možda malo OT, ali za vašu informaciju (za one koji smatraju da ginekolog mora malo počeprkati 'tamo dole' svakih mjesec dana :x ):
Most practitioners will do an initial vaginal exam at the beginning of pregnancy to do a pap smear, and other testing. Then they don't do any until about the 36 week mark, unless complications arise that call for further testing or to assess the cervix. If your practitioner wants to do a vaginal exam at every visit, you should probably question them as to why.
Vaginal Exams During Pregnancy
There is no need for any vaginal exams during a normal pregnancy. The average healthy woman will manage her entire pregnancy without one.
Most women will be offered a PAP smear at first consult if they haven’t had one recently, but they can decline and say that they’d prefer their regular GP to do it for them.
There’s no need for a vaginal exam to determine dates either, if the woman can give a good menstrual history. If she cannot give an accurate date of her last menstrual period, then she can request an early ultrasound.
If the doctor suggests he needs to examine her to determine that all is normal anatomically then the woman can state that she has no problems with menstruation, intercourse, frequent UTIs, abnormal vaginal discharge or any other gynae probs therefore there is no reason to suspect any abnormalities.
If she has a history of gynae probs, infertility, if her mother used diestriol during pregnancy with her or if she has painful intercourse, difficult consummation etc then she’d be wise to have an exam to exclude abnormalities.
Make sure that:
You understand why the exam is being done and what the examiner hopes to ascertain from it
The procedure is explained to you and you are asked if you consent to it or not
Inform the examiner if you have a latex or any other contact allergy
You have an empty bladder
You are warm
Are comfortable
Adequately covered
Privacy is ensured
Ask for extraneous people to leave the room
Lie flat and squarely on your back with your bottom on the bed
Breathe deeply throughout the exam
Try to relax your pelvic floor muscles
Ask the examiner to explain clearly to you what he finds on exam.
I wouldn't do a vaginal exam:
If the woman asked me not to
If I thought the woman was in the latent phase/early stages of labour, as it would only discourage her. I'd encourage her to rest instead.
If I wanted to know if the cervix was fully dilated. I'd just wait and see!
If I thought the baby was in posterior position – there is nothing I can do about it if it is!
Unless my findings were going to alter what we were doing.
It's inappropriate to do a vaginal exam:
Because the shift is changing and, we want to know where you are.
Because the staff want to know where you are at in your labour but don't have the time to sit and observe or be with you.
Because the anaesthetist is going home and doesn't want to be called back in an hour to give you an epidural (unless you have indicated you are considering one)
Because the Registrar is going off duty and wants to hand over your care to the incoming Registrar.
Just to check how you are doing
Because it is hospital policy to do routine 4-hourly vaginal exam
Because your obstetrician wants to be present for birth but not to be standing around for hours waiting, or miss the whole thing (unless you specifically want your obstetrician present).
When vaginal exams are contraindicated:
If the woman refuses the procedure for reasons of culture or FGM etc
When there is a placenta praevia
With extreme care when there is any abnormal vaginal bleeding pre-natally
Unnecessarily if the woman is GBS pos with ruptured membranes
If the woman has an active Herpes lesion
There was an article in the medical journal, the Lancet a couple of years ago written by an obstetrician. He wrote that he couldn’t see the whole point of information seeking vaginal exams, especially trying to work out what position the baby was in (i.e. posterior, transverse). He noted that there were only 3 diagnoses which counted. The baby is:
1. Coming out soon
2. Coming out later
3. Not coming out at all
I think he has something there – people make it all so complicated when it's all fairly simple!
Who’s Having Vaginal Exams?
BellyBelly midwife, Alan Rooney says: “I have never had a homebirth mum request a vaginal exam.
I think that, in hospitals, many mums expect to be given a VE. In my experience, when I have admitted a woman in labour, a frequent question I get is, Do you need to do an internal? or When are you going to do the internal? or some such question.
I do not believe that women are happy to have vaginal exams, but I think that most women accept them as an expected part of pregnancy. I am sure that if they were given all the facts then a lot more women would be saying no to vaginal exams.
I would imagine that the risk of infection is quite low from a VE, but there is still a risk. And the more often someone goes sticking their fingers in, the higher the chance of introducing an infection. This is more of a concern if the waters have broken, as not only can you give the mum an infection, but you could also give the baby one.”
If You Want to Avoid Pain Relief, Avoid an Exam!
Birth Attendant and BellyBelly’s Creator, Kelly Zantey, says: “Vaginal exams can be the final breaking point for women in labour. If they have an internal and are disappointed at how dilated they are, it can be the reason they choose to have that epidural or other pain relief because they feel they have nothing left inside them to keep on going when the end is far in sight (to them anyway!).
No-one knows how quickly or slowly a woman will dilate, but knowing an actual number can severely throw a labouring woman off track. A client of mine had an internal and was found to be 4cms dilated. She was devastated after labouring all day, and it took much work to get her focused and back on track, allowing her body to labour without distraction and stress. Not only that but her parents then turned up uninvited and again she had lost focus! We quickly dealt with that, but after a few good hours of hard work in the bath, focusing on the HypnoBirthing she had been learning, she had her baby soon after – not bad for someone who was 4cms hours earlier. She could have given up and opted for pain relief thinking she would have many hours to go – but she dilated quickly after the internal. It’s so unfair to a labouring woman to have to go through that, the feeling of defeat or seeing a mountain in front of them when they have already worked so hard – this is why I believe it’s best not to know or have internals unless there is a compelling reason. As well as this, if you are not dilating fast enough for the hospital or doctor, then it’s a reason for them to initiate further intervention like the syntocinon drip or rupture of membranes etc
It’s very important to ALWAYS remember that when you are in a hospital, no-one HAS TO DO ANYTHING! All treatment is by consent and patient choice ONLY. Policy is not law and procedure being done against your will is grounds to sue. Doctors / midwives need YOUR permission to do anything to your body. If they aren't convinced there is a good reason for a procedure then decline it.
