Brace Yourself: What’s With the Pregnancy Internal Examination

by Joshua Calton-Weekes |
Updated on

You might as well lose those inhibitions because the internal examination in pregnancy is unavoidable – and all important

Internal examinations. Not everyone’s favourite part of having a baby, it has to be said. Unfortunately, they’re necessary.

Another internal examination in pregnancy? They’re often the only way a doctor or midwife can monitor just what is happening during your labour – and each one means you’re that bit closer to meeting your baby.

You might be offered a vaginal scan for your 12-week scan if your womb is sitting very deep in your pelvis, or if you are overweight.

‘You can opt out of a vaginal examination if you want to,’ says Dr Christina Yu, Consultant in Obstetrics and Fetal Medicine at The Portland Hospital. ‘Internal examinations can be painful, but we know that we only do them when absolutely necessary.’

What is a membrane sweep?

Before you’re offered an induction you’ll be offered something called a ‘membrane sweep’ to help you go into labour. Your midwife will put her finger into the cervix and make a circular, sweeping movement to separate the membranes surrounding your baby.

If this isn’t possible, she’ll just massage. You may find this uncomfortable or painful and bleed a little, but it does make you more likely to have a natural labour.

You’ll be offered a membrane sweep from 40 weeks in the first pregnancy, or at 41 week antenatal appointment if you have had baby before.

When you’re being induced

When you are being induced, synthetic drugs are used to kickstart labour are put into your vagina in the form of a gel, tablet or pessary. These drugs are prostaglandins and work in the same way as the natural hormones that stimulate labour.

You will have more internal examinations six hours after you’ve had a tablet or gel inserted into your vagina to see if your cervix has softened.

You’ll be offered a membrane sweep from 40 weeks in the first pregnancy, or at 41 week antenatal appointment if you have had baby before

The dilation test

At regular stages during your labour, you’ll have regular vaginal examinations to see how dilated you are. Usually after a contraction finishes and when you say you’re ready, your midwife will use her fingers to feel your cervix and measure how dilated you are.

Monitoring your baby’s heartbeat

If your midwife can’t get a good trace of your unborn baby's heart rate through a hand-held ultrasound monitor or a cardiotocograph machine (CTG), then she’ll put a clip on your baby’s head to record her heart rate. This is attached during a regular vaginal examination. At this point your waters will be broken if they haven’t been already.

Having your water broken (Amniotomy)

Having your waters broken means another internal examination. Artificial rupture of membranes (AROM) is also known as amniotomy. It’s when your midwife inserts a special, sterilised tool called the amnihook into your vagina to puncture the amniotic sack. What we call ‘waters breaking’ is your amniotic fluid rushing out of your vagina.

Losing this amniotic fluid between your baby and your uterus stimulates your contractions. The synthetic prostaglandins also help to get your contractions going.

However, it’s really common for your contractions to not be strong enough after you’ve had your waters broken. So your midwife will put you on an oxytocin drip. Like prostaglandins, oxytocin is a synthetic version of the natural hormones you produce to get your contractions going. When you’re on an oxytocin drip, your baby's heart rate will also be monitored.

Internal examination after birth

Your first examination after birth is really important. Your midwife will check your vagina and the area around it after you’ve had your baby to assess any damage that needs looking at, for example you may need stitches.

The initial examination can be painful so you’ll be offered gas and air to help cope while it’s happening. Your midwife will also take your blood pressure, temperature and pulse to make sure you’re doing well.

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