Q & A: Prenatal Pelvic Exams

Q: I am ten weeks pregnant and would like to have the care of a midwife
for my entire pregnancy. I wanted to know if my wishes for not wanting to
have any internal exams throughout my pregnancy would be honored. - L

A: That depends on who you see. First, let's talk about the reasons to do these exams. Midwives and OB's offer PAP and STI (formerly known as STD) testing in pregnancy. Some providers perform these tests "routinely;" others of us offer and give the mama the choice to have the testing, not have the testing, or defer the testing to 6 weeks postpartum. Some STIs can cause miscarriages or birth defects, so catching and treating them is great. PAP tests during pregnancy are more likely to have a false positive result (the test says your cells are abnormal, but nothing is actually wrong), so some women who haven't had a history of abnormal PAPs defer those to 6 weeks postpartum. If you have a abnormal PAP result during pregnancy, current practice standards are to recommend a colposcopy, even though some research shows that repeat PAPs in some cases can be as effective as the invasive and painful colposcopy.

Another reason to do a pelvic exam is to see how big your uterus is, as this is a tool for determining when you are due.

Another reason to do a pelvic exam is to perform "pelvimitry." This is measuring with the midwife/doc's hands to see how big your pelvis is. This information is of moderate usefulness: Hormones at the end of pregnancy, and particularly once labor starts, will make the pelvis more flexible and better able to expand. Also, even if your pelvis is "too small," the only way to test it is to go into labor and see if it progresses! If you have had a vaginal birth before, you have what is called a "proven pelvis."

Vaginal exams can also tell the midwife/doc (and you!) if you are showing any signs of going into labor...which can be a good or bad thing, depending on how many weeks you are.

For my personal practice, and that of many midwives I know, these reasons are explained and then the mother chooses if and when she wants exams. There may be waivers that need to be signed, but it isn't a really big deal. Other provider types may consider these exams "required." As with everything else, if this is important to you, ask your provider how they feel about this before or at your first appointment. If your provider is not comfortable with your choice on this issue, there are plenty of others around who will be.