First and foremost, vaginal exams are like IVs…I’ve never met a single person who liked them
What are some reasons a provider would perform a vaginal exam during my pregnancy?
It’s common for a provider to do a vaginal exam when you first start to see them, because they may do a pap smear. Your provider may perform a speculum exam or a vaginal exam (depending on how many weeks pregnant you are) if you are bleeding, contracting regularly, or if they think something is wrong. There is no current recommendation for a provider to do a vaginal exam at every single prenatal visit.
What exactly are they “looking” for, anyway?
When a healthcare provider performs a vaginal exam, they’re looking for: how dilated you are (how open your cervix is), your effacement (how thin your cervix is), the baby’s station (how “low” the baby is), how soft or how hard your cervix is, the position of your cervix (anterior, mid, or posterior), the presenting part of the baby (what part of the baby is closest to your cervix), and any abnormalities.
There is a great article called The Myth of the Vaginal Exam that does a fantastic job at explaining all the elements a healthcare provider is looking for when they perform a vaginal exam. I also wrote an article called Cervical Dilation Explained by a L&D Nurse. If you have any questions, talk to your provider.
When I’m in the hospital to have my baby, who will be performing vaginal exams?
Your provider, your nurse, and possibly a resident (if you deliver at a teaching hospital) may perform vaginal exams.
How often will they be performing them?
There are a lot of reasons why a healthcare provider may perform a vaginal exam. If you choose to deliver in a hospital (as opposed to at home or a birthing facility), there are typically policies in place for nursing staff. In addition, your nurse will use their nursing judgment. Most nurses will perform an initial vaginal exam to see what they’re working with. For instance, if I were laboring someone I would initially perform a vaginal exam to ensure that the baby is vertex, or head down. I can usually tell by performing Leopold Maneuver’s, but I still always perform a vaginal exam. I want to know what the cervix feels like and I realllllly want to be sure what part is presenting before I labor someone…and (so far) I’ve never been wrong about what presenting part I feel when I perform a vaginal exam. Your baby’s head feels hard (like touching your forehead). Your baby’s bottom feels squishy (like touching the tip of your nose). When your nurse performs that initial vaginal exam, they are assessing all of those cervical elements (dilation, effacement, station, position, and consistency). If you’re not in active labor, and you need medication to induce or augment your labor, how hard or how thick your cervix is will help determine what type of medication would best help you to dilate. If your bag of water has not broken, your healthcare provider may gently press on your baby’s head to see if the baby is nicely engaged in your pelvis. If your bag of water is broken, your healthcare provider will be able to tell if the baby’s head has an unusual amount of molding and sometimes they can tell what position your baby is in (is your baby looking to the right or the left, or are they looking straight up or straight down). I could go on and on about this first vaginal exam.
Usually after this first vaginal exam, you don’t have to be “checked” frequently. Most hospitals will have a policy about performing a vaginal exam prior to giving you pain medication through your IV, because pain medication can sometimes make it difficult for your baby to breathe if it’s given shortly before the birth of your baby. Again, most nurses can use their nursing judgment. If I had a patient who had a very low tolerance to pain, was pregnant with her first baby, if she was “checked” recently, if she was not very dilated to begin with, or if she wasn’t contracting very often (any combination of these factors), I may decide to give IV medication without performing a vaginal exam. Your nurse will look at the whole picture.
Why does it hurt when some people “check” me?
Sometimes your cervix is in a difficult position to reach. If you’re in labor, your perception to pain may be heightened.
When should I want a vaginal exam during labor?
If you think you’re about to deliver your baby and you want your provider there for the delivery, then you probably want a vaginal exam. You don’t have to have a vaginal exam every time you have vaginal pressure when you’re in labor. If it’s your first baby, chances are the baby will not just fall out. There is no reason to routinely perform a vaginal exam. A lot of times, everyone around you is so excited, they just want to know 🙂 But it will happen, and there isn’t any rush. And again, it’s sooo uncommon for a baby to just fall out of a vagina. So remember this, and try not to worry 🙂 Your nurse will constantly be evaluating the whole picture. If you have any questions or concerns, talk to your healthcare provider.
Other great articles…