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.

Vaginal examinations are often part of cervical screening (pap smear), pregnancy and labour care.

During labour, a vaginal examination helps your doctor or midwife assess your cervix, to help understand how far along you are, or to start an induction of labour.

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 only happens with your consent.

Agreeing to a vaginal examination

Before you have a vaginal examination, your doctor or midwife will explain why they recommend the procedure. They will also explain how the examination is done so that you can make an informed decision. This way, together with your healthcare team, you can decide if it is the right procedure 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 you may have
• have a support person with you during your vaginal examination
• choose not to have a vaginal examination

Throughout your vaginal examination, your doctor or midwife will do their best to make sure you are comfortable and make every effort to protect your privacy and dignity.

If your doctor or midwife has students with them, you can choose if you want them to be present or not during your vaginal examination. You have the right to decide.

What happens during a vaginal examination?

You will be asked to lie in a semi-reclining position with your knees bent and apart. 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 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 it is.
• They will feel for your baby’s head to check what part is coming first and what position your baby’s head is in and if the membranes are intact or broken.
• They will then discuss with you what they found during your exam.

If you are having a vaginal examination to have a 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 to view your cervix.

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

What does a vaginal examination feel like?

Everyone’s perception will be different. Many describe vaginal examination during pregnancy as uncomfortable.

Some people may find them to be painful, distressing and invasive. If you feel this way, its important that you voice your concerns to your care provider. Many people feel this way, and you are not alone.

If the vaginal examination causes pain, it’s very important to let your doctor or midwife know immediately so they can stop. They may be able to adjust the process or stop completely.

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)
• your health team recommends an induction of labour

During labour, you may be offered a vaginal exam:

• during active labour to assess how far you have progressed
• if your doctor or midwife suspects your labour is not progressing
• if there are any concerns with your baby’s heart rate

Your doctor and midwife will aim to keep the number of vaginal examinations you have to a minimum.

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 and choice to decide if you do or do not agree to have a vaginal examination.

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 by:

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

These methods to check how your labour is progressing are not as accurate as a vaginal examination.

Although, research investigating vaginal examinations has found that it is unclear how helpful they are during labour, especially every 4 hours. There is also not enough research to establish which is the best way to assess how you are progressing through labour. More research is needed to check this.

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 right for you and to work in partnership with them.

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

Benefits of a vaginal examination during labour include the following:

• A vaginal examination can tell your doctor or midwife how your labour is progressing.
• Your doctor or midwife can feel your baby’s presenting part, learn their position and check where your baby is placed in your pelvis (station).

Risks 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 if good hygiene guidelines are practiced.
• 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 premature rupture of your membranes. Some people also find vaginal examinations to be humiliating, painful, distressing and traumatic.

Vaginal examinations are 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 have the opportunity to give your informed consent.

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

If you aren’t satisfied with your healthcare, there are 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’re unsure about something that happened to you, especially during labour, birth or in an emergency situation, it is a good idea to meet with your doctor or midwife for a debrief of the events. This is an opportunity for you to ask questions so that you can better understand what happened.

Resources and supports

• 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 Aboriginal and/or Torres Strait Islander people who are pregnant.
• 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.