by Kerry Tuschhoff, HCHI, CHt
What most expectant parent don't realize is that they truly are in charge of their baby's birthing. They get to choose the way the labor and birth go, as well as their baby's care after birth. It is no different than any other service that you pay for, except that it is much more important. You are paying the doctor's nurse's and other staff's salaries, and you deserve to get what you want. If there are true complications, that's when the doc, midwife or nurses step in and help. Just like being a Lifeguard at a pool: No one needs to do anything except keep a watchful eye on things, and if anyone's in trouble, that's when they jump in to help.
Routine vaginal exams are very common in late pregnancy
Benefits: A routine vaginal exam at the end of your pregnancy actually has no benefits since your present dilation/effacement/station are not indicators of when your birthing time will begin.
Risks: There is a small risk of infection and PROM (Premature rupture of membranes) (See Henci Goer's The Thinking Woman's Guide to a Better Birth for realities for related studies pgs 204-209) Stripping of the membranes is often done as well during a routine vaginal exam, (see below) and can cause many days of cramping, bleeding and possible sleep loss without any benefit.
Alternatives: You can tell your care provider that you would prefer not to have one. And keep your panties on.
vaginal exams measure several things:
Vaginal exams do not measure:
Vaginal Exams during the Birthing Time
"Let's see how far along you are." Vaginal exams are administered in your birthing time to assess dilation of the cervix.
Benefits: This really has few benefits, as it tells you nothing about when the baby will be born, but has some risks. Having a vaginal exam when you feel "pushy" may be of help to ascertain if you are fully dilated.
Risks: Every time an attendant checks the mother's cervix, the risk of infection is increased, especially if her bag of waters is broken.
Vaginal exams may also cause the mother to tense up, and her ability to relax is reduced. Some women like to find out how far they are dilated, but this is not a reliable way to figure out how long a she has left. In fact, it might discourage her if she finds out she is dilated less than she imagined, and this emotional element is very important. If a woman is not dilating quickly enough, interventions may be instituted. This puts additional stress on the birthing woman.
Aside from obvious risks, vaginal exams can be very uncomfortable, especially if performed during a surge. (Ed.: Before one is done, take a deep breath and as you exhale, concentrate on your "Anesthesia" programming, "seeing" the anesthesia all around your cervix, and relaxing your pelvis.) Further, it is impossible to predict how long your birthing time will last from how far a woman is dilated. It would be well advised to pay attention to emotional signposts instead. They give a lot more clue to where a woman is progressing in birth.
A procedure called "Stripping the membranes? consists of separating your bag of water from your cervix, during a vaginal exam. It may be done without your consent or knowledge, and this can be avoided by talking to your doctor before any internal exam.
Benefits: Some believe that it will bring on birthing surges within 24-48 hours. There is no scientific data to back this theory up.
Risks: There is a risk of infection and premature rupture of membranes, and it may be painful.
Alternatives: You can tell your care provider that you would prefer not to have the procedure done.