Internal examinations in pregnant women are generally performed before giving birth, but can also be performed in certain circumstances. For example, when bleeding occurs during pregnancy or as one of the methods of labor induction.
For some people, an internal examination may sound scary because it means the doctor or midwife will insert a finger into the vagina to check the cervix. Not infrequently for some people this can cause trauma or fear.
So, here are some facts about internal examinations for pregnant women that are interesting to know.
What is meant by Internal Examination in Pregnant Women?
Source: Freepik
An internal examination is a procedure in which a midwife or doctor inserts their fingers into the vagina to feel the cervix, and to estimate how dilated it is during labor.
With an internal examination, it is also checked whether the cervix is thinning. This is an important part of the progress of labor. Sometimes, an internal examination is done to try to help determine the position of the baby, by feeling the baby’s “presenting part”, which is the part that is pressing on the cervix.
An internal examination is also performed as part of the examination to see whether the pregnant woman’s water has broken.
The most common problems caused by internal examinations are pain and discomfort, and for some, embarrassment.
A study in Türkiye involving pregnant women with a history of spontaneous labor and who had previously given birth showed that routine internal examinations near delivery may cause a slight increase in pain compared with ultrasound to assess the progress of labor.
It is important to note that an internal exam can increase the risk of infection, even if done carefully and with sterile gloves. An internal exam can push normal bacteria found in the vagina towards the cervix. There is also an increased risk of rupture of the membranes by applying too much pressure to the cervix.
During labor, it is safest to perform as few cervical examinations as possible, especially if the membranes have ruptured to limit the risk of infection.
3 Examples of Internal Examinations for Pregnant Women
Source: Freepik
1. Internal Examination to See the Opening
If your pregnancy is going well and normally without any complications, your doctor or midwife will only ask you to do an internal examination after the time you are about to give birth. The internal examination is done to check how far the cervix has opened, which will tell them how far along the labor is.
You will be asked to strip from the waist down. The doctor or midwife will tell you to lie down comfortably, with your knees bent. Then the doctor or midwife will put on rubber gloves and apply cream for lubrication.
Then he or she will insert two fingers into your vagina to feel your cervix. Your doctor or midwife may also place his or her other hand on your belly to check the top of your uterus.
2. Membrane Sweep
If it looks like your baby will be born later than the estimated date of birth (EDD) , you may be offeredmembrane sweepor also known as the natural induction method towards the end of pregnancy (around 40-41 weeks).
Membrane sweepis a procedure in which your doctor or midwife inserts a finger into your vagina to reach your cervix and gently makes a sweeping motion to separate the membranes. This procedure can help start labor more quickly.
Membrane sweepaims to stimulate the production of the hormone prostaglandin to help labor begin and irritate the cervix to cause it to contract.
The separation of the membranes or membranes on the cervix is not painful, but you may feel a little uncomfortable afterwards.
3. Speculum Examination
If there are problems with your pregnancy, such as suspicions that you have an infection, are bleeding, or have premature rupture of membranes , you may undergo what is called a speculum examination.
A speculum exam is when a small, gel-coated instrument is inserted into the vagina to check for any cause of bleeding, or to check whether your water has broken.
For this procedure, an instrument made of plastic or metal is used for vaginal examination. You will be asked to lie down, with your knees bent on the edge of the table.
After warming the instrument in warm water, the doctor will gently insert the instrument to open the vagina. This speculum examination will help the doctor see inside the vagina and cervix.
This procedure is not painful, but can sometimes be uncomfortable. You may also have an internal examination if your midwife or doctor thinks you are in early labor or need to give birth sooner than expected.
8 Goals of Conducting Internal Examination on Pregnant Women
Source: Freepik
The doctor, nurse, or midwife will perform an internal examination to check the cervix of the pregnant woman. The cervix is checked for the following:
1. Widening or Opening
How open the cervix is will be checked. This is measured from 1 to 10 cm. If it has reached 10 cm, it means it is fully open or fully dilated.
2. Cervical Consistency
During pregnancy, the cervix will feel firm and narrow, which is also called immature. When it is time to give birth, the cervix will become firm and elastic. In this condition, the cervix is said to be ripe and ready to give birth.
3. Cervical Position
During pregnancy, the cervix tends to be behind (or posterior to) the baby’s head. As the cervix matures (ready for birth) and during labor, it moves forward, making it more accessible to the doctor/midwife.
4. How Far Has the Baby’s Head Descended into the Pelvis?
It is measured from minus 3 (-3), which means the baby’s head is high and not moving, to plus 3 (+3), where the baby’s head can be seen at birth. Most babies’ heads are at -2 at the start of labor and 0 to +1 when pushing begins.
5. Cervical Condition
During pregnancy, the cervix lengthens, thins, shortens, and softens to open the vaginal canal for childbirth.
An internal vaginal examination is also performed to check how thin the cervix feels and is measured as a percentage from 0% to 100%.
0% is when the cervix is long and thick, 100% is when the cervix is paper thin, when most of it has been pulled up and absorbed into the lower segment of the uterine wall.
6. How well the baby’s head is positioned in the cervix
The part of the baby that ‘leads the way’ during labor is called the ‘presenting part’. Normally, the presenting part is the baby’s head. However, it may also be the baby’s bottom if in a breech position .
The doctor or midwife will try to estimate how well the baby’s head or presenting part is tilted towards the cervix. A well-positioned head is thought to be more efficient in dilating the cervix during labor.
7. Baby Lying Position
The baby can lie in two positions, posterior or anterior. This can be felt if the cervical opening is more than 4 cm, but sometimes it is difficult to determine accurately.
8. To Prevent Inducing Labor
Sometimes, an internal exam during labor may be recommended to prevent the mother from taking induction drugs. An internal exam helps the doctor know the progress of labor, and if necessary, induction needs to be given to the mother.
Tips to Avoid Pain During Internal Examination
Source: Freepik
Anxiety and fear often occur before and during a pelvic exam. This exam can trigger negative physical and emotional symptoms such as pain, discomfort, anxiety, fear, and embarrassment.
These negative symptoms can interfere with the smooth running of internal examinations resulting in delayed or avoided care and significant health consequences.
Communicate with your doctor or midwife if you feel nervous and tense. They can help position you to feel more comfortable.
Try to do slow, deep breathing exercises. Take a few deep breaths and exhales before the exam if you are afraid to calm yourself down. Relaxing your shoulders, abdominal muscles, and the muscles between your legs is very important during the exam.
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By knowing the ins and outs of internal examinations in pregnant women, it may affect the fear and anxiety that you feel before facing it. So that the internal examination does not feel painful, you should try to relax when undergoing it. Hopefully this information is useful!
Republished with permission from theAsianParent Indonesia
