Vaginal Exams: When to get them and what do they mean?

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 My doctor  said I am 1 cm dilated. Does that mean I should expect to go into labor any moment?

I am regularly approached with this question. The answer is very simple – No.

Many women can walk around for weeks with their cervix slightly dilated. This is not necessarily an indicator of the onset of labor. In fact, for my first pregnancy, my own OB and midwife didn’t check my cervix until I was well into labor. I even asked my OB at my 38-week visit if he was going to do a vaginal exam. To my great relief, his response was that it wasn’t useful at the time and the procedure to check the cervix isn’t particularly comfortable for the mom. So, why do it?

In my opinion, having this information before contractions start is not helpful to the care provider or the mother. As previously mentioned, it does not mean labor will start immediately. Also, I often find that if the mother knows of some cervical progress, she becomes very anxious about her upcoming labor. Then, either she can’t relax because she expects labor to start at any moment, or is disappointed when it doesn’t start.

So, when is it ideal to find out your cervical dilation? 

A good rule of thumb for this is: will the information obtained be useful in making decisions? When you first arrive at the hospital or birth center it is helpful to know find out your base line. How far along are you?  If you are not that dilated, you may have the opportunity to go home. If admitted too early in the labor process, you run the risk of the care provider wanting to “speed” things along artificially.

Another time to check is if there is concern about the baby’s position or progress of labor. 

There are certain “emotional signposts” that can reveal what stage of labor the mom is in.  If she is in active labor or transition, her emotions, sounds, movements and ability to communicate during a contraction will be different then those of early labor. This may give the impression the mother is near fully dilated, then upon exam, it is revealed the mother is only a few centimeters dilated. This can indicate that the baby is malpositioned – likely either posterior or the head is asynclitic (tilted). Knowing this, the mother and her support team can work to re-position the baby.

It is also good to get an exam when considering an epidural. 

As a doula, I have worked with some mothers that found this information very helpful in making the decision if or when to get an epidural. Here are two common scenarios I have seen regarding this decision:

1. A mother had stated before labor that she intends to forego pain medication, but is now reconsidering it. When examined, they find she is almost fully dilated and she makes the decision to keep going without medication – since by the time she is prepped and the epidural is administered, she will likely be fully dilated and may be ready to push.

2. The other side I have seen is when the mother learns she is not all that far along, and is concerned about her energy level and pain tolerance to push forward without the assistance of pain medication.

Getting a clear picture of where you are in the labor process can be helpful in making important decisions.

It is also important to get examined if the mother has the urge to push.

Sometimes, depending on the baby’s position, the mother may have a premature urge to push. That said, I do know of some birth professionals who believe the mother should always follow her instincts and not be discouraged from pushing if she feels the urge, fully dilated or not. Those I have worked with, admittedly, in a hospital setting, feel it is best for the health of the cervix and the pelvic ligaments not to push until fully dilated. I have seen some care providers help stretch the cervix open the last centimeter or push aside a little cervical lip; but I have not seen a care provider encourage a woman to push without the knowledge of the status of her cervix.

There are also times it is suggested not to get repeated vaginal exams.

Once the amniotic sac is ruptures, it is best to have as few exams as possible.

The more times a vaginal exam is given, the higher chance of introducing infection, since the amniotic sac creates a barrier for infection.

Also keep in mind that vaginal exams are subjective. If measured by numerous people, you are bound to get slightly different results. It could be very discouraging to have one person say you are 5 cm dilated only to have another state you are only 3 cm along.

Some hospitals are teaching hospitals and may ask you if you are okay with having a student perform an examination. Do not feel any pressure to submit to this if you are truly uncomfortable with the idea.

Repeatedly doing exams to find out progress and can make the mother feel pressured to dilate at a certain rate.

The well-known midwife, Ina May Gaskin, talks a lot about the “Sphincter Law.”  She says that the cervix is a sphincter and when feeling shy, pressured or embarrassed, it does not respond well and closes up. If the mother is feeling like her body is not performing as expected, this can have a psychological impact on her which will just slow down the whole labor process. Again, we come back to: if the information gathered is not helpful in the decision making process, why do it?

I hope this discussion of vaginal exams and when to get them has created some clarity on the subject. It could be a great jumping off point for you and your care provider to talk about while discussing your upcoming labor. This way, you know what to expect and have an opportunity to state your wishes.

Happy birthing!

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Debra Flashenberg, CD(DONA), LCCE, E-RYT 500 is the director of the Prenatal Yoga Center. She has spent most of her life performing and was introduced to yoga through a choreographer in 1997. After several years as a yoga student, she decided to continue her education and became certified as a Bikram Yoga instructor. After being witness to several “typical” hospital births, Debra felt it was important to move beyond the yoga room and be present in the birthing room. In 2006, Debra received her certification as a Lamaze® Certified Childbirth Educator. In September of 2007, Debra completed a Midwife Assistant Program with Ina May Gaskin, Pamela Hunt and many of the other Farm Midwives at The Farm Midwifery Center in Tennessee. Drawing on her experience as a prenatal yoga teacher, labor support doula and childbirth educator, Debra looks to establish safe and effective classes for pregnancy and beyond. She is the proud (and tired) mother of new baby boy, Shay.

The views and opinions expressed on this blog are purely the blog contributor’s. Any product claim, statistic, quote or other representation about a product or service should be verified with the manufacturer or provider. Writers may have conflicts of interest, and their opinions are their own.

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