I am so thankful to my OB and MFM and will be for the rest of my and the baby's life.  And while my case is not typical and my doctor already knew I was high risk, it is worth mentioning.  There is some good that comes from early internal exams for some women, I know because I am one of them.     


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#27 of 27 Old 03-26-2012, 01:58 AM
 
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Just wanted to add that I did have an OB and had no internal exams. And it wasn't from me refusing them (although I would have), he was just very natural-minded and progressive and since there is no need to do an internal exam for a healthy, normal pregnancy he doesn't do them. He doesn't even check at the end of the pregnancy to see if you're dilated, or if your cervix has thinned, he just lets nature take its course. The baby will come when it comes, knowing whether you're dilated isn't going to speed it up. So, to answer the OP's question- nope, not necessary in a normal, healthy pregnancy.


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