by Laura Dana, LCCE, CD(DONA), CAPD
I haven't met many women who were happy to have an exam done while being pregnant. For that matter, I haven't met too many women who were happy to have it done while not pregnant, but what is the purpose behind performing the vaginal exam in pregnancy? If it is patient led, meaning that the patient is the one requesting it, what would be her reasoning? On the other hand, if it is physician or midwife prompted, what are they looking for and why?
It's certainly easier to be the examiner performing this function, but not always easy to be on the receiving end, and in pregnancy, this particular event can cause women to be uncomfortable, emotionally as well as physically. Having a vaginal exam is more like an invasion into the most personal of all our belongings...ourselves. However, let us take a look at this on a more clinical level.
There are real reasons for checking a woman's cervix to ensure a safe and healthy pregnancy, but just like so many "interventions" offered during pregnancy, it is important for each woman to be aware of the potential drawbacks to such a decision before she complies. What would be the reasoning for needing to "know what's going on" other than pure curiosity? Who exactly is directing the VE to be done? Consider the following scenarios:
There are definitely real reasons for VE during pregnancy, but if a woman perpetuates a healthy pregnancy, what then would be the reason? So much of the research shows us that fetal and maternal outcomes are much better with the least amount of intervention. Do women consider the VE to be "intervention", "routine", or "necessary"? Ask three different women and you may very well get three different opinions. After all, it's a very personal decision to make, but has she actually considered the benefits and risks before allowing the exam to proceed? Does she know anything of alternatives to the manual VE, such as NST (non-stress test), BPP (biophysical profile), keeping track of kick counts, high level sonogram, or any other less invasive offerings? Does she know that the actual exam itself can bring on internal discomfort associated with cramping and bleeding?