When do I have to have an internal?

There are a few reasons why vaginal examinations (internals) need to be done. They are only done when it is necessary and the reason will be explained to you at the time.

Although they can be uncomfortable they shouldn’t be painful. The best thing you can do is try to relax and let the midwife, or doctor, find the information she needs as quickly as possible.

In pregnancy
If you have problems in your pregnancy such as:

• you think your waters have gone but your baby isn’t due yet
• you are having abdominal pains
• you think you may have an infection
• you are bleeding

you may have to have what is called a speculum examination.

A speculum is a sterile instrument that is inserted into your vagina and opens the vagina so that the midwife, or doctor, can see the cervix (neck of the womb). The same instrument is used for a cervical smear. Depending on the reason for the examination, a swab (like a long cotton bud) may be used to gently swab the area.

Only when we know that we will not be causing possible harm to your baby would we do a vaginal examination with our fingers. This digital (with fingers) examination may need to be done after the speculum examination, but not always.

In labour
Internals are often done in labour to check how labour is progressing. We need to know this to be able to care for you and your baby properly. Sometimes we can tell what’s happening by how you are responding to the contractions and how well your baby is coping, but there may be a time when we need to check the progress; perhaps to offer pain relief safely or to plan ahead.

We do an internal by wearing sterile gloves and inserting the index finger and middle finger into the vagina. In this way we can feel how hard the cervix is, whether it is getting shorter and if it is dilating (opening). We can also tell whether your baby is head or bottom down, and which way he is facing. Finding this information takes a little time but it is all relevant.

If you are worried about internals have a word with your midwife, who will be able to reassure you.