Vaginal Examinations: What They Are, What They’re Not, and Why You Can Say No

9 May

When we picture labour, most of us imagine this: a hospital room, a bed, and someone checking “how many centimetres you are.”

It’s such a normalised image that many people assume vaginal examinations (VEs) are just part of the deal—something that has to happen during labour.

But here’s the truth that should be shared more openly:

Vaginal exams are not compulsory.
Not at 4cm. Not every 4 hours. Not at all, if you don’t want them.

They are a choice—and like any choice in labour, you deserve to understand the full picture so you can make the right decision for you.

🤔 So What Is a Vaginal Exam?

A VE is when a midwife or doctor gently inserts two gloved fingers into your vagina during labour to assess:

How open (dilated) your cervix is
How soft and stretchy (effaced) it has become
Its position (anterior, posterior, central)
Baby’s position in the pelvis and how low their head is

It’s usually recorded on a chart (the “partogram”) and used to assess whether your labour is progressing at the expected rate.

🧠 But Here’s What Most People Don’t Know:

A vaginal exam is only ever a snapshot.
It tells us what your cervix is doing in that moment. It doesn’t tell us:

How long your labour will last
How quickly your cervix will change next
Whether your baby will be born soon
If anything is “wrong”

Labour isn’t predictable or perfectly linear. Someone can go from 4 to 10cm in an hour—or stay at 6cm for hours and then suddenly give birth minutes later.

Your body isn’t a factory, and your cervix isn’t a progress bar.

So when decisions are made purely based on centimetres—like starting a hormone drip because you’ve “stalled”—it’s not always in your best interest.

⚠️ What Are the Downsides of VEs?

While vaginal exams can sometimes be clinically helpful (we’ll get to that), it’s important to be aware of the potential risks and drawbacks:

Increased stress and adrenaline
If you’re told you're “not progressing,” it can trigger fear and frustration—two things that suppress oxytocin and can actually slow labour down.
Emotional impact
For many people, VEs can be triggering, especially if they’ve experienced sexual trauma, vaginismus, or pelvic pain.
Physical discomfort
VEs aren’t usually painful when done gently, but they can be uncomfortable, especially during a contraction or if performed repeatedly.
Infection risk
The more VEs you have—particularly after your waters have broken—the higher the risk of introducing infection.

🩺 Are There Times When a VE Might Be Helpful?

Yes. Vaginal exams can be helpful when:

There’s concern about baby’s position (e.g. if your labour is very long or irregular)
You’re considering pain relief and want to weigh up options based on how far along you are
There’s a medical decision to be made, and the result would guide that decision

But that’s the key: it should only be done when the information matters to you and would change something you want to do.

🔄 Are There Alternatives?

Yes! Skilled midwives often use external signs to assess labour progress:

How you move, vocalise, or breathe
The “purple line” or “rumpel line” (a discolouration that moves up the buttocks)
The pressure you feel in your pelvis
How your body behaves during contractions

Some of the most accurate cues come from you—your instincts, your rhythm, your gut feeling that something is shifting.

🗣️ But What If I’m Pressured Into One?

Unfortunately, many women are. The language used in hospitals can feel more like a command than a conversation:

“Let’s just check you.”
“Time for your next exam.”
“We need to see how you’re progressing.”

But unless there’s a true emergency, you always have the right to say:

“No, thank you.”
“Can we wait a little longer?”
“I’d like to understand why this is being recommended.”
“What would happen if we didn’t?”

Consent is not a tick box. It’s an ongoing, informed conversation.

If you don’t want a VE, that decision must be respected—without coercion, guilt, or judgment.

💬 So What Should I Put in My Birth Plan?

Your birth preferences are a great place to set expectations around VEs. You might want to include something like:

“I decline routine vaginal examinations. I am open to discussing one if a clinical reason arises.”
“I would prefer external signs of progress to be observed first.”
“Please always ask for my consent and explain the reason before suggesting a VE.”

Setting this tone early makes it easier to uphold your boundaries later—even when things feel intense.

🌟 Final Thoughts

You can absolutely have a positive, supported birth without ever having a vaginal exam.

You can also choose to have one—or several—if they feel right and helpful in the moment.

There’s no gold star for declining. And no shame in accepting.

But what matters most is this:
That you knew it was your choice.
That you understood the pros and cons.
And that you were never made to feel like your consent didn’t matter.

Because this is your body.
Your birth.
And you are in charge.

If you found this helpful, feel free to share it with someone else who’s preparing for birth—and if you want to go deeper into birth rights, informed decision-making, and advocating for yourself during labour, we dive into all of this (and more) inside the Every Birth Education course.

You're not just giving birth to a baby—you're stepping into your power.
And that starts with knowledge.

mariah howgill