Vaginal Exams…Are They Necessary?

A hot topic when it comes to pregnancy, labor and delivery is vaginal/pelvic exams. For some these exams can be one of the biggest causes of anxiety in pregnancy, and it’s no surprise as to why, most of us are not super comfortable being expose to a practical stranger. However, for many women who are surviors of sexual abuse, vaginal exams could be a major trigger. Some OB/GYNs insist that vaginal exams are just a part of routine prenatal care, but there is a rather large part of the birthing community who are very much against unnecessary vaginal exams and medical interventions. 

First let’s look into the history of vaginal exams. Maybe you’re like me and had never really thought that far into the past to think about what midwives and women used to do for hundreds of year. Were they doing vaginal exams through pregnancy and all through labor? The answer is no, they were not. Until the 1900s midwives believed in very little vaginal interference unless they were dealing with a complicated birth, like a malpositioned baby. Between 1900 and the 1970s medical professionals started to break the body down into basically a machine and instead of looking at it as a woman, as a whole, they began looking at the specific parts that had to do with birth – the uterus, the cervix and the baby. Now that’s great that we understand the human body even better, however, labor and childbirth don’t always run like a well oiled machine, every birth is a unique experience. 

In our modern day it seems like medical providers are obsessed with measuring progress, which is the main focus on performing vaginal exams through labor. Checking cervical dilation, cervical effacement, cervical tilt, fetal station (how far the baby has descended into the pelvis, if at all) and presentation of the baby (which way the baby is facing). Typically mothers are offered a vaginal exam at the beginning of pregnancy to perform a PAP smear if she doesn’t have a recent one on file, and then no more until around week 36 when providers want to perform them each visit to check for cervical changes. 

Is checking cervical progress a good indicator of whether or not birth is imminent? Well, research has shown that there is a particular substance secreted into the baby’s lungs which triggers labor, so cervical progress isn’t a very good indicator on when birth will happen. Pregnant women can actually be slightly dilated for weeks (1-2cm) before active labor ever even begins, but when it does it typically goes fast. This is a huge reason why there are many in the birthing community that believe in as little interfering as possible. When a woman is left alone to birth with minimal interruptions, in peace, her body feels safe to open up and birth. Excessive vaginal exams can cause unnecessary tension and anxiety in the body inhibiting the natural course of birth to happen.

So because the progress that’s measured in a vaginal exam doesn’t give an accurate estimation of when labor will actually begin and too much interference can actually cause birth to stall, are they even necessary? There are indeed some instances when vaginal exams are recommended for medical purposes such as, a history of infertility, painful intercourse, suspicion of cervical problems such as scarring or preterm labor, and also to check how favorable the cervix is if an induction is necessary. When it comes to necessary vaginal exams it’s so important to follow the lead of the mother as to not cause any trauma, especially if she is a survivor of sexual abuse.

As a trauma informed doula myself, it’s incredibly important for me to get to know my client and her history so I can best support her in all circumstances through labor, delivery and postpartum, including the possible need for vaginal exams. As her doula and advocate I pay close attention to her body language and to the provider to be sure she is feeling comfortable. My biggest concern is being sure that the medical provider is respecting my client and making sure her feelings and requests are being heard and honored. It’s vitally important to be aware of these things because as labor and delivery are progressing, especially in a medical environment things can happen and change rather quickly. Any unexpected changes, like emergency procedures, increase the likelihood of mom becoming anxious and unsure about what’s happening to her body and could be a likely trigger for past trauma.

My goal as a doula is to do everything I can to be sure that a mother has the best birth experience as possible, which ultimately means, I do not want it to be a traumatic experience for her. When looking at birth as a whole, we know generally how everything progresses along those 40+ weeks. But when you look at pregnancy and birth individually, everyone is unique because every woman has her own unique past. And even with subsequent pregnancies, a woman is shaped by each experience. One pregnancy and labor a woman may experience zero complications and the next a whole series of them. And while vaginal exams can be useful, they are not the be all and end all for measuring progression. Yes, vaginal exams are typically done throughout pregnancy (beginning and multiple times near the end) and possibly during labor to monitor progressions, but it’s important to know that you do not have to consent to them if you’re uncomfortable with them and you’d like a more hands off approach to your pregnancy and labor. However it’s equally important to know that emergencies CAN arise and call for the NEED to check the cervix to assess how to move forward safely. 

All in all the decision of whether or not to perform/receive routine vaginal exams should be shared between provider and patient to determine if the potential benefits outweighs potential harm. This decision will be even more crucial when it comes to trauma survivors who may be more sensitive to the invasive procedure.