Are vaginal examinations really necessary during pregnancy and childbirth?

There are things in our lives that just seem normal to us because everyone does them and that's just how you do it. And then we are surprised when we meet people, often outside of our culture, who have never heard of it or who somehow instinctively reject it. Certainly, a few things come to mind now. For example, that in the West we use toilet paper, but in many, actually most of the countries in the world, people wash with water. Funny? No, just different. Now what if I tell you that routine vaginal examination during pregnancy is not a worldwide practice? That there are many countries where this is not done and that birthkeepers in various native peoples in particular often rule this out on principle.

I first experienced a different form of “birth surveillance” with an 83-year-old midwife in Guatemala who belonged to an indigenous people. During my midwifery training in Germany, I traveled to Guatemala for 6 weeks during the holidays to take part in a midwife exchange program. It was so rewarding.

I observed her during some homebirths in her mountain village at the foot of a volcano and took part in her life with her extended family. During the homebirths, I noticed how little she did. That got me thinking. She just let the woman do it, she let her birth and listen to her inner self. Certainly, there was also far more trust among the people, since those births so often took place within their walls. But what she never did was examine vaginally. She observed and thanks to her many years of experience, she quickly realized what phase the woman was in. I found that fascinating. She would sometimes ask me if I wanted to do an exam (she knew Western midwives 'always' did) and I realized she had no experience with it. After more than 60 years of experience and hundreds of home births (including twins and breech presentations), no vaginal examination. I was impressed and deeply shaped. Even during my internships with home birth midwives in different places in the South of Germany and my induction period in the birth center in Hamburg, I had to realize that extremely few examinations were carried out (and certainly not in the check-up appointments). Compared to what I was drummed into in the clinic, this was a big paradigm shift. Why am I telling you this? Well, it's very simple. Vaginal examinations are not particularly pleasant, they are also sources of infection and there is no evidence-based reason to endure them, especially during pregnancy. I am very much in favor of free choice and enlightenment. And it is your absolute right to politely decline a vaginal exam, simply with the all-important question, "Is this necessary?" Because what the doctor would find is usually a closed cervix that just wants to be left alone.* In the course of my work as a midwife and through experience gained in various countries such as Germany, Asia, and Latin America, I have drastically reduced the frequency of vaginal examinations. There have been a few home births where I didn't feel for the cervix at all. I've always wondered what benefits it would bring us in this situation and weighed that against the risk of infection and the general disruption of the birthing process. I also worked with a Hilot, a Filipino midwife, on the Philippine island of Palawan, and she was able, this is not invented, to predict how long the birth would take by feeling the pulse on the woman´s wrist and index finger. And believe me, she was always right. In the picture, you can see Nanay (Mother, as we call her respectfully) while she executes her gift. She also predicted my birth time exactly. Read about this in my blog article "Laya´s Birth).

By now I can instinctively feel pretty much how far along the woman is in her birth. And whether the cervix is ​​4 or 5 centimeters is not decisive.

There are about 4 points in which you, as an experienced midwife, can assess quite well how far along a woman is. At least this is my own experience. For example, the transition from so-called practice labor to active birth. When the woman just needs to focus more and become more withdrawn during the contractions. Point 2 is active labor around the "5-centimeter mark" when many women are throwing up and stronger contractions overwhelm them. This is often a very important phase in which "the body decides over the mind" and pure acceptance is required. And then of course there is the phase when the adrenaline kicks in and the woman giving birth just doesn't want to anymore. Sentences like "I can't take it anymore!" Or "When will it be over?" Are not uncommon and are expressed in all languages ​​of the world with the same intensity. Around this stage, the cervix is ​​almost open. And of course, the 4th point is when the pressure increases, which of course you have to ask yourself whether this is the amniotic sac or the child's head, which is causing the urge to push. Of course, every woman is different and I've had a few surprises too. But I've never regretted my decision to be sparing with touching the cervix. Maybe this article will encourage you to say “no” when you find it uncomfortable. Because I want to make it clear to you that this is your fundamental right. Routines must be questioned and adapted to the needs of women and babies. Thank you for reading! *Should premature labor occur (premature contractions, premature rupture of membranes, bleeding), this is of course something else, and then palpating the cervix and cervix makes a lot of sense. However, great attention must be paid to hygiene, precisely because of the risk of infection already mentioned.

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