Vaginal examinations in pregnancy and birth

What is a vaginal examination?

A vaginal examination is an internal physical examination done by a doctor or midwife.

In most cases during pregnancy, this procedure helps your doctor or midwife to assess your cervix to help understand labour ‘readiness’ and progress.

If a cervical screening (pap smear) is being taken, a speculum is used to open the walls of the vagina so the cervix can be seen clearly.

During induction planning and in labour, a vaginal examination can be done to make an assessment about how thin your cervix is and how much the cervix has dilated (opened). During labour it can also help your care provider to assess the stage of labour, how your labour is progressing and the position of your baby.

How is a vaginal examination done?

Before the exam starts the doctor or midwife will:

• explain the reason they are recommending the exam and how it will be done
• if your give your verbal consent for the examination you will then be given some privacy and asked to undress from the waist down
• ask you to lie down on an examination table with your feet together and your knees bent and apart

During the exam they may:

• press along your lower belly or abdomen to feel for abnormalities or sensitive areas
• look at and touch areas of your vulva
• wipe a cotton swab across your vulva to send for testing
• open your vagina with plastic or metal tongs (called a speculum) so they can see your cervix. They may also scrape a small part of your cervix (called a cervical screening test) or wipe your vagina with a cotton swab to send for testing
• put their gloved fingers inside your vagina, while feeling the outside of your tummy with their other hand

What does it feel like?

A vaginal examination during pregnancy may be uncomfortable. This is because of the increased sensitivity of the tissues and extra blood flow to the pelvic area. Vaginal examinations should not cause you pain.

If it is causing you pain, it is important that you let the doctor or midwife know so they can stop.

Why might a vaginal examination be offered?

During pregnancy a vaginal examination may be offered if:

• your routine cervical screening test is due
• there are complications in your pregnancy
• induction of labour is recommended
• if an internal swab is needed; for example, to check for Group B streptococcus (GBS) or other infections
• you are in labour and there is need to assess your labour progress

When are they offered?

A vaginal examination may be done in the first trimester of pregnancy, for example if you are due for your cervical screening test or if you have had any bleeding or pain.

For the remainder of pregnancy, vaginal examinations are not usually done unless there is a complication or if induction of labour is recommended.

Hospital guidelines for vaginal examinations in labour vary. However, maternity care providers are generally advised to offer a vaginal examination:

• within 4 hours of presentation
• every 4 hours when a woman is in active labour
• if there are any clinical concerns

If there is a suspected delay in labour progress, your doctor or midwife may recommend a vaginal examination before the routine 4-hour period.

If the stage of labour is uncertain, a vaginal examination may help with decision making and planning for your labour.

Ideally, vaginal examinations, whether during pregnancy or labour, are kept to a minimum and will only be done with your consent.

What if I don’t want to have a vaginal exam?

Depending on each woman’s circumstance, some women may never be offered a vaginal examination during pregnancy. If you are offered one, it is always your choice.

You will be asked to give your consent to having a vaginal examination before it is done. It is important that you understand what is involved and why it is being recommended. If you choose to, you can request a ‘chaperone’ (another person) be present during the vaginal examination.

What are the alternatives if I don't want a vaginal exam?

A vaginal examination can be very helpful to clarify cervical dilatation, thinning and labour progress. But it’s not the only way to assess your readiness for labour or its progress. Some women and their maternity care providers prefer not to do vaginal examinations unless they are really necessary.

Other ways to assess labour progress include maternity care providers observing the behaviour of the labouring mother and external physical signs of progress; for example, a purple line developing between the mother’s buttocks.

It’s important to tell your care providers what’s right for you and to work in partnership with them.

What are the risks and benefits of having one?

Some women may experience a small amount of spotting (blood) from the vagina after an internal examination. This is usually nothing to be worried about. If you experience heavy bleeding following an internal examination contact your doctor or midwife immediately.

The risks of having a vaginal examination are low if hygiene guidelines are followed and the clinical reasons for having one are clear. The examiner needs to wash their hands, wear disposable gloves, use lubricant and, if necessary, use sterile swabs and speculum.

Vaginal examinations can increase the risk of infection to a mother and baby. They can also increase the risk of premature rupture of the membranes. This is why they should not be done without a clear reason.

Another risk of a vaginal examination is that they can misdiagnose labour progress, which can be physically and emotionally devastating to a mother. If a slow but normal labour is misdiagnosed as being abnormal, this can lead to unnecessary labour and birth interventions.

Vaginal examinations are not recommended in labour if a woman:

• has had an antepartum hemorrhage
• has ruptured membranes but is not in labour
• has placenta praevia or if the position of the placenta is not known
• if she is in suspected preterm labour

Speak with your maternity care provider about what is right for you. It’s important you understand why a vaginal examination may be necessary and to give your consent first.

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

If you aren’t satisfied with your healthcare, there are many people you can speak to, including:

• 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 aren’t sure about something that happened to you, especially during labour, birth or in an emergency, it’s a good idea to meet with your doctor or midwife. This is an opportunity to ask questions so that you can better understand what happened.

Resources and supports

• It’s a good idea to speak to your doctor or midwife if you want more information on this topic.
• Call the National Sexual Assault, Domestic Family Violence Counselling Service on 1800 RESPECT or 1800 737 732 (24 Hours a day, 7 days a week).
• Visit the Australasian Birth Trauma Association website 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 (Mon to Fri, 9am to 7:30pm AEST).