Vaginal Exams In Pregnancy, The Benefits & Risks You Should Know.
As you reach the end of your pregnancy, your obstetrician or midwife might tell you they are going to do a vaginal exam at your next appointment. This may be very exciting to you, especially as you are likely. getting to the point where you want this pregnancy to be over. But what is the purpose of having a vaginal exam before labour starts and are there any risks to it?
If you consent to having a vaginal exam, because it is optional, and you have to give your consent, the health care practitioner will insert two gloved fingers into your vagina to determine several things. They are feeling to see if the cervix is thinning out or is it still thick, is the cervix firm or has it started to soften and get stretchy and has any dilation taken place. They can also feel how high baby is above the pelvis, or if they have engaged into the pelvis, this is known as the baby's pelvic station.
A vaginal exam in the weeks leading up to labour can be helpful in determining the possible success of a medically induced labour. And when I say successful, I mean that the labour would end in a vaginal exam as opposed to a surgical birth. Known as the Bishops Score, 5 characteristics of the cervix are examined and given a score of 0 to 3. The higher the score, the more likely the induction will require less interventions and end in a vaginal birth.
Having a vaginal exam in the final weeks of your pregnancy and being told that your cervix is softening, or thinning or even slightly dilated can be welcome information to someone who feels like they have been pregnant for soooo long!!! However, I have to say that if you agree to one, and your cervix is still long, firm and you aren't dilated at all, this doesn't mean anything bad is happening and that you won't go into labour soon.
Take any information you get from a vaginal exam in your final weeks with a grain of salt. Vaginal exams can only tell us what your cervix is doing at that exact moment in time. It can't tell us what your cervix will be like a day later, a week later or two weeks later. If you are told your cervix is 2 cm dilated and softened. That does not mean you are in labour, or going to go into labour any time soon. Subsequently, if you are told your cervix is firm and closed, don't worry, that doesn't mean you won't go into labour that night or in a few days. In other words, be careful about getting to invested in the information you get.
One of the more concerning risks for a vaginal exam, at any point in your pregnancy or labour is infection. Infection can occur when it is introduced via the insertion of anything into the vaginal vault and one of the reasons why vaginal exams are not don't constantly in pregnancy or repeatedly throughout the labour.
Any infection that arises in pregnancy or the labour will be treated with antibiotics and after the birth, baby will be monitored for a period of time to ensure they did not infected and require treatment. After my second birth, it was discovered that my son had an infection and he was admitted to the special care nursery for a week for observation and a round of antibiotics.
As an add on to Benefit # 2, sometimes the information you get in a vaginal exam in pregnancy can actually make you more depressed. Learning your cervix hasn't started to do anything can be anxiety inducing. Plus this can increased your stress hormone levels, that can actually block oxytocin from flowing and actually inhibit labour from starting. A little like a self fulfilling prophecy.
Read more about how stress can affect labour progress!
And while this isn't always the case, I've certainly had clients that this has happened to, sometimes, the care provider, while doing the exam, will sneak in, what is called, a Stretch & Sweep. This is a procedure done, as a preliminary step to a medical induction, and requires consent, like any other medical procedure.
It's done by the care provider, inserting a gloved finger into the cervix and sweeping around the top of the cervix to dislodge the amniotic membrane from the top of the cervix.
The theory is, that when it is done, usually multiple times, it will shorten your pregnancy by four days. Not that you will go into labour in four days, but that your labour would start four days earlier, than if you didn't have a sweep at all.
If you are having a medical induction this procedure can be a good option to encourage your body to go into labour, however if you are having a boring, uncomplicated pregnancy and an induction isn't medically necessary then it might be wise to hold off on The Sweep until 40 weeks. Risks of the sweep include, infection and an increased risk of your waters breaking prematurely, which would potentially mean an increase in infection and an induction if labour doesn't start on its own.
Ultimately though, the key risk here is your provider not being honest with you and doing the sweep without your consent. And that, is just, wrong.
So make sure if you agree to have a purely optional vaginal exam prior to going into labour, that you make sure you speak to your care provider about risks and benefits and ask them if they plan to do a stretch and sweep during the exam and let them know if you would prefer not to. It's fine if you choose to, but you want to be told if it is going to happen. Informed Consent is not an option.