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Thursday, 16 February 2017

Knocked up....now what? Cervical Examinations

Cervical exams used to be a routine procedure in Western practises for the later stages of pregnancy (normally from 36 weeks) I therefore, rightly or wrongly, questioned whether it was something routinely practised here in Thailand.

I am only 28 weeks pregnant myself, and have so far only had to drop my pants for vaginal ultrasounds in the early stages of my pregnancy, but my doctor has advised that she will discuss birthing options with me from 36/37 weeks as I may have a ‘big baby’ on the way. At 36 weeks is about the time when she may be likely to routinely check my cervix and I’m conscious that my Ob/Gyn may use this method to help her make decisions about my birthing choices. But,

  • Is it really necessary?
  • Are there benefits to this procedure?
  • Are there disadvantages to this procedure?
  • Are there alternatives to this procedure?
  • Could/should I decline this procedure?

Firstly, having researched mums experiences in Thailand it seems that my fears are not unfounded. Mums do give accounts of simply being told, not asked, by Doctors that a cervical exam is required. So,

Is it really necessary?
After speaking with experienced birthing professionals here in Thailand and looking at evidence based resources it appears to me to be clear that under NORMAL CIRCUMSTANCES IT ISN’T NECESSARY. Of course, there may be extenuating circumstances and you must always listen to your healthcareproviders, but generally speaking there are other ways to check on the progress of your pregnancy and baby, that are far less intrusive.

Are there benefits to this procedure?
I haven’t really been able to get a good answer to this. I’m sure some Doctor’s may tell you that they can better feel, and understand, the progress of your pregnancy if they carry out this procedure, and of course if it is a medical necessity (for a particular reason, not just because its procedure) there would be a benefit, but no one I have contacted or any resource I have read suggests that there is a particular benefit to having a routine cervical exam (at least not before 41 weeks where an argument could be made for having a more thorough check on things up there or a membrane sweep – again a topic for another day)

Are there disadvantages?
Some people, and studies, do suggest that cervical examinations can increase the chances of going into early labour. This is likely linked to a chance of member sweeping at the same time, either proactively or by accident. But recent studies have also shown that a routine physical exam done properly should not affect your pregnancy or birthing progress. Of course, this does not take into account any psychological disadvantages that individuals may need to consider. Not everyone is, or will be, comfortable with someone carrying out this type of personal examination, and it is very important to factor in your psychological needs as well as physical needs (yours and baby’s) at such a stressful, and lets face it - hormonal, time.

Are there alternatives?
Yes, NORMALLY THERE ARE ALTERNATIVES. Again from looking at evidence based resources, an experienced Ob/Gyn should not need to intrusively poke around to work out where, or how, your baby is lying at any given time. They can feel positioning through your stomach and see it via ultrasound.

Could/should I decline this procedure?
If you are comfortable with the procedure, have considered the possibility of it affecting the progress of your pregnancy and how you would feel about that, then there appears to be no reason to decline the procedure if your Ob/Gyn happens to be old fashioned and wants to carry out such an exam.

However, there appears to be very little reason to have such a procedure (other than exceptional circumstances, when you must always listen to your healthcare provider) so therefore little reason why you should simply just accept to have it.

What I mean is, unless my Ob/Gyn can give me a valid reason then I think I will leave my knickers on and politely say no if she suggests it.

I have recently been raising more, polite, queries with my Ob/Gyn and have been politely declining some things, for example I declined yet another HIV and Syphilis test and also a routine urine test, as there seemed little indication that these were medically required at the time, so I figured it was simply a routine way of the hospital to make money, something I am getting wiser to.

But ladies, it is very very important that you do not simply take my word for any of this, I am not medically trained in anyway, and this wriggling worm inside me qualifies me for very little (other than maybe winning a competition for who has the weakest bladder in my household). So I urge you to get informed, to ensure that you give true consent to any, and all, procedures carried out to you and your baby.

I recently watched this You Tube clip from Evidence Based Birth about this very subject 

I would highly recommend watching it to prepare yourself in case your Ob/Gyn in Thailand does try to, or suggest, routine cervical examinations.

Get Informed, give True Consent!

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  1. Its so different having a paid for healthcare as obviously I just accepted everything going but you seem to have your head screwed on right and are doing what is important for you and wriggly worm.
    Thanks for linking to #ablogginggoodtime

    1. I think you hit the nail on the head - so often it comes down to having a paid or unpaid healthcare system, and unfortunately it can rule so many decisions that healthcare providers make, or choices they choose to give. I hear such bad press about the NHS at the moment, but can't help wishing I was back home sometimes using UK midwives, but I know our little one will have many many different experiences and if I try to keep my head screwed on it will all be alright! Thanks so much for your comment.

  2. Its really interesting getting a different countries perspective and you sound like you are really researching and looking into decisions you make so you are in charge of your body and your pregnancy. I just went along with everything as a first time mum but when I have my second I want to be able to challenge things more and ask for things I think I need. Thank you for linking to #stayclassymama xx

  3. I started off the same as you and was going along with stuff, which I think is what we all do hun. It was only when I discovered that the same things were appearing on my bill over and over again, like HIV tests, which I knew were pointless and simply just to make money for the hospital, that I started to take more notice and now I love researching everything, it's making me feel so much more empowered during the pregnancy. Thanks so much for the comment!