Internal exams: necessary in late pregnancy?

I recently had my first baby and have talked with many friends about their pregnancy and birth experiences. I find it puzzling that my OB did not perform an internal exam at all during my pregnancy, even when I was admitted for an induction two weeks past my due date. I was finally checked internally a couple of hours after the induction had started. I have not heard of anyone who was not examined internally at the end of their pregnancy. What are your thoughts on this issue?

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ABOUT THE EXPERT

Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

I, also, find this extremely odd. I am assuming that you had an internal exam with your initial OB visit. This must be done to ascertain the size of the uterus, assess pelvic dimensions (some omit this because it does not say a great deal) and a speculum must be placed to visualize the cervix and take the pap and cultures for sexually transmitted diseases and for performing a wet mount on any suspicious discharge.

Internal checks at the end of the pregnancy are a matter of some controversy. I do not routinely do them until 39 to 40 weeks because they do not provide much information. I will do them, however, if the client wishes me to.

After 40 weeks, in my opinion, an internal exam should be done weekly in order to assess cervical ripeness; non-stress testing should be done once to twice weekly after 41 1/2 weeks. These postdate protocols vary somewhat from site to site but the omission of cervical checks after 40 weeks is not the norm. And even more odd is the practice you describe of not even checking the cervix when admitted for an induction.

I hope you are able to establish a more satisfactory relationship with a different doctor (or CNM) for your next birth. If you wish to find a certified nurse-midwife for yearly exams or for another pregnancy call: 1-888-MIDWIFE.

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