Midwives, nurse practitioners and doctors perform pelvic exams during an early prenatal visit for several reasons. This manual examination of a woman's reproductive organs can yield information about the pregnancy. It also provides an opportunity to screen for infections and other conditions that could impact maternal or fetal well-being.
Preparation
The woman is asked to empty her bladder, completely disrobe and put on a paper jacket to facilitate a clinical breast exam. Then she lies down on the exam table and s places her feet in stirrups with her knees bent. Her hips must be placed on the edge of the table. By keeping her hips relaxed and allowing her knees to fall open, the woman facilitates the examination.
Time Frame
Typically, the pelvic exam is done at the first prenatal visit, or within the first three months of pregnancy. Delays due to patient preference or a history of normal tests within the past six months don't prove uncommon. A pelvic exam can normally take about fifteen or twenty minutes.
Function
Examining the external genitalia first, the doctor looks for swollen glands, prolapsed tissue, disease outbreaks and the presence of abnormal odor or discharge. Next, she inserts a warm and lubricated speculum into the vagina, noting the color and tone of tissues. When the speculum is opened the caregiver uses a light to examine the cervix, or mouth of the womb, and note its angle and appearance. Cotton swabs culture the cervix and surrounding areas. Preserved in a medium, they'll be used to check for infections. A brush obtains cervical cells for the pap test, which rules out precancerous conditions.
Significance
Removing the speculum, the caregiver inserts two fingers into the vagina and places her non-dominant hand on the woman's abdomen. Pushing the two hands together allows her to judge the size and weight of the uterus, which should correlate with pregnancy dates. She also feels the ovaries for masses and tenderness. According to Anne Frye, author of "Holistic Midwifery", palpating the ovaries is impossible after the first trimester because the expanding uterus carries them upward. Gauging the distance between bones and the general shape of the pelvis give some clues that may predict relative ease of birthing. However, because bands of cartilage that stretch during labor separate the bones of the pelvis, women frequently can birth large babies regardless if they fall short of ideal pelvic measurements.
Considerations
Soren Ventegodt, Medical Director of Quality of Life Research Center in Copenhagen, Denmark, wrote to the British Medical Journal regarding pelvic exams as a traumatic experience, particularly for women who have survived sexual abuse. Physical therapist Penny Simkin and family therapist Phyllis Klaus, authors of "When Survivors Give Birth", assert that pregnancy is a time when a woman may be overwhelmed by repressed memories; her body may remember what her mind forgot. Being flat on her back, with someone standing over her touching her inner thighs, may trigger panic. Caregivers that react with coercion, defensiveness, or dismissal risk reminding women of unpleasant experiences. Instead, Ventegodt suggests slowing down and being attentive during every aspect of the exam, an approach which can improve women's perceptions of the procedure.
References
- "Hollistic Midwifery"; Anne Frye, 1998
- "British Medical Journal", Medicine and the past. Lesson to learn about the pelvic examination and its sexually suppressive procedure, Søren Ventegodt, Feb. 20, 2004
- "When Survivors Give Birth"; Penny Simkin, PT, Phyllis Klaus, MFT, 2004
