Can we discuss internal exams?

Sprite2012 · October 2012

I've seen these mentioned on the 3rd trimester board and on October BMB. My midwife hasn't said anything about them, so I'm pretty clueless.

From what I understand, your health care provider starts doing them at 37 weeks? What consists of an internal exam? Why are they done? Is there a reason to opt out of them (I've seen some women say they "won't do one until XX weeks")? Thoughts, opinions?

JulieN0704 · October 2012

My office starts them at 35-36 weeks. To my knowledge, in addition to the GBS test at that first visit, they also do cervical checks. I learned yesterday in the FB group that you can decline them (I really didn't ever think to decline them, so I was surprised that people were). The reasons they gave for declining were so that bacteria wasn't introduced to the vagina, and also if there were no signs of imminent labor. *shrugs* I'm going to get them, it's standard practice and I see no reason not to.

sara785 · October 2012

I'm pretty laid back, so I do what is standard for my practice. They start internals at 36 weeks and I'm fine with that. I think people opt out because it doesn't accomplish anything, just lets you know what's going on.
It basically is just the practitioners hand inside feeling for dilation and effacement. The other hand may be on your pelvis to push down a little if they need it. It takes less than a minute and is really no biggie and is no more uncomfortable than a yearly exam. The biggest hassle is that you have to get undressed and redressed so quickly lol!
My uterus is tilted, so my doc always had me put my fist in the small of my back to lift my hips up a little when she examined me with DS. Not sure if my ute changed position with this one yet, but I hear it's supposed to when PG.

shanflan02 · October 2012

I had a doctors appt today and I'm 35w1d. I was getting swabbed for that group b test and since she was in the neighborhood she checked my cervix. I don't know if there is an exact time when they check you. They are checking to see if your dilated, they feel up there with their fingers.

WVUPetunia · October 2012

I've had a few now because of PTL symptoms. They're done to check dilation and effacement. I really wasn't in any position to refuse them because she had to see if my contractions had changed my cervix (and they had). Basically, she sticks her hand up there for a few seconds, checks for the dilation and effacement, and that's it. I thought she was going to knock me off the table the first time because I had no idea what to expect.

sara785 · October 2012

I will say that during labor, they are a whole other type of uncomfortable. My docs are all women and always have been. When I went into labor with DS, the doc in triage was a man and he EXAMINED me like a man. No respect for any pain that was going on in that area!

Aloe0l · October 2012

Our practice starts them at 36 weeks, coinciding with the GBS test. They check yoru cervix for dilation & effacement like the pp said.

IMO - they are pointless. They really don't give you any good indication of progress.You can go from 1cm to active labor in less than 24hrs, or you can sit at 3-4cm for weeks.

Also, some women find them painful, and, anytime anyone has their hands up there you risk infection.

Jnt1008 · October 2012

I think they're pretty standard for all the reasons that everyone else posted. I do, however, know that some Dr.s don't do them at all. I had them done with my first pg and they're really no big deal.

They also help determine wether the baby's head has descended into the pelvis. I don't believe that they increase the risk of infection until or unless your water has been broken already. Otherwise it's no different than continuing to have sex, let's say.

jacksmom119 · October 2012

I never got one until I went to the hospital to be induced at 41 weeks and even then I had to ask!

brooke&ryan&baby · October 2012

I had my first one at my 35w appointment. Doc told me he was going to check how far I was progressing. I literally didn't really feel anything. he just checked to see the dilation and thinning of my cervix. I've heard that they hurt like hell, mine didn't - and maybe it's just because I'm still early, so I could see why someone wouldn't want it done. My OB did ask if I wanted them done or not so they must not be medically necessary.

milesc · October 2012

I think 36weeks is the normal... As PP said, they just will have you undress, and checks for dilation/effacement. I personally don't have an issue with them- they do them for a reason so I wouldn't opt out of them- knowing more about what your body is doing couldn't hurt. I never found them to be painful, and they really quick. They will (should) swab you at 36 weeks to test if you are GBS+, and it sounds like some practices will swab your vagina, others will swab your bum (mine are vagina swabbers- haha). This is also a super quick and painless procedure.

Sprite2012 · October 2012

It sounds like internal exams are really no big deal. I guess I won't think about it anymore! I'm really ready to just go with the flow and finish this pregnancy. If my midwife thinks an internal exam is a good idea, I will undress ;-)

Thanks ladies!

pink26 · October 2012

As far as declining them, like PP said....People decline not only because of the bacteria that can enter (which to me isn't the worrisome part) but because a. they are uncomfortable. b. they tell you nothing. ok they tell you dilation/effacement but it means nothing. you can be 0 cm dilated then go into labor that night or you can be 3 cm dilated for three weeks. Personally that would drive me crazy! and c. my close friend had her MD accidentally break her water during one and ended up getting induced that day.

My MW doesn't routinely do them unless I request them. I dont plan on it.

alanap · October 2012

The midwive practice that I go to doesn't do them unless requested for the two reasons already mentioned...

1. There is a risk of introducing bacteria to the area

2. It means nothing. You could be 2cm dilated for several weeks or go from 0cm dilated to active labor. In fact, Ina May's book references dilation changing, meaning you could go backwards (e.g. I was 3cm, but now I'm back down to 1cm). It can create false hope and frustration for women.

I will not have any internals done until I am in active labor.

btudorica197 · October 2012

Just to add more evidence, I start mine at 36 weeks as well (along with GBT). As everyone has said, it just checks dilation. I'm going to do it because it's a pretty standard thing and why not?! I've done everything else they've recommended, so this is no exception (IMO). Hope this isn't too redundant from all the other posts.

Sprite2012 · October 2012

alanap:
The midwive practice that I go to doesn't do them unless requested for the two reasons already mentioned...

1. There is a risk of introducing bacteria to the area

2. It means nothing. You could be 2cm dilated for several weeks or go from 0cm dilated to active labor. In fact, Ina May's book references dilation changing, meaning you could go backwards (e.g. I was 3cm, but now I'm back down to 1cm). It can create false hope and frustration for women.

I will not have any internals done until I am in active labor.

That's right, I remember her talking about this. I read this book awhile ago...maybe I should re-read.

teresamartini11 · October 2012

I think refusing one because you are worried about infection is a little silly, if you are still having sex. I'm pretty sure the gloves are going to be cleaner then a penis.

MommyLuvsMe1210 · October 2012

teresamartini11:
I think refusing one because you are worried about infection is a little silly, if you are still having sex. I'm pretty sure the gloves are going to be cleaner then a penis.

Yes This. Also, if it were so dangerous, they wouldn't be done in the first place.

BarooGirl · October 2012

My Dr checked at my 35w appt since he was in the area doing the GBS test. He then said that would be the last unless I wanted another. He said they didnt really mean anything.

mopsie · October 2012

My friend sees a MW and said they're very "hands-off" and she didn't get an internal til her water broke (at 39w2d) and she was in labor. My OB doesnt' do it until 38 weeks because he doesn't like to irritate the area and/or cause bleeding if there's no reason to think I'm close to being in labor. But if I'm getting contractions or bleeding, he does internals as early as 36 weeks if I want. A lot of my friends turn down internals because they don't really do anything.

SamiandEric913 · October 2012

Two experiences: I was checked when I was 37w with ds, and I seriously thought the nurse's hand was gong to come up my throat and out my mouth-- it hurt so freakin' bad! I was not dilated at all. The checks experienced in labor did not hurt like that--they were small potatoes compared to contractions.

Last week, I was in triage for possible PTL and was checked, and it was not nearly as painful--just a bit uncomfortable. I wasn't dilated at all this time either. In other words, it just depends on who checks you and how 'enthusiastic' he/she is.

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Can we discuss internal exams?

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