Vaginal examinations in pregnancy and birth

What is a vaginal examination?

A vaginal examination is an internal physical examination where your doctor or midwife gently inserts a speculum or their gloved fingers inside your vagina to check your cervix. It should only happen with your informed and voluntary consent.

Vaginal examinations can be part of cervical screening (pap smear), pregnancy and labour care. Whether one is recommended will depend on your situation. The reason for the examination should be clearly explained to you.

During labour, a vaginal examination may help your doctor or midwife assess your cervix or understand how your labour is progressing. It may also help them to plan or start an induction of labour.

Even if one is recommended, you still have the right to ask questions, ask about other options or say no.

How is a vaginal examination done?

A vaginal examination is a procedure where your doctor or midwife gently inserts a speculum or 2 fingers inside your vagina to assess your cervix — this should only happen with your informed consent.

Agreeing to a vaginal examination

Before you have a vaginal examination, your doctor or midwife should explain why they recommend it, what it involves, what the possible benefits and risks are, and whether there are other options.

This information should help you decide what is right for you. This is called informed consent and shared decision-making.

Before you decide if you agree to a vaginal examination, your doctor or midwife must give you the opportunity to:

• ask questions
• voice any concerns or past experiences that may affect how you feel about the examination
• have a support person with you during your vaginal examination
• choose not to have a vaginal examination
• ask for more time, where possible, before deciding
• ask about alternatives, including what may happen if you decide not to have the examination

Throughout your vaginal examination, your doctor or midwife will do their best to make sure you feel safe and comfortable. They will make every effort to protect your privacy and dignity, and to communicate with you in a respectful way.

If your doctor or midwife has students with them, you can choose if you want them to be there during your vaginal examination or not. You have the right to decide who is in the room during any examination.

You can also change your mind or ask for the examination to stop at any time before or during the procedure.

Questions to ask before agreeing to a vaginal examination

To help you decide whether you want to have a vaginal examination, you might like to

ask your doctor or midwife:

• Why are you recommending a vaginal examination now?
• How is a vaginal examination done and what might it feel like?
• What are the possible risks, benefits and discomforts for me and my baby?
• What other options are there if I do not want to have a vaginal examination?
• Can a support person be in the room with me during the examination?
• Can I have more privacy, take more time, or be in a specific position so I am more comfortable?
• Can I request a female doctor or midwife to do the examination?
• What happens if I say no, or if I want to stop once the examination has started?

The answers to these questions may help you make an informed decision that feels right for you.

What happens during a vaginal examination?

You may be asked to lie in a semi-reclining position with your knees bent and apart.

Before starting, your doctor or midwife should explain what they are about to do and check that you still agree to continue.

The process of a vaginal examination in labour generally involves your doctor or midwife doing the following:

• They will wash their hands, wear sterile gloves and use sterile techniques to prevent infection.
• They will assess the outside of your vulva.
• They may need to apply sterile lubricant or obstetric cream on their forefinger and middle finger before gently inserting them into your vagina.
• They will identify your cervix and assess it, including how dilated (open) it is.
• They will feel for your baby's head to check which part is closest to the birth canal, what position your baby's head is in and if the membranes are intact or broken.
• They should then discuss with you what they found dn for your care.

If you are having a vaginal examination for cervical screening or to check if your waters have broken early, your doctor or midwife may use a speculum. A speculum is a piece of medical equipment that holds your vaginal walls open so the cervix can be seen more clearly.

If at any point you feel uncomfortable, distressed, or want the examination to pause or stop, tell your doctor or midwife straight away.

Read more about a vaginal examination during a cervical screening test.

What does a vaginal examination feel like?

Everyone's experience is different. Many describe vaginal examinations during pregnancy or labour as uncomfortable.

Some people may find them to be painful, distressing and invasive. This can be more likely if you feel frightened or rushed, have experienced trauma before, or do not feel that you have freely chosen the examination. If this is how you feel, tell your care provider. Your feelings are valid.

If the vaginal examination causes pain, it's very important to let your doctor or midwife know immediately. They should respond to what you tell them and stop if you withdraw your consent.

Why might I be offered a vaginal examination?

During your pregnancy, you may be offered a vaginal examination if:

• you are due for your cervical screening test (speculum examination)
• you are bleeding or feeling pain during your first trimester (speculum examination)
• to check for Group B streptococcus (GBS) or other infections (vaginal swab)
• an induction of labour is planned

During labour, you may be offered a vaginal exam:

• during active labour to assess how your labour is progressing
• if your doctor or midwife suspects your labour is not progressing as expected
• if there are any concerns with your baby's heart rate or wellbeing

Your doctor and midwife will aim to keep the number of vaginal examinations to the minimum needed for your care. They should explain each examination and you will need to provide your consent.

What if I do not want to have a vaginal exam?

If you do not want a vaginal examination, your doctor or midwife will discuss other options with you.

It is your right to decide whether or not to agree to a vaginal examination. Your decision should be respected, and your consent should never be assumed or pressured. You can also change your mind and withdraw consent after having agreed to one.

What are my options if I do not want a vaginal exam?

If you do not want a vaginal examination during labour, your healthcare professionals can assess your progress in other ways by:

• observing and listening to how you are feeling and acting in labour
• asking you how you feel
• looking for other signs of progress

These methods may give less precise information than a vaginal examination, but they can still be useful and may feel more acceptable to you.

Research has not clearly shown how helpful routine vaginal examinations are during labour, especially when done regularly, such as every 4 hours. More research is needed about the best way to assess labour progress.

Some studies suggest a link between having multiple vaginal examinations during labour and a higher risk of infection for your baby.

It's important to tell your care providers what's acceptable to you, and what support you need so that decisions can be made in partnership with you.

What are the benefits and risks of having a vaginal examination?

Possible benefits of a vaginal examination during labour include the following:

• It helps your doctor or midwife understand how your labour is progressing.
• Your doctor or midwife can feel which part of your baby is facing towards your birth canal, learn their position and check where your baby is placed in your pelvis (station).

Possible risks or downsides of a vaginal examination during labour include the following:

• A vaginal examination may increase your risk of infection, as well as your baby's. The risk is low because doctors and midwives follow standard hygiene practices.
• If your healthcare professional diagnoses your labour as slow, vaginal examination can lead to interventions to speed up your labour. Examples include breaking your waters, medicines or a caesarean section. These interventions may be physically and emotionally distressing for you.
• A vaginal examination may increase your risk of rupture of your membranes.
• Some people may find vaginal examinations to be painful, distressing and traumatic.

Vaginal examinations are generally not recommended if:

• you have experienced antepartum haemorrhage — vaginal bleeding after 20 weeks of pregnancy and before you have gone into labour
• your waters have broken, but you are not in labour
• you have placenta praevia or if the position of your placenta is not known
• your doctor or midwife thinks you may be in preterm labour

Speak with your maternity care provider about what is right for you. It's important you understand why they recommend a vaginal examination and possible other options. You should have the opportunity to give or refuse informed consent.

Who can I speak to if I'm not satisfied with my healthcare?

If you aren't satisfied with your healthcare, or if you feel your choices, dignity, privacy or consent were not respected, people you can speak to include:

• your doctor or midwife
• the health complaints agency or health department in your local state or territory
• the Australian Health Practitioner Regulation Agency (AHPRA), if you have a concern about the unsafe behaviour or practice of a registered health practitioner
• the National Health Practitioner Ombudsman

If you're unsure about something that has happened to you, especially during labour, birth or in an emergency, it is a good idea to meet with your doctor or midwife to discuss the events. This is an opportunity for you to ask questions so that you can better understand what happened.

You also have the right to give feedback or make a complaint without it affecting the way you are treated.

Resources and support

• Learn more about informed consent in pregnancy and labour on the NSW Government website.
• Call 1800 RESPECT the national domestic, family and sexual violence counselling, information and support service on 1800 737 732.
• Visit Birth Trauma Australia for information and support, including peer-to-peer support.
• Visit the PANDA (Perinatal Anxiety & Depression Australia) website for information and support after a traumatic birth. You can call the PANDA national helpline on 1300 726 306.
• The Centre of Perinatal Excellence (COPE) has information on preparing for birth support before, during and following birth.

Languages other than English

• The Australian Charter of Healthcare Rights includes information about informed consent translated into many community languages.
• The Multicultural Centre for Women's Health has a catalogue of health resources, available in many community languages.

Information for Aboriginal and/or Torres Strait Islander peoples

• The Australian Nurse-Family Partnership Program (ANFPP) is a nurse-led home visiting program that supports pregnant Aboriginal and/or Torres Strait Islander females. Contact your local Aboriginal Health Service or Aboriginal and Torres Strait Islander health worker to find out if this program is available to you.
• ForWhen has resources for Aboriginal and/or Torres Strait Islander people and connects new parents to mental health services and supports — call 1300 24 23 22.

Information for sexually and gender-diverse families

Visit Rainbow Families to find resources for sexually and gender-diverse families.