Vaginal examinations are often taken for granted in labour. Many women would be led to believe they could not birth a baby without having a vaginal exam, but the truth is, if a baby is going to be born vaginally, it will be born regardless of whether a vaginal exam (VE) has been performed. That said, there are some really good reasons why your midwife or obstetrician might recommend one (or more). VEs are mainly done to obtain information that is relevant to that particular labour or the circumstances of the labour. It might be suggested:
- To determine if a woman is in labour, because it is not helpful to the woman or her support people to spend many hours in a delivery suite when labour hasn't yet started.
- To confirm whether the baby is coming down bottom first or head first.
- To determine whether the head is engaged deeply in the pelvis, and perhaps the position of the baby (although I believe this isn't really relevant until later in labour)
- To assess the progress in labour, which, combined with an assessment of the position of the baby, can help midwives and obstetricians to suggest positions and movements that can be helpful for encouraging the baby to turn naturally.
A lot of information can be obtained from a VE, but that is not to say that at every VE, your midwife or obstetrician will obtain all of this information: sometimes, it is only important to know that your cervix has opened more, whereas other times it will be more important to track the position of your baby's head.
I would do a vaginal examination:
- If the woman asked for one, perhaps because she would feel more reassured to know that she is progressing well in labour, or if she wanted to know the exact position of her baby to guide her movements and positions in labour;
- To reassure her that yes, labour is progressing really well, if she is feeling that it is all too much and she is at the end of her tether (although this very rarely happens as most of my clients attend a Calmbirth (R) course);
- Always before providing medical forms of pain relief (except nitrous oxide gas). This is because it is important to know that a woman is in labour before giving an epidural, but it is also important to know that she is not very close to birthing her baby, as this would mean that the epidural would take full effect after the baby arrives. It is also important if morphine is used, that we know that the baby is unlikely to make an appearance shortly.
It's not my practice to do a vaginal exam:
- Frequently if the woman is in early labour, as it is discouraging to hear, "You're 1cm" when this was the case 12 hours before, despite contractions.
- If I thought the woman was fully dilated. In this case, I wait for the urge to push to intensify, so that it is present during the entire contraction and is an irresistible urge. At that time, the woman is most often fully dilated and we see the baby's head very soon. Doing vaginal exams to confirm that a woman is fully dilated can often lead to premature pushing, before the baby's head has descended deeply into the pelvis. This early pushing - often directed - can lead to more tearing. And nobody wants to tear if it can possibly be avoided!