A vaginal exam, an internal exam, a cervical exam…all the same thing! During these exams, your Health Care Provider (HCP) will insert their gloved fingers into the vagina to feel for the cervix. Once they find the cervix, they will then estimate how open or dilated it is, how ready the cervix is for labour and how thinned out the cervix is (effacement). These exams can also assess the station or position of the baby in relation to pelvis, the position of the baby and position of the cervix.
Pelvic exam…what’s the difference?
Pelvic exams are a little different because a speculum is inserted into the vagina instead. Part of prenatal care includes a pelvic exam during the pregnancy to look for any abnormalities and infections. A pelvic exam could also be done early on in the pregnancy to evaluate whether cervical weakness is happening which could lead to miscarriage or preterm labour.
If you have any vaginal bleeding during the pregnancy or are leaking fluids then one of these speculum exams will need to be done. For bleeding, a speculum will widen the vagina and allow the source of the bleeding to be spotted. If you think your water might have broken (amniotic fluid around the baby) then a speculum exam may be done to take a sample of the fluid leaking out of the cervix to determine if it is in fact amniotic fluid.
Back to vaginal exams!
If your pregnancy is uncomplicated, then likely your next internal exam will be when you are term (37 weeks) during a clinic visit or when you present in labour.
Once you are term a membrane sweep can be offered in the clinic. A membrane sweep is an internal vaginal exam where your HCP will reach in to find the cervix and if it is open a little and they can insert at least one finger then they can move it back and forth for a few seconds, basically sweeping along inside the cervix. The idea behind this is to release hormones that might bring on labour. During Mama Coach prenatal classes, we talk about this as an option to try bringing on labour for mom’s once their pregnancy is term.
Is it uncomfortable?
Questions like this are difficult to answer because pain is subjective! Typically, these exams are more often described as uncomfortable then painful. Vaginal exams in early labour can be a little more uncomfortable then later when in active labour. Early on in the labour, the opening of the cervix is still fairly far back (posterior) so it is a bit of a reach and we are feeling for just a small opening. Later, as labour progresses, the cervix opens wider and comes forward (anterior) making it much easier and kind of right there when it comes to finding it!
After an internal vaginal exam, you might experience some spotting. The cervix is fragile so if it is touched it can bleed a little.
Positioning for both a vaginal exam and a pelvic exam are similar. If you are having a pelvic exam then you may need to put your legs up in stirrups or your feet into footrests. During vaginal exams likely just putting your heels together in the middle of the bed and allowing your legs to relax open is enough. Just follow your HCP suggestions when it comes to positioning, the idea is your legs need to be relaxed open with your bum nice and relaxed into the bed.
What can you do to help?
If you find these exams uncomfortable, then try to take some nice slow deep breaths. Think of the relaxation type of breathing where you take a slow deep breath in through your nose and even slower deep breath out through your mouth. This same breathing technique is what can help get you through contraction pain during labour as well!
How often will my cervix be checked in labour?
During pregnancy your cervix is closed, during labour your cervix opens to 10cm to allow for the birth of your baby. Most women will be given a vaginal exam on admission to determine where we are starting from and these exams are continued throughout labour to determine progress.
Mama Coach prenatal classes cover the 4 reasons a vaginal exam would be done during labour.
- If the mom is requesting medication for pain management, an assessment would need to be done to know where she is at in the labour to offer the best choices for the stage, she is in.
- If there are concerns with the babies’ heart rate, it would be worth checking to see where things are at in the labour.
- If a mom feels the urge to push, feels lots of rectal pressure, then that is a good reason to check as it might be time to have a baby!
- Finally, if it has been 4ish hours then we then a check is warranted just to make sure adequate progress is being made as the expected rate of cervical dilation is about ½ a centimetre per hour.
Please reach out to the Mama Coach in your area if you are interested in learning more in a prenatal class!