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Old 06-30-2008, 09:15 PM - Thread Starter
 
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So my midwife today said that next week I could request a vaginal exam, to check for dilation, if I wanted. She said it's my choice. What are the pros and cons of having a vaginal exam at this point (on Thursday I'll be 38 weeks)?

And here's some good news...the baby is measuring 36cm. I measured small last week so they wanted to send me in for an u/s if this week he was still measuring outside of the 2cm range. He grew 1.5 cm so he's in the range and all caught up! Phew!

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Old 06-30-2008, 09:26 PM
 
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I had my first vaginal exam last thursday, at 37 weeks. The midwife said she could tell I was 2cm dilated "all the way up".
For me personally, I like knowing these things. I also don't ever have any bleeding from an exam, so I don't see a disadvantage to them.
If there are any other cons, I'm not aware of them.

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Old 06-30-2008, 09:34 PM
 
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Pros-you know what your cervix is doing at that moment, can get things going if your body is ready

Cons-introduces germs up there, (not many because she will be wearing a sterile glove but i've heard it can increase the risk of infection?) can be discouraging if you are not dilating or effacing at all, can cause irritation/spotting/annoying ctx.

With my DD I had one at 40 weeks and was very discouraged because I was not dilating or effacing at all. Turns out DD was born 2 days later :

This time I have not had one yet but I am considering it at my appt. tomorrow just because I am curious.

The bottom line is.... don't read too much into it, because you could be totally closed and go into labor that night, or you could walk around dilated for weeks
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Old 06-30-2008, 09:35 PM
 
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Ditto the dilated for weeks part *points to self* I'm either 100% effaced or dang close and 5+cm and have been 4cm+ for the last 3 weeks. Still no baby!

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Old 06-30-2008, 09:37 PM
 
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I'm on the fence about these. I had one today because I have never had an internal or anything with these midwives and have had tons of menstrual cramps the last 4 or 5 days. But nothing else. Turns out "not even a fingertip". I knew that, really. Which is fine, I'm only 38 weeks. I don't expect to have this baby before 40 weeks... Also, I was 2cm dilated with my son for 5+ weeks before he came, with a little help of AROM.
I don't think it's a big determinant, but if you are interested, why not?

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Old 06-30-2008, 10:05 PM
 
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I don't see the point.
You could be not dilated at all, which might discourage you, but then you could go into labor the same day and dilate quickly.
Or you could be 4cm dilated and get your hopes up then walk around that way for 4 weeks.

I personally decline vag exams without good reason (for me that has been twice in 4 pregnancies, to confirm a vertex position).

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Old 06-30-2008, 10:10 PM
 
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My babies tend to be breech so sometimes they check internally if they can't tell from the outside. When I've had OB's they always want to check. When I've had homebirths they rarely want to check. This time I'm doing an ABC so it's my choice. I'm totally a curious person and want to know even though I KNOW I will walk around dilated to 4 or more for weeks. Still - I do like to know where the head is.

Pros - if you're a curious person it gives you one less thing to wonder about.

Cons - for me it's when you're not dilated at all. Even though I know that doesn't mean a darn thing it can still be frustrating, yk?

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Old 06-30-2008, 10:30 PM
 
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I've often thought about writing an essay on dilation checks, the premise being that humans are obsessed with rating things on a scale of 1 to 10. And that's usually how it goes. It's not "You're dilated 10 cm." it's more "You're a 10!" I personally don't see a point in them. However much you're dilated means NOTHING as far as when labor will get going, I find them very uncomfortable, and I really don't want someone else in my space. But that's totally my perspective. I honestly don't understand the curiosity, as it really isn't a good indicator of progress, but to each her own.
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Old 06-30-2008, 10:59 PM
 
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Originally Posted by njbeachgirl View Post
i've heard it can increase the risk of infection?
i think the increased risk of infection is because bacteria that can be hanging around externally near the vaginal opening can be pushed up inside where it can grow and flourish.

personally, i fall into the "not unless there's something to learn from it" camp. and i don't consider dialation or effacement to be reasons for a check for the same reasons as nearly everyone else has listed already. another reason i don't like them is b/c they make me cramp. when i was in labor with dd, the only times ctx were actually painful (not just something that i had to work with) were when i was getting checked, and when i was on pitocin.
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Old 06-30-2008, 11:08 PM
 
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Originally Posted by veganf View Post
I don't see the point.
You could be not dilated at all, which might discourage you, but then you could go into labor the same day and dilate quickly.
Or you could be 4cm dilated and get your hopes up then walk around that way for 4 weeks.

I personally decline vag exams without good reason (for me that has been twice in 4 pregnancies, to confirm a vertex position).
ITA with this.
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Old 06-30-2008, 11:09 PM
 
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Originally Posted by ekblad9 View Post
My babies tend to be breech so sometimes they check internally if they can't tell from the outside. When I've had OB's they always want to check. When I've had homebirths they rarely want to check. This time I'm doing an ABC so it's my choice. I'm totally a curious person and want to know even though I KNOW I will walk around dilated to 4 or more for weeks. Still - I do like to know where the head is.

Pros - if you're a curious person it gives you one less thing to wonder about.

Cons - for me it's when you're not dilated at all. Even though I know that doesn't mean a darn thing it can still be frustrating, yk?
What's an ABC?

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Old 06-30-2008, 11:16 PM
 
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alternative birthing center.
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Old 06-30-2008, 11:37 PM
 
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I'm another one who declines vag exams without reason. I probably won't have one until I'm in labor. It doesn't really tell me anything useful, and there are some risks associated with it.
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Old 07-01-2008, 03:27 AM
 
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they are placed there for the amusement of those who like to point them out.
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Old 07-01-2008, 10:51 AM
 
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I would never get one.
Cons:
>>Uncomfortable or hurt
>>Can introduce germs and cause infection
>>They don't tell you anything constructive (you could be closed and start labor that day, or 4cm and not go into labor for 4 weeks).
>>They can discourage you and cause you stress if you aren't dilating and you want to be.
>>A lot of times a care provider will strip your membranes while doing the exam and not even ask you whether it is ok. Then your body can be pushed into labor when you aren't ready yet and you could have a long and complicated labor because it wasn't really time yet.

Pros:
I can't think of any.
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Old 07-01-2008, 10:59 AM
 
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As I said in a different thread last week, I have a no fingers in the buki policy. No need.
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Old 07-01-2008, 11:17 AM
 
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I don't think there is any pro if she is just checking for dilation or effacement- those updates don't really tell you anything.

Cons:

-Raises your chances for infection/ germs.
-Causes discomfort for no reason.
-Some care providers will use this information to force inductions and make you think your body is not capable of going on its own. On the other side, they can take this information and get your hopes up that your baby will be coming soon.
-Membrane sweep- either by consent or not might cause you to go into labor before you are ready, or it will just cause a lot of painful contractions that do nothing.


My MW checked me at 36 weeks to confirm the baby was head down (we were unsure from belly check and HB). It was very quick, but still caused me to have constant BH for the following two days. Although worth it in the end for my own piece of mind (I was terrified she was breech), it was not fun.

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Old 07-01-2008, 11:40 AM
 
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I was just thinking about this yesterday and decided that if my midwife wants to do an exam I am going to decline. No matter the results that baby comes when the baby comes, and it does not help my mental status one way or another knowing I am xx amount of centimeters dialated or nothing at all. I dont need to get my hopes up, nor do I need to get disappointed.

I will just continue to wait patiently, plus I am a big baby and really, really dislike getting checked. My last ob was not the most gentle and I am sure that doesn't help.
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Old 07-01-2008, 01:31 PM
 
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My OB will not do an internal exam unless there is a medical reason or I should demand one. I will not be planning an internal exam until I am at the hospital in labor.

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Old 07-01-2008, 05:06 PM
 
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I like to follow my progress. I love my MW and know that she would not do anything (like a membranes sweep) with out my consent. She is always extremely gental. Honestly if you're seeing a care provider that you are worried would do something like that with out your consent, you should really be seeing someone else.

I am one that slowly dialates a bit for a few weeks before labor starts. I wouldn't know that with out checks as I'm not coordinated enough to check myself.

I dont see how the increased risk of infection "from germs around the vagina being pushed in" is any greater with a VE then it is with sex - honestly, wouldn't that be worse? I do understand that there could be germs from the mw or ob, but mine washes her hands and then uses a sterial glove, so i believe the risk to be minimal.

With my iron being so low recently I have had several checks to determin position and to track my progress etc in case things started to pick up. Every woman needs to make this decision for herself but I really dont believe there is a right or wrong answer to it. If I had a male doctor whom I was uncomfortable with, I probably wouldn't want to be checked either. But I think it's really situational.

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Old 07-01-2008, 05:14 PM
 
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No pros that I know of.

Cons are infection, setting up expectations for labor to start that are inaccurate, possible induction if they want to "move things along", possible breaking of waters without permission, its possible painful and almost always really uncomfortable....

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Old 07-01-2008, 06:19 PM
 
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The only thing it will tell you is what you are at the time of the cervical check. You can actually goes backwards as a result of a check, rather than forwards, and it will tell you nothing about when and if labor might get started. I personally have declined all through this pregnancy and will do so until I am in labor and someone gives me a darn good reason to go poking around up in there...

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Old 07-01-2008, 08:21 PM
 
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I had one a couple weeks ago just to make sure there wasn't anything crazy going on (we were going on a day long out-of-state trip that weekeend).

I had one near term with my last pregnancy, and it was nice to get confirmation that the changes I was feeling in my cervix when my son mashed his head into it (i.e. it stopped hurting and feeling like a pap smear and started to feel like a deep, pleasant, stretching) were actually real.

I don't think I'll do any more this pregnancy, because while I am curious I'm also getting impatient and I don't think more information will help with that


Interestingly, I don't mind them during pregnancy but I don't like them during labor. I'd rather just go with the flow then.
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Old 07-03-2008, 07:24 PM
 
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According to one of my midwives, the only time you need an internal exam is when you feel the urge to push- you want to make sure that your cervix is out of the way so you don't hurt it.

I agree with all the former responses... including risk of infection, especially if you're being checked at a doctor's office or at the hospital while in labor... they're dirty places. At least at home your body is used to those germs so I don't think having sex encompasses the same risks unless you're having sex outside your home.
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Old 07-03-2008, 08:36 PM
 
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According to one of my midwives, the only time you need an internal exam is when you feel the urge to push- you want to make sure that your cervix is out of the way so you don't hurt it.
And that's a dubious reason. There are those who absolutely insist that the true urge to push is only accompanied by full dilation, so a check for completion is a moot point. Likewise, "full dilation" doesn't necessarily mean you should push if you dont' have the urge. I personally don't feel I have enough experience to say whether I think this is true, but in my previous births, it bears out.
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Old 07-03-2008, 09:02 PM
 
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For me, personally, it's a sacred space. Mine, DH's, and the baby's for the trip.

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Old 07-03-2008, 09:06 PM
 
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I had one this morning. I found out I am 2 cms dilated and not thinned at all. It didn't hurt at all, just pressure. I did it because I never did with the other 2 and I was wondering if I dilated much before labor.
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Old 07-08-2008, 06:18 PM
 
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One more Con:
As someone mentioned - they can be used to force induction on you.
Happened to a friend of mine, she was about 3 or 4 cm for 3 weeks straight. So her OB wanted to induce and said, "That is unheard of!" She was close to her due date at the time of induction as well - so she must have been having the internal exams regularly from 37W on.

I figure if she had not had those internal exams, that conversation would have never come up!

As others have said, why get your hopes up if you're dilated & effaced - when nothing could happen for weeks?
Likewise, why get discouraged if you're NOT dilated & effaced - when you could deliver in a matter of days?

It's just not a meaningful thing.

As for infection - I'm GBS+, so I KNOW there's a risk from exams of pushing harmful bacteria from the vaginal opening up to the uterus. And even if you test negative for GBS, it could appear later - so even with a sterile latex glove, there's still an issue of the exams leading to increased risk of infection.
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Old 07-08-2008, 06:58 PM
 
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I'll check myself if I really want to know. It's my body.

I'm in the group that sees NO benefit in a care provider checking, just a lot of reasons not to.

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Old 07-08-2008, 07:30 PM
 
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I just had my 35 week appointment with my midwife and I asked her when she usually starts doing vaginal exams because I was expecting to have one next week or so. She said, "When you're in labor."

So we had a long discussion about it. She sees no benefit in knowing dilation or effacement before labor begins, because it does not really mean anything. You can walk around at 3cm for weeks or you can be closed up tight and go into labor the next day.

She would use one to check for vertex position if she could not easily palpitate the position, but would not go near the cervix unless I request it. She followed this with, "But you can check yourself if you want to." And she described to me what to look for, which was great!

As far as checks during labor go she likes to do one as soon as she comes (for the home birth), to know what the starting point is. She recommends the before pushing check for first time moms, but if you labor the baby down gently without forced pushing (some women feel the need to do this and some don't) there is no need to check.

So, that's my MW's opinion.

As for me, I like knowing things. I check my blood sugar for the fun of it, if I had a sphygmomanometer I'd check my BP for fun too. I'm too much of a scientist... I'd be getting checked every 20 minutes and making graphs during labor if it were practical.

I'll probably request more exams than she usually does because the curiosity will be killing me.

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