How and what do they actually do during internal exams?

[Bex174]

I'm at a stage where I'm considering birth plans - twins so no idea if c-section or natural as yet, but I'm trying to think of all my preferences for both well ahead so I'm totally informed whatever happens.

I've been reading some threads and there seems to be a general consensus that internal exams can really hurt and be rather excruciating, sometimes more so than the birth? With many opting not to have them?

When I looked up what an internal exam is, it just says a midwife/doctor pops two fingers up your vagina to feel for your cervix and that it should all be only around a fingers length in? That doesn't sound too bad to me, I mean sometimes (TMI possibly!) my other half pops 2 fingers in when we're having some fun and it doesn't really hurt as such...

So I'm thinking I must be missing something here and maybe something else happens that causes the pain?

Just so I don't have a 'surprise' when the time comes, would someone mind letting me know what an internal exam actually is?

It feels much like a smear to me -some people find them find, I find them hellish.

It's not the fingers inside as such, it's the swirling around

Most people find them fine though - although lying down to have it done can be uncomfortable in itself.

OP, imagine two fingers in your vagina, but they are actually a lot deeper - right up in your cervix - the fingers are twisted, twirled and stretched. I would describe my experience as this. A MW has her whole hand in my cervix, (long fingers, uncut fingernails), whilst I am having a powerful contraction AND she won't remove their hand, even though I am crying out and begging her to stop, and she is saying "just a bit longer, there's a good girl". I found the internal exams violating and painful. I refused ALL internal exams when I was in labour with my other children. IMO, the exams only benefit the HCP, a diagnostic tool , so no benefit to the labouring woman.

Internals aren't always bad though. I appreciate there are lots of people on MN who have found them difficult but, like everything else, you only tend to hear about them when its been painful.

The one thing I wrote in my first birth plan was that I wanted to be informed about (and give consent to any) internals. The midwife was aghast and said that was agiven. She was brilliant and said if I felt it went beyond just uncomfortable she would stop. That should be normal procedure.

You need to stress it at the beginning when you're introduced to your delivering midwife.

Beatrice, I am so sorry for your experience. May I ask if you ever complained about your barbaric treatment?

I found internals absolutely fine (I find smears fine too). My express consent was always gained and the midwives were respectful and explained everything.

It was of benefit to me as a labouring woman. First time round because we knew something wasn't right and it was the quickest, simplest way of establishing what that was. Second time round, it was necessary as part of a decision making process.

I've even had the whole hands up me experience (very stuck baby, attempted manual rotation) and even that wasn't too bad. For me it was manageable because I felt respected and involved.

Remember it's your body and your choice. You don't have to consent to internals. Ask why they want to do them and make a decision. You can also ask the midwives/doctors to stop if you change your mind.

I found some Ok and some painful, I had gas and air to help and midwives that listened and stopped if I asked.

I never had any problem with them, and had a very long labour for DD, so had looooaaads. I didn't find them painful at all, just a bit uncomfortable.

Question for MNers who refused internal exams : without them, is there a way to know how many centimeters you're dilated ?

No Ele. But all an internal at 10pm tells you is how dilated you are at 10pm not necessarily much about where you will be in an hour or when you will deliver.

They do have ways of looking at how labour is going more generally.

Interesting Penguins, thanks !

I have to say I liked knowing how far along I was (even though you're right, it didn't give me any idea how much longer was left)

In my case it just told us how far along I wasn't .Which triggered an emotional collapse from me and then accepting various interventions I didn't want. I preferred not knowing (and my two natural labours have gone slow -slow- off like a rocket, so there is a chance knowing was actually counterproductive because it implied things were 'worse' than they were).

Horses for courses and all that

I didn't find them painful at all, just to give you another perspective on it! They're very quick, known they they're looking for and then out again. Plus, if you're in the throws of labour, you barely feel them among the contractions

They never bothered me, slightly uncomfortable but not painful.

I needed internals to try and ascertain the position of the baby's head. We knew something wasn't right but the external palpation only revealed dd to be back to back. Her head was too low for us to know what was happening. It was only an internal that showed her head to be transverse and asynclitic (facing my hip and ear first).

It's not just a dilation issue sometimes. Of course all this should be explained before, during and after.

I had an internal against my consent, so I'd say be vocal if you're opting out (we were and she did it anyway)
As a result the idea makes me feel ill, very violating. Definitely will not be happening again

I'll be declining them next time, I find them really painful and in retrospect told me nothing useful about how my labour was progressing as I spent a day at 2cm then went to fully dilated within a couple of hours.

I also find smears painful so perhaps some women have more sensitive cervixes?

Agreed Grantaire. I said I was happy if there was a specific reason or a worry either of us was at risk. It was general ' let's see how you are getting on' internals I didn't want.

I only had 2. They were totally fine.
Second one was really important as it confirmed Id arrived at hospital 8cm dilated and really needed to get into a birthing room ASAP!

I've only had two and they were uncomfortable but I think it helps the mw know how far dilated you are and it was good for me to know too so I knew I was nearly at the end.

I have two dc and with both got to the hospital with about an hour to spare, DS was examined and I was 9cms dilated and with DD I was 8cms dilated.

If you can ask for has and air first I think it helps to have something else to concentrate on and I think if you weren't in labour it would feel like a smear test. It does hurt if you're having a contraction, but they try to do it in between contractions and I think they just keep still if you have a contraction and they're still checking you.

Never made me bat an eyelid tbh. If internals are the thing bothering you in labour you must have lovely gentle contractions! I'd disagree with the comment that as a diagnostic tool they only benefit the hcp, it's quite nice as the one in labour to know how it's going too.

That simply isn't true. People find different things painful. I found pushing and crowning easy. Doesn't mean I think others do. In a long b2b labour with forceps, internals were one of the worst bits for me.

That's kind of what I mean Penguin, for me with a big baby stuck in deep transverse arrest, with minute long contractions every two minutes for 16 hours, there wasn't any space to register anything else as painful.

With dd2 I'd put no internals on my birth plan. Problem was mW didn't believe I was in active labour, so by the time she actually got round to doing one (with my consent) I was 9 cm.... quick dash to the delivery room and dd2 born 20 minute later.

Crazyqueen, my dd was in deep transverse arrest too. My contractions were 2.5 minutes with a 30 second gap all the way through with no peak to them, just the same intensity throughout. For 31hrs. I had an 8hr second stage. WhereTF dd was going, I have no idea. That's dd though. Head in the clouds, aimlessly drifting. I do think with that labour the internals passed me by as I was in a whole other place. I also know that there was so much swelling and moulding caused by the position that one sensation just added to the general sensation iyswim.

It is important that all women understand that internals are different not only woman to woman but caregiver to caregiver and can be different in subsequent labours or even the same labour but at a different point. It is nothing to do with pain thresholds and any woman should say NO clearly and firmly at any point and expect to be listened to.

You don't have to agree to an internal, you can decline them if you're concerned.

I personally don't find internals painful at all as long as I'm not having my cervix touched at the height of a contraction. Even with a posterior cervix I don't have a problem with them as long as I relax. I have never found a sweep painful either. Not everyone has a problem with them but I do not doubt that they can be very uncomfortable for some women.

I wouldn't want loads done though because I don't like being interrupted whilst in labour nor do I appreciate being made to 'adopt the position' in between contractions as it invariably involved at least one contraction whilst laying on my back (internals can be done in other positions by experienced and confident caregivers but I'm yet to meet a willing midwife/doctor).

I do say all of this as someone who had two entire hands shoved up for internal manoeuvres to be performed for a shoulder dystocia and even that didn't hurt any more than having a baby half out did.

I didn't find them painful. Uncomfortable enough to use the gas and air but not painful. With #1 child I had a few internals which coincided with contractions amd that did hurt but that was more because i couldn't move what with having a midwife elbow deep in me.

They are over quite quickly. And I found them useful as it helped me to know that this were progressing. And with #2 child the mw told me he was back to back which explained the excruciating pain...