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Midwife Talks

The Vaginal Exam - All You Need To Know

- Feb 23rd, 2023

In the world of OBGYN, a vaginal/cervical/pelvic exam can provide a lot of information. In pregnancy and labor , the vaginal exam is done to gather information about cervical dilation, effacement , baby’s position in relation to the pelvic bones. It can also help determine if the membranes are ruptured (if “the water has broken”). For GYN purposes, a vaginal or pelvic exam can be done to visualize the cervix, take a sample of cells for cervical cancer screening (or PAP smear) and HPV testing. Also, it’s used to insert an IUD or perform an endometrial biopsy, to name some procedures.

During pregnancy and labor

During your initial prenatal visit, a vaginal exam is offered to perform a PAP if you haven’t had one per the ASCCP guidelines (which is not yearly, as some providers still like to practice). This pelvic exam is done with a speculum, but you may also be offered a digital exam (with the provider’s gloved fingers) to perform pelvimetry and/or assess the positioning of your uterus and assess your ovaries.

Some providers will offer a vaginal exam starting from your 36 week visit, weekly until labor begins and throughout the labor process. This exam is usually just a digital exam (usually accompanied with an US to assess fetal growth, don’t get me started on that! Different topic for a different post) and is done to collect the information about the dilation, effacement, position, consistency of your cervix and also the position or station of your baby’s head in relation to your pelvic bones.

Dilation: Measured in centimeters when it starts to open. It is the opening of this donut shaped organ. So if you can picture a donut, where the donut hole is the dilation, and as your birthing process progresses that donut hole continues to widen.
Effacement: That would be the thickness of the cervix. Going back to the donut, picture the height of the donut getting smaller. So as the the birth process (the 1st stage of labor) progresses, that cervix becomes thinner and thinner, and actually becomes a part of the lower uterine segment. The forces your body provides (uterine contractions or your surges) pull the cervix back , causing it to thin and open.
Position: When the body is not yet ready to start the birth process , your cervix is tucked away more posteriorly in your vagina. As the your body gets more ready for this process to start and once it has started the cervix will move more anteriorly. So when this is checked, you may here the words, posterior, mid position or anterior, which describes the position of your cervix.
Consistency: This too is felt by the examiner’s gloved fingers, and may be described as firm or soft. As your body gets ready for the birthing process to begin, the cervix will gradually become softer and softer.
(all these parameters may be given a score and totaled to give the Bishop’s score)

Do I have to get checked at 36 weeks?

The short answer to this question is NO! If you have a low risk, healthy pregnancy, there are no signs of preterm labor ( any labor starting before 37 weeks of pregnancy) there is absolutely no clinical reason to check your cervix. This will give the information of all parameters stated above, but will not tell you when your labor will start and if you will birth vaginally.

It may be done if you request it and would like to have this information just for your knowledge. It may also be done if you are afraid of vaginal exams in labor and have not experienced them before. In a controlled setting, it may be a good idea to experience an exam so you know what to expect. This is purely the decision of the pregnant person though.

Vaginal/cervical exams during labor

Depending on your provider and the circumstances of your birthing process, the timing of these exams changes. Meaning if you are in spontaneous labor, undergoing an induction of labor, if you are having an unmedicated birth experience or a medicated one.

Usually if you’re heading to a hospital or birth center to birth your baby, you will be offered an initial exam to establish a baseline when you get admitted. If you’re having an out of hospital birth, this may look completely different, but always good to establish some sort of baseline.

When your labor process is uninterrupted and unmedicated , there really is no reason to check the cervix routinely. There are external ways you can tell the labor is progressing and the body is doing what it is supposed to be doing. Only if there is suspicion that the labor is protracted or obstructed then another exam is warranted to gather all information in order to establish a plan of care. But when I say obstructed or protracted, I mean truly that and not when the body decides to rest before it continues again. Following the physiologic pathway it knows to do. There are normal plateaus in labor, that don’t necessitate any intervention. For every birthing person this looks a little differently, especially in terms of timing. That’s why you need a trained clinician to know when that is happening.

Usually, these are midwives, because they are trained in the physiologic process and know to tell when something not normal is happening. And more importantly, they are there with you and have been witnessing your process and you go through it. When an OB is your primary care provider, it is the hope that you have a good L&D nurse that understands the physiology so she can report back to the MD the true picture and also advocate for you.

For your GYN exam or Annual exam

If you are going to be seen by a provider who will perform a vaginal/pelvic exam for a specific reason/issue or just for your annual health check up and cervical cancer screening, here are some things you should know and can do to make yourself more comfortable.

First of all… YOU ARE IN CONTROL !! This is your body and you call the shots. Inform your provider if there is anything they need to know to make this exam more comfortable for you. If they don ‘t tell and reassure you that you can stop them at any time, please do so yourself.

You can say : “If I say pause, please stop what you are doing and give me a minute, I will tell you when it’s ok to continue. ” OR “If I say stop, please stop and get out”

If your exam includes the use of any instruments, you can ask to see the instruments ahead of time and even feel them if that’s possible. When I need to use a speculum, I offer my clients to feel it ahead of time and help me insert it to the vagina if they’d like. Some may not like that, because they don’t feel comfortable or they just prefer to focus on something else, but they may need a support person in the room with them, or listen to a meditation or music. It’s important to have these conversations with your provider when you are fully clothed, as being wrapped in a gown (especially those paper ones) feels a little vulnerable . If they don’t offer a blanket to cover up with, I suggest you bring one with you to make you feel less exposed.

For those who have experienced trauma, I urge you to find a provider that you trust and will make them aware of your history, just so that they can make this exam the least uncomfortable as possible and not triggering.

I hope you found this post helpful! If you have any questions/comments please share those with me in the comments section or private message at [email protected] .