Friday, July 30, 2010

Vaginal Exams: Useful Tool or Unnecessary Intervention?

Vaginal exams are something that women have come to accept as an uncomfortable part of being pregnant and having a baby. Before the onset of labor, a care provider may put their gloved fingers into the vagina of the expectant mother to check her cervix and see if it has opened up, and how much. During labor vaginal exams are routinely used to determine how much progress a woman has made in labor.

Effacement is the thinning of the cervix, and is expressed generally as a percentage. 80% percent effaced, for example, indicates that the cervix has thinned out 80% and still has another 20% to thin out completely. Effacement can precede or accompany dilation.

Dilation or dilatation (depending on your preference of terminology) is the opening of the cervix. Generally 1 fingertip-breadth (of the provider who is checking you) equates to 1 cm of dilation, 2 fingertips equals 2 cm, and so on, all the way up to 10 centimeters (or "complete"). The provider actually sticks their fingertips into the cervical opening to check this measurement.

Many times the vaginal exam is used to guess how much longer a woman may have left before the baby will be born. Unfortunately, this is a poor indication because every woman dilates and progresses at her own pace. There are many factors that affect labor progress, and it's unrealistic to rely on cervical checks to predict the future. I believe vaginal exams are a small part of our modern world's effort to control labor, combined with the use of medications to start and speed up labor to try and fit it into our schedules and what we think labor should look like.

Vaginal exams are uncomfortable in the least, and sometimes downright painful. At times during labor the provider may want to do a vaginal exam at the height of a contraction, which makes it even more uncomfortable. From my experience, it can also interfere with the laboring woman's focus and coping techniques and make it harder for her to work through the contraction.

Vaginal exams can be harmful. Yes, you read that right. Downright dangerous. When anything is inserted into the vagina (gloved or not) it brings bacteria from the outside of the body into the birth canal. Our bodies have different types of bacteria in different places, and they're not meant to be mixed up and put in places where they aren't normally found. This can cause maternal infection and fever, particularly if the bag of waters has already ruptured.

If your has water broken (before or during labor) and you want to avoid the risk of infection, AVOID VAGINAL EXAMS.

The reason hospitals have time limits on labor (baby must be born within 12, 24, or X number of hours after rupture of membranes) is because of this risk of infection. If you avoid vaginal exams (or anything that could contaminate the birth canal) you may virtually eliminate this risk, and you can safely wait for labor to start and progress on its own.

I've covered the risk. Now let's talk about the alternatives.

How Dilated Am I? Assessing Dilation in Labor WITHOUT an Internal Exam.: This is a really good blog post outlining multiple ways of checking labor progress without an intrusive vaginal exam. These methods include closely observing outward signs from the mother including the sound of her voice, smells, irrational thinking, feeling the top of the uterus, and more. I've found it to be extremely helpful.

Checking dilation without a vaginal exam: I love this post, as it outlines very specifically how to use touch to measure the space between the top of the fundus (uterus) to the breastbone:

"During a contraction and with mom on her back, determine how many fingerbreadths of space are between the fundus [top of the uterus] and xiphoid process [the triangular tip of the breastbone] at the height of a contraction.

5 fb = no dilation
4 fb = 2 cm
3 fb = 4 cm
2 fb = 6 cm
1 fb = 8 cm
0 fb = complete"

My understanding is that it's best to use the fingerbreadths of the mother herself, but someone else can check the measurement as well.

Isn't that great?! These posts give great information that can help empower women to stay comfortable and safe in labor, and also arm them with tools to help them in the process.

Here is another article outlining The Dangers of Vaginal Exams if you want to learn more.


  1. I HATED getting checked. I felt like it was what THEY wanted to do, not me. I did appreciate that at my 38, 39, and 40 week appointments they let me decline an exam. I told them I didn't want them because I wasn't even having contractions---and I knew that my body wasn't ready yet. In the hospital though, they would check me as if it was something to cross of their list (usually it was because they were asked to by the supervising physician. And for someone who wasn't dilated at all, OUCH. Worse though was during labor. I was thinking to myself, "Do you really need to check? Can't you tell I'm having strong, steady contractions and am obviously progressing?" That's way cool that there's other ways to check, if needed.

  2. Jamie, I totally agree. I did have vaginal exams during labor with my home birth, but it's because I requested them. My midwife told me up front that she didn't have to do any vaginal exams. I had become dependent on that number after having four babies in the hospital, and I wasn't aware of alternatives either. I hope with the next baby I'll be able to let go of that dependence and trust more fully in the process of birth and my body's ability to do it without stringent monitoring.

    One thing I forgot to mention in the post is that many times vaginal checks are extremely disheartening for the laboring woman. I can't tell you how many times I heard the words "I'm going to check you now and see how you're progressing" and think to myself "I really hope I'm (X) dilated..." only to find out I wasn't as dilated as I hoped to be. My labors have typically been longer than the curve the hospitals use as a guide, and I always felt pressure to progress faster than I did. Each time that happened I lost a little faith in myself and my body and there were times I gave in to the pressures of the hospital and let them intervene because of that lapse of faith. It's not only an unnecessary intervention in and of itself, but vaginal exams themselves can lead to further unnecessary interventions

  3. Now, can we teach providers not to do VE's constantly? As an apprentice, I was taught to check the ladies from 36 weeks on. I HATE doing that, especially to primiparas(first time moms) and since it doesn't really tell when the mom is going to go into labor, and it can introduce infection, why can't we( midwives and docs) just keep our hands outta there? I do much better watching the mom and seeing how she's reacting to the labor! Or watching the "purple line" progress (as dilation increases, there is a faint purple line on the mom's backside(butt crack) that grows longer...:)

  4. Many midwives do not do vaginal exams, because of the dangers you listed. Also, when vaginal exams are necessary, it is possible to do them without discomfort or pain to the woman. Many doctors, however, have inadequate training to make this possible.

    I had a homebirth with a midwife and was only checked twice during my labor, once when she arrived (6 cm) and once to determine if I could push. I'm sure if I'd had a hospital birth with an OB/GYN that I would've been checked much more frequently.

  5. My first was a hospital birth, and EVERY SINGLE checkup I had a cervix check (and never thought to ask WHY??), and I was checked every single hour for my 30+ labor! Yeah, doing a UC homebirth this time.