Tuesday, October 21, 2008

Vaginal Exams in Pregnancy

Do I have your attention? Here's a topic that is never addressed, but affects all pregnant women. I'll tell you straight up that I am opposed to vaginal exams. No pregnant woman should have one. Let me tell you why.

First of all, there are a few bits of information that a vaginal exam can tell you. They can, of course, tell you if the cervix is dilated and softening, effacing, or thinning (all meaning the same thing), and what station the baby is at, meaning, where the baby is in relation to the pelvis. None of these bits of information will tell you when labor will start.

OBGYNs, and midwives alike, usually start doing vaginal exams between 36-38 weeks, just to see what's happening. Literally, just to see what's happening. Likely, nothing is happening!

You can walk around dilated for weeks. I recently had a student walk around 5 cm. dilated for about 4 weeks. She was even 90% effaced. It meant nothing. She gave birth nearly a week past her "due date." But her family had come to town when they found out she was that far along, plans were being postponed, and she was in the "any minute" mode. She was contracting too, but it would fizzle out after several hours. She finally had to send everyone home and just wait.

These women who are dilated, and know it, often are the ones that get induced. Not because of medical reasons, but because they just couldn't stand the emotional roller coaster anymore. Their labor should have been the easiest!

Let's say you are told that you are not dilated at all -- the cervix is hard -- not soft at all. How do you feel? Sad. Like your body doesn't work right. Like you might be pregnant forever! But if it's one of the first vaginal exams, you probably still have hope that the next one will be better. Well, what if it's not? What if even the next one tells you the same thing after that? Now how do you feel? You are probably signing up for an induction because you have no confidence in your body to do this on its own. Even if you aren't looking at your calendar for an induction date, you know that you are starting from "zero." Emotionally, this is so hard. You know that your body, when it does start labor, is going to have to work that much harder. You start doing labor math (your enemy), thinking your labor just got that much longer, and now you are resigned to have an epidural because it's just so hard and so long.

Do you see where I am going with this? Women can be dilated and not be in labor, and likewise, a woman who is not dilated can start labor and give birth that same day. I've been that person! It happens.

Vaginal exams in pregnancy put you on an emotional roller coaster that no pregnant woman needs to be on! The end of pregnancy is hard enough, physically and emotionally. It's usually an anxious time, and vaginal exams just add to that anxiety, often creating more stress.

Bottom line (no pun intended): There is no medical reason to have a vaginal exam, but loads of reasons to avoid them. I didn't even address the "accidental" stripping of membranes, even possible breaking of water. I've known lots of women who are worried about bleeding a few hours afterwards, not knowing that their membranes had been stripped. Again, adding to the anxiety...

It's hard to say no -- everyone is curious -- even me! But have faith in your body. The vaginal exam road is worth saying off of! It's like I always say, the baby will come out! Your body will start labor when the time is right for baby and for mom.


Sarah said...

Love it, Donna! So true about the lack of necessity and the emotional toll a V.E. takes on a pregnant woman. I only had one in my first pregnancy and I was sad about my state of nothingness that whole day.
I feel for your student. Sounds like she might've been in early labor off and on for that month. That's not fun, and it is thought of more flippantly than it should be. Even without V.E. to tell you something's going on, contractions all the time are no picnic, because THEY make your hopes go up (and can completely wear you out). And, having been in her shoes, I have to say there's one reason it can turn into an "easy" labor: she's been doing it so long that she's used to it and may not take most of the labor seriously on birth day, so it seems short, as well. But I don't believe you'll find many people who have experienced it who will describe the whole experience of prodromal labor as easy (or fast). I'd say the "easy" labor more likely belongs to the woman who is walking around unaware that she is 90% effaced and 5 cm dilated without any noticeable contractions.

Kate's mommy said...

Good topic, Donna! I agree with you - this mentally messes up the soon to be laboring woman. And I know all about the no-permission giving stripping of membranes. That sets up the woman right there to stop trusting her care provider(rightly so), which is a TERRIBLE place to be in hours before her birth. I'm not going that route again! :)

Anonymous said...

Isn't that assuming that pregnant women are some how out of control emotionally? I am able to take the up to date information about my pregnancy and handle it. I don't walk around freaking out that I am dialted or that I'm not. Women can hold themselves together and hear information wtihout freaking out

Donna Ryan said...

I hold to the belief that it puts a woman, unnecessarily, on an emotional roller coaster. I, over the years teaching, have never heard a woman say how glad she is that she had a vaginal exam, but have heard plenty of women say that they wish they didn't know the results. It's pointless and causes stress. Why know? Physically, it doesn't make a bit of difference in the pregnancy or the labor. I'm glad to know that some women, like "anonymous," can keep it together. As a general rule, I strongly advise against it.

Donna Ryan said...

I went to Walmart tonight and kept thinking about this topic. A woman who doesn't let it (information from a vaginal exam) bother her, or freak her out (usually over several weeks) that she is or is not dilated, probably has the confidence in her body to do what it needs to do. Maybe she is surrounded by people who believe in her, she has great caregivers, or she has given birth before and knows what her body is capable of. But to a woman who has pressure to set an induction date, is surrounded by people who tell her their horror stories (look out for those baby showers!), or has never given birth before, she might have a harder time trusting her body. The information learned from a vaginal exam, whether "good" or "bad" can hinder how she feels about her body and her impending labor.

Carmen said...

Thanks Donna, being a first time mom whose water broke less than twelve hours after a somewhat rough vaginal exam five weeks early. One can’t help to speculate what sent me into labor 35 weeks to the day in an otherwise very healthy pregnancy!

Shannon and Casey said...

So true! I was one cm on Tuesday, was in labor Wed. and had her on Thursday. I was kind of let down that I was only at 1 cm, but the whole time your voice was in the back of my mind saying, "vaginal exams don't mean anything", so I didn't think too much of it. Still, I had to know for some reason! Next time will be different I'm sure.

Christina Pond said...

I was 3 days shy of being 2 weeks "late" and I had not dilated at all. When doctors are using big words like induction it gets scary, and you are on a time clock. You are 10 months and beyond pregnant, and bloated and ready to hold your baby and not be pregnant. When you are told you have not progressed, you start to wonder if your body has forgotten how to do this thing!!

My contractions and plug started at 9 am, and I labored all day, my water broke at 7 pm and by 9 pm I was dilated only to a 2!! Can you imagine my disappointment? But from 9 pm to 3:51 am, I dilated, and gave birth.

I went from 0 to 10 very quickly I do believe... Vaginal exams hurt, leave you open to infection, and do nothing for you emotionally.

The best thing is to watch for the emotional sign posts of labor. They are much more reliable. When I said the "F" word, was screaming and felt like puking, my husband told me I was in transition and almost to the finish line, and I needed no vaginal exam to comfort me at that moment, hearing him say that, was encouragement enough!