Hesperian Health Guides

Chapter 19: Advanced skills for pregnancy and birth

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HealthWiki > A Book for Midwives > Chapter 19: Advanced skills for pregnancy and birth

Vaginal exams during labor

a midwife speaking while she uses gloved hands to examine a woman.
Your cervix is still closed. You've been in labor for 12 hours with no change. I think it's time to go to the hospital.
A vaginal exam can help you decide when to get medical help.

Most women’s labors progress normally, and usually, there is no need to do a vaginal exam. But a vaginal exam can be useful because it is the most sure way to know if labor is progressing normally. An exam can show you how open a woman’s cervix is and whether the baby is breech or head first.

Vaginal exams have risks, so only do one when it is truly necessary.

WARNING!    Any time you do a vaginal exam, even when you have washed your hands and are wearing gloves, you risk passing harmful germs to the woman in labor. For this reason it is best to avoid vaginal exams if all is going well.

  • Never do a vaginal exam after the waters break unless it is late in labor or there is an emergency. The risk of infection is great.
  • Never do a vaginal exam if the mother is bleeding from the vagina.

How to do a vaginal exam

It is difficult to describe how to do a vaginal exam in a book. Vaginal exams are best learned by practice. Be sure to have an experienced person teach you before you try doing one yourself.

  1. Explain to the woman what you are going to do and why.
  2. Have the woman rest on her back with her legs bent and open.
  3. Wash your hands well with soap. Put on sterile or very clean gloves.
  4. Gently put 2 fingers into the mother's vagina. If she is in early labor, you will usually have to reach inside almost as far as your fingers will go to find the cervix. If the woman is in late labor, the cervix may be pushed closer to the outside by the baby's head.
  5. Feel the cervix.

    If the cervix is closed, it feels long and firm, like your nose. As the cervix begins to open, it gets more flat. The opening cervix feels like open lips stretched over the baby's round, hard head.
    illustration of the above: 2 gloved fingers inside the vagina.
    MW Ch19 Page 340-2.png
    MW Ch19 Page 340-3.png

    The baby's head will feel hard behind the cervix. If you feel something soft behind the cervix, the baby may be breech (bottom first).

    MW Ch19 Page 340-4.png

    Sometimes, near the end of labor, the cervix is almost open enough but there is a little bit of cervix left on one side. It is best to wait until the cervix is gone for the mother to start pushing.

    When you cannot feel the cervix at all, it is completely open. It is now safe for the mother to start pushing.

a midwife and a woman in labor speaking during a vaginal exam.
The cervix is completely open — now it is safe to push.

This page was updated:11 Sep 2019