Internal Exam

6 Replies
Joan - April 14

My doctor gave me an internal exam at 36 weeks and at my 37 week appointment she said she would not check internally again till my due date. Has anyone else experienced this? Everything I've read says they normally check you for progress your last month. I kind of would like to know what is going on down there. I know I should have asked her but she seemed very rushed.


Toya - April 14

I'm not getting an internal exam until I'm 38 weeks and that's a week and a half from now. They told me that they don't do internals at 36 weeks unless you show signs of preterm labor.


E - April 14

I too am not being checked untill 38 wks and that's about 6 days from now!!


K - April 14

I had one every week since 36 weeks. Now that I am past my due dat (41 weeks) I have one twice a week


Joan - April 14

Well my next appointment is 3 days before my due date so hopefully she'll check next week.


Erin - April 18

I found a really good article on this. Hope it helps. "The Myth of the Vaginal Exam" Vaginal exams. I don't know a single woman who likes them. However, there is a myth perpetuated in our society that v____al exams at the end of pregnancy are beneficial. The common belief is that by doing a v____al exam one can tell that labor will begin soon. This is not the case. Most pract_tioners will do an initial v____al exam at the beginning of pregnancy to do a pap smear, and other testing. Then they don't do any until about the 36 week mark, unless complications arise that call for further testing or to a__sess the cervix. If your pract_tioner wants to do a v____al exam at every visit, you should probably question them as to why. Vaginal exams can measure certain things: Dilation: How far your cervix has opened. 10 centimeters being the widest. Ripeness: The consistency of your cervix. It starts out being firm like the tip of your nose, softening to what your ear lobe feels like and eventually feeling like the inside of your cheek. Effacement: This is how thin your cervix is. If you think of your cervix as funnel-like, and measuring about 2 inches, you will see that 50% effaced means that your cervix is now about 1 inch in length. As the cervix softens and dilates the length decreases as well. Station: This is the position of the baby in relation to your pelvis, measured in pluses and minuses. A baby who is at 0 station is said to be engaged, while a baby in the negative numbers is said to be floating. The positive numbers are the way out! Position of the baby: By feeling the suture lines on the skull of the baby, where the four plates of bone haven't fused yet, one can tell you which direction the baby is facing because the anterior and posterior fontanels (soft spots) are shaped differently. Position of the cervix: The cervix will move from being more posterior to anterior. Many women can tell when the cervix begins to move around because when a v____al exam is performed it no longer feels like the cervix is located near her tonsils. What this equation leaves to be desired is something that is not always tangible. Many people try to use the information that is gathered from a v____al exam to predict things like when labor will begin or if the baby will fit through the pelvis. A v____al exam simply cannot measure these things. Labor is not simply about a cervix that has dilated, softened or anything else. A woman can be very dilated and not have her baby before her due date or even near her due date. I've personally had women who were 6 centimeters dilated for weeks. Then there is the sad woman who calls me to say that her cervix is high and tight, she's been told that this baby isn't coming for awhile, only to be at her side as she gives birth within 24 hours. Vaginal exams are just not good predictors of when labor will start. Using a v____al exam to predict advisability for a v____al birth is usually not very accurate, for several reasons. First of all it leaves out the factor of labor and positioning. During labor it's natural for the baby's head to mold and the mother's pelvis to move. If done in early pregnancy it also removes the knowledge of what hormones like Relaxin will do to help make the pelvis, a moveable structure, be flexible. The only real exception to this is in the case of a very oddly structured pelvis. For example, a mother who was in a car accident and suffered a shattered pelvis or someone who might have a specific bone problem, which is more commonly seen where there is improper nutrition during the growing years. During labor v____al exams can't tell you exactly how close you are either, so keeping them to a minimum then is also a good idea, particularly if your membranes have ruptured. Okay, so there's not really a great reason to have a v____al in exam done routinely for most women. So are there any reasons not to have v____al exams? There sure are. Vaginal exams can increase the risks of infection, even when done carefully and with sterile gloves, etc. It pushes the normal bacteria found in the v____a upwards towards the cervix. There is also increased risk of rupturing the membranes. Some pract_tioners routinely do what is called stripping the membranes, which simply separates the bag of waters from the cervix. The thought behind this is that it will stimulate the production of prostaglandins to help labor begin and irritate the cervix causing it to contract. This has not been shown to necessarily be effective and does have the aforementioned risks. In the end only you and your pract_tioner can decide what is right for your care in pregnancy. Some women refuse v____al exams altogether, so request to have them done only after 40 weeks, or every other week or whatever she feels comfortable with. Inducing *because* your cervix is unfavorable is a big recipe for trouble, especially for first time moms. I have been hearing this "logic" more and more lately. 1st time mom goes in for 39 or 40 week appointment and very little cervical progress is noted. Rather than give mom the full 42 weeks (a__suming mom and baby are healthy) the implication is made that obviously mom needs help; that she won't go into labor on her own. I have heard some moms say that they need to be induced (had to be induced with all their babies) because they never go (never will go) into labor on their own. Really and truly? Mom would eventually go into labor. To induce labor with an unfavorable cervix increases the c-section risk. This isn't my opinion, it's pretty well acknowledged. The Bishop's Score should be used when making induction decisions in cases where induction isn't vital for the health of mom and baby. I guess induction is at least better than just scheduling a c-section for lack of progress. Unfortunately that trend seems to be growing a whole lot too. I have hosted the baord for going on 2 years and this trend is really recent. At least with an induction mom does have a chance of avoiding an induction (50/50 for a first timer with an unfavorable cervix). Really think hard about inducing before 42 weeks if you and baby are healthy- especially if your cervix is unfavorable. If your body isn't ready that should be a red flag that you need more time not an induction. A ripe piece of fruit is plucked very easily from the tree. An unripe piece needs a lot more force and could be damaged in the process.


Toya - April 18

Erin, excellent medical review! Very informative and accurate! Many procedures today are done by dr's so that they have more control over the labor and birth in an attempt to avoid "law suits". Pregnancy is NOT an illness, so I don't understand why we look at it as a medically supervised event...Dr's are for the ill...Some people are ill during pregnancy, but if that's not the case...medical intervention is not necessary.



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