Vaginal examinations: Reasons, risks and benefits.
What is a vaginal examination? A vaginal examination is performed during labour to assess progress, at the end of pregnancy to perform a membrane sweep, or during induction to insert medication and to check progress throughout.
During the examination a midwife will insert two fingers into the vagina and into the cervix if open to determine dilation of the cervix. Other things your midwife is checking for is:
- Position of your baby, she does this by feeling the sutures on the baby’s head to determine which way your baby is facing.
- How low/high your baby is in the pelvis
- Is your cervix posterior (at the back) or anterior (at the front)
- The consistency of the cervix, is it soft or hard?
- Effacement (How long your cervix is), as your cervix will start off at approximately 2-3 cm long and slowly efface (meaning shorten and thin out) during the early stages of labour.
By performing this examination, she will be able to tell if your cervix is ‘favourable’ which tells medical professionals how likely you will go into spontaneous labour on your own or how likely an induction will be successful. This is done by a bishops score whereby they will consider all findings of the examination and give it a score.
For a first-time mum the cervix is predicted to open approximately 2 cm every 4 hours, or half a cm per hour. For women who have had babies before it is predicted to be around 1 cm per hour. In the UK vaginal examinations are usually performed every 4 hours to check the progress but please note that it is not an accurate prediction of how your cervix is doing or is going to do in the next hour or two. It is a very small snapshot in time, telling you exactly what the cervix is doing in that moment and cannot predict the future.
Take this example for instance: A woman may be examined and found to be 2cm dilated, she is then examined four hours later and is still the same but give birth 1 hour later. Examinations themselves can stall labour as it can hinder the production of oxytocin and cause you to release adrenaline. If you are feeling uncomfortable or frightened in anyway then your oxytocin levels will drop, and adrenaline will take over. You need oxytocin for labour to flow, and to contract your uterus which opens your cervix. Once your cervix has opened fully you will be ready to give birth to your baby.
Benefits to a vaginal examination:
- To determine your baby’s position if labour has slowed. This may be due to the fact that baby is not in a good position and there may be ways to help you get in an optimum position to help your baby manoeuvre into the pelvis. Not being flat on your back will decrease the likely hood of this as baby will have more space to navigate down. Being on your back presses on the sacrum and decreases the pelvic outlet by 30%.
- If you have requested it and feel it would benefit you to know what is happening to motivate you help labour progress.
- If baby is found to be in distress via fetal monitoring. Having an examination at this point may tell the practitioner why the heart rate is slowing. Perhaps your cervix is fully dilated, and baby is low in the pelvis and ready to be born?
Risks of a vaginal examination:
- You are at higher risk of infection if an examination is performed. Even though hands are washed, and sterile gloves are used, there is still bacteria outside of the vagina that can be introduced inside. The risk also increases with each examination performed and certainly if several practitioners are doing so.
- If you have had previous trauma to that area, a vaginal examination can be extremely triggering and bring feelings of extreme discomfort both physically and emotionally.
- Can hinder the labour progress further as if found to be the same dilation as previously, then this can be disheartening and leave you feeling deflated. Feeling this way is likely to have an impact on your oxytocin levels which can stall or halt labour all together.
- May also disrupt and halt labour as usually you are asked to be on your back during the procedure. This is especially so if you have been freely moving around or in the birth pool beforehand.
Vaginal examinations are optional, and it is completely your choice to decide if you would like one or not. Unfortunately, it is often assumed in the medical world that everyone offered will accept it without question. However, know that you may accept a vaginal examination or decline at any point during your labour. Your healthcare provider needs to discuss the reasons for wanting to perform an examination and what the risks and benefits are. They also must respect your decision to decline. You may be told that it is policy or procedure to perform a vaginal examination before entering the birth centre for instance. However, you can respectfully remind them that there are other ways to determine labour progress, and cervical dilation. Such as your behaviour, the purple line that is situated just above your sacrum (this line increases the more dilated you are, and rhombus of Michalis ( a prominence at the base of the spine when your baby is almost ready to be born.
It is solely your choice whether to have a vaginal examination or not and once you have been given all the risks and benefits that are relevant to your situation, you can then make a truly informed choice about what is right for you.
For more information on vaginal examinations visit: https://www.aims.org.uk/information/item/vaginal-examinations#:~:text=A%20VE%20involves%20a%20midwife,changes%20that%20might%20be%20happening.