The Dangers of Vaginal Exams

Vaginal exams who likes them? If you answered no one that would be true! They are an embarrassing but necessary part of being pregnant and giving birth...everybody knows that...or are they?

The theory behind a vaginal exam is that before the birth of your baby, it will tell you about dilation and "being dilated" means you're about to go into labor.

During the birth of your baby, these exams give your care givers valuable information about the progress of your labor. So basically, a vaginal exam is good for you!

In actuality, the facts are quite different. Vaginal exams are almost always unnecessary and can be downright dangerous. Yes, dangerous! They are a form of invasion and they are extremely painful while in labor.

The mechanics of labor and when labor will start

Did you know that some women are dilated 5 to 6 centimeters before going into labor...for days or even weeks? Others are 1 centimeter and suddenly go into labor.

Dilation is by no means an indication of the speed of your labor either. There again are some moms who can go from 1 to complete dilation in a couple of hours while others putter around at 4 or 5 for a while.

And guess what?

All this is normal, yes normal!

Women are not cookie cutter copies of each other. As our fingerprints are unique so is the way your body gives birth! A lot more goes into knowing if your body is close to birth than just dilation.

Here are some markers that your body is gearing up for birth...all these can be determined by a vaginal exam...but as you will learn later it may be best to leave well enough alone..

Dilation: Means how wide your cervix is open.

It is assessed in centimeters up to 10. HOWEVER, it is false to believe that 10 centimeters is as far you need to dilate. A better way to say that you are fully dilated would be to say that you are complete instead of 10 centimeters. Your cervix - given time - will dilate as much as it needs to in order to let your baby go through.

Effacement: This measurement is about the thickness - or lack thereof - of your cervix.

It is measured in percentages. 100% means you are effaced - no cervix to be felt - and 0% means there is no effacement. It may help you to know that your cervix is roughly 2 centimeters in length. It needs to open (dilate) and efface (shrink in length). So 50% effaced means your cervix is now 1 centimeter, 75% means it is 1/2 centimeter, etc.

Station: This refers to the position of your baby in relation to your pelvis.

This is measured in either pluses or minuses. Minuses, your baby's head is not engaged into your pelvis to pluses, your baby's head is being born. If your baby is at zero station, his head is engaged.

These three numbers - dilation, effacement, station - together give you a better idea of what your body is doing. But other things can be determined from a vaginal exam.

The position of your baby: It will be referred to by 3 letters.

R for right

L for left

O for occiput (head down)

A for anterior (baby's back to your front)

P for posterior (baby's back to your back)

So for example, at the time of birth, you may hear that your baby is ROA (right occiput anterior) or LOA (left occiput anterior), etc.

How is this possible?

The bones in your baby's head are not fused and where these bones meet can be felt by palpation. These areas are called suture lines. Not all the sutures feel the same and therefore your care provider can determine the position of your baby's head by where his sutures face in comparison to your pelvis. Neat but unnecessary information UNLESS there is a problem.

Position of your cervix: As your body gears up for birth, your cervix will move from posterior (facing toward your tailbone) to anterior.

The problem is some women only do this while in labor.

Lastly, the consistency of your cervix - referred to as ripeness.

Normally your cervix feels like the tip of your nose. During ovulation and while it is preparing for birth, your cervix feels more like your ear lobe. As the birth of your baby approaches the consistency of your cervix will be more like the inside of your vagina or your mouth.

As we said all this is neat stuff...but necessary? No, they are not! Remember that none of these "indicators" can predict when YOUR BODY will decide it is time...the only way to be certain of the exact time is to schedule a c-section.

Now let's mention the dangers of vaginal exams:

NO ONE can predict how much your pelvis will open and/or how much your baby's head will mold. So unless your baby is gigantic - and no 8 to 10 lbs is not gigantic - a vaginal exam is a waste.

Let's say you are dilated 3 centimeters and your due date comes and goes without your baby? Or worse, you have been in labor for a while you are working hard, you were checked 2 hours ago and were at 4 centimeters...and now you find out you are still at 4! How is that for morale?

Some moms stall and that is okay as most of them "catch up!" Many care providers feel - and know - that a better indicator of your progress is your emotional signs and not the information obtained from vaginal exams!

There is no such thing as a true sterile exam...once a glove is in the air it is not longer sterile. Moreover, as fingers enter your vagina they push all the bacteria toward your baby which is never good nor safe, especially if your membranes have ruptured. Infections can be life threatening to your baby.

Neonatal infection rates - infection in your baby at birth - were found to increase solely because of vaginal exams. A study found that having a vaginal exam right at the beginning of labor increased the risk of neonatal infection by 250%, even after taking into account GBS - Group B strep - status (Hannah, 1997). Yes, 250%!

Obviously neonatal infection rates were further increased by multiple digital vaginal exams during labor. Another study showed that the risks increased depending on the number of exams performed and this independently of whether your membranes had ruptured or not (Seaward, 1998). The odds roughly doubled compared with women having fewer than 3 exams! The greatest increase was to women receiving 7 to 8 exams.

So the truth about vaginal exams is that at best, they give information that is unnecessary and at worst, they can be life threatening. If you are healthy and there are no complications, you can manage your entire pregnancy without one. We did!

Anne Frye - a world renowned midwife - says that dilation can be ascertained without a vaginal exam. That's right checking dilation without a vaginal exam is possible! There is way to check by gauging fundal height - where the top of your uterus is located - in relation to your xiphoid process.

Your xiphoid process is the cartilage at the lower end of your sternum - rib cage.

Your birth attendant can determine how many fingerbreadths of space are between the fundus and xiphoid process at the height of a contraction.

5 fb = no dilation

4 fb = 2 cm

3 fb = 4 cm

2 fb = 6 cm

1 fb = 8 cm

0 fm = complete

To some this does not make sense: that the space between your xiphoid and your fundus shortens - becomes narrower - dilation advances since your baby engages more and more as the contractions push him inside the birth canal. Remember, the upper segment of your uterus thickens as labor advances. Your uterus also rises more as contractions intensify. This is also the reason why this must be done at the height of a contraction. Midwives have reported this to be very accurate...and a bonus no fingers where they do not belong!

Happy birthing!

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