Mother and Baby

Internal Examinations During Labour: How Many Are Necessary?

Section: Labour & Birth
Internal Examinations During Labour: How Many Are Necessary?

That moment when the midwife snaps on her gloves and lubes up makes the best of us shudder. But internal examinations are over quickly and will help your labour progress safely and smoothly

Being internally examined while you’re in labour will feel invasive and uncomfortable – not to mention a tad embarrassing – there’s no getting around that. But it’s how your midwife determines how far along you are in your labour and the position of your baby, among other things.

What is an internal examination?

An internal, or vaginal, examination is usually conducted by your midwife, who will gently inserting her gloved fingers into your cervix to confirm how your labour is progressing. Sounds painful, but she’ll probably make things a bit easier by using an antiseptic obstetric cream called Hibitane.

‘Most women find vaginal examinations very uncomfortable,’ says Jane Munroe of the Royal College of Midwives. ‘But as with all types of pain or discomfort, it’s more painful for some women than others.’ Part of your midwife’s skills is being very sensitive to this, so let her know if it’s really too much for you to handle.

Don’t worry – the examinations shouldn’t affect your baby, but too many examinations, particularly if your waters have broken, can risk giving your baby an infection. 


What’s the purpose of an internal examination?

Loads of different things will be checked, including how open your cervix is (otherwise known as your dilation) by measuring from one to 10cm. When you’re nearing double digits it’s time to push.

The position of your cervix is also looked at. As your labour progresses, the cervix will move forward, away from its pregnancy position of behind the baby’s head, making it more accessible for your midwife.

‘The examinations will sometimes be used to check which position the baby is in,’ explains Jane. ‘And they can also tell when there is a need to break the waters, for example, when labour is being induced.’

Your midwife will feel how far your baby’s head has come down and measure this progression from minus three, meaning the baby’s head is high and not engaged, to plus three where the baby’s head can be seen at birth.

The examination will see how well your baby’s head is sitting on the cervix and when you’re around 4cm, the position that your baby is lying in will be checked.


How often can you expect to be examined?

You’ll most likely be examined by your midwife approximately every four hours while you’re in labour.

‘You shouldn’t be examined more than seven times during your labour,’ advises Jane. If your midwife wants to examine you more, ask her to clarify why this is necessary and check with another medical expert if you aren’t satisfied.

‘The number of examinations you have will depend on how long you’re in active labour,’ Jane explains. ‘The number won’t depend on your pregnancy type, but if you need your labour to be induced you may need more examinations.’

You’ll most likely be examined by your midwife approximately every four hours while you’re in labour

When can you request an examination?

If you aren’t sure about whether you want to have pain relief, you can ask your midwife to give you an internal examination to access your progress.

The answer may help you make your mind up – if you’re in a lot of pain but still have a long way to go then you may want to choose a pain relief method to help you with the remainder of the labour.


Do you have to say ‘yes’ to an examination?

The simple answer is no. It’s your choice.

‘There are signs in women’s changing behaviour that inform midwives how labour is progressing,’ says Jane. ‘Nobody wants to undertake unnecessary vaginal examinations, as they can be very uncomfortable and a possible risk of infection for the baby.’

There’s no escaping the fact that an international examination is uncomfortable and will probably make you wince, but it’ll help to figure out how labour is progressing which can only be a good thing! 


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