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Preparing For Labor

Internal Exams: What Can They Really Tell You?

Some moms walk around 4+cm, 90+% and 0 or lower for weeks. Others go from nothing to labor overnight. Why? Because birth is so much more complex than cervical stats.

Yes, progress prior to labor is good because it means less work that you have to do in labor.

But, lots of prior progress doesn't always guarantee a short, easy birth nor does no progress mean a long, hard birth. Basically- Anything can happen!! Once baby decides it is time things have a good way of falling into place. Early progress or not.

A disturbing trend lately is Dr.s telling moms (especially 1st timers though veteran moms are told this too) that because they don't have progress at, say, 38 weeks, that that means they need a c-section. Unsuspecting moms believe this and schedule a c-section for 39 weeks. Never mind that normal, healthy term goes all the way to 42 weeks. And that even the ACOG recognizes the only way to know what will happen in birth is for mom to actually get to try labor and delivery. The ACOG does not advocate scheduling c-sections unless it is necessary for the health of mom or baby and induction isn't an option. So, if you have a Dr. who is pushing you towards a c-section for lack of progress, ask them about the ACOG's stance. You can read more on the acog's website ( or in their book "Planning your Pregnancy and Birth."

Take internal exams with a grain of salt. They can tell you how far you will have to go once labor starts but not when it will start- very important difference.

I have already decided that if I have more kids I will have one internal around 39 weeks b/c I know that curiosity will get the best of me. But I will not have anymore exams after that. I will also try not to obsess about the stats or read much into them. I have been on this board for over 2 years. I no longer put stock in their findings.

This is a cool article called "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 vaginal exams at the end of pregnancy are beneficial. The common belief is that by doing a vaginal exam one can tell that labor will begin soon. This is not the case.

Most practitioners will do an initial vaginal 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 assess the cervix. If your practitioner wants to do a vaginal 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 vaginal 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 vaginal exam to predict things like when labor will begin or if the baby will fit through the pelvis. A vaginal 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 vaginal exam to predict advisability for a vaginal 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 vaginal 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 vaginal in exam done routinely for most women. So are there any reasons not to have vaginal 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 vagina upwards towards the cervix. There is also increased risk of rupturing the membranes. Some practitioners 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 practitioner can decide what is right for your care in pregnancy. Some women refuse vaginal exams altogether, so request to have them done only after 40 weeks, or every other week or whatever she feels comfortable with.

Home | Guide to Labor | Inductions | Internal Exams | Natural Labor Inductions | Check Your Own Cervix | Pain Management | Myth of the Big Baby | Dangers of Cytotec | Labor Tips

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Preparing for Labor by Amber