I’m often asked if midwives perform routine vaginal exams during prenatal visits.
My answer is simple—no we do not.Why? Because there is no evidence that shows any benefit from the procedure unless you are planning an induction.
A routine prenatal vaginal exam is where a woman is checked for how dilated—or open—their cervix is, how much it has thinned, and the position of the baby in the mother’s pelvis.
Is this helpful? Yes and no.It can satisfy your curiosity about how open you are, it can confirm baby’s position, but it doesn’t tell us when the baby will be born. Midwives usually determine fetal position easily by feeling your belly. Sometimes ultrasound is needed to confirm positioning.
In cases of induction, it’s helpful to know what’s happening with your cervix beforehand to decide if induction at that time is the best choice and which medications should may be most effective.
The EvidenceOne study from 1984 showed that there was triple the risk of water breaking prior to the onset of labor when moms had routine vaginal exams. Avoiding this is preferable as it can lead to increased interventions such as induction of labor or an increased risk of infection in both the mother and the baby.
While the 1984 study was small (about 350 women) another study in 1992 had almost double that (over 600 women). The second study showed no increased risk associated with having a routine vaginal exam starting at 37 weeks. But then again it also showed no benefit—unless it was related to induction.
Why would the two studies show different results?There were some questions about whether the doctors in the first study had swept the membranes of the women whose water broke after vaginal exams. Sweeping or stripping the membranes can increase the risk of your water breaking before labor starts.
In ConclusionAs midwives, we typically do not do routine vaginal exams at the end of pregnancy unless requested. And we usually don’t offer it unless there is a good reason to do so. If you want to have it done it’s absolutely your choice, but the evidence says there’s no real benefit, but there’s also no harm.
If you do not want a vaginal exam it’s okay to say “no thank you” to your care provider.It’s your body. You don’t have to give a reason why you don’t want a vaginal exam.
If you’d like to back up your choice with the studies I mentioned, click on the links or review the sources link below for a list.
Wellness Guides & More From Christina Holmes & Birthways Midwifery & Birth Center.