What is normal practice at OB/GYN during pregnancy?

Family, Education, Health and Pets
1
Hi all,

I am currently 7.5 months pregnant and followed by an OB/GYN in Cham, ZG. He seems very knowledgeable and has been a great doctor as far as I can tell. I had my daughter in the US and I must say that practices are much different here in Switzerland.

Over the past week or so, I have started to feel a bit different and I just wish the doctor would do physical exams. In 7.5 months, he has never checked my cervix or for dilation etc. In the US, come 6 months, very regular physical exams were performed. My mom, who is a doctor and mother of 5 children assured me that, in France, physical exams happened at every appointment. In Germany, my sister in law said that she had many as well... Can someone let me know of their Swiss experiences? Is it normal to have not been checked yet?

Thank you for all the help!

2
Can you not just ask the doctor to do it?

(Genuine question!)

3
In my experience there is less intervention here. My doctor did most checks by ultrasound not physical exams. He monitored baby, growth rates, heart rates, and cervix all by ultrasound. Of course there were some blood tests and the like as well, but nothing physical. I think only the midwife did a physical check of the cervix during the birth process.

4
I am trying to figure out if it is normal practice or not. If most women tell me that it is normal NOT to have it done during regular check-ups, I will ask my doctor to see me for it. If most women say that they had physical exams done while being pregnant as part of normal care, I will look into a different doctor as I would assume I am not receiving optimal care from this OB/GYN. In my case, I have been complaining of very frequent contractions, extreme fatigue and feeling the baby low, all symptoms that should require an exam. I want to make sure I am in good hands before he attends the birth of my child....

5
Important question: Do you have ultrasounds at every appointment? Then he can definitely see the state of your cervix. Actually, if you have contractions, it is probably best not to do any manual exams.

In my case: I am approaching my 37th week, and my last manual check of my cervix was in the 32th week. I had another appointment last week (36th week), I had nothing to report, and the doctor was happy. Apart from taking samples for checking for streptococcus, no other exam was performed. In and out in 15 minutes max.

(This is at Unispital, Zurich, I only have Grundversicherung.)

6
Hi Laura, do you have a midwife ? To check for contractions and the babys heartbeat was my midwifes method to ensure all was ok. I was also told to go to hospital if my baby stopped moving as much or started moving a lot in an unusual way for my pregnancy. If you have any worries at all you should be able to see someone who can check you out and make sure everthing is ok.

Its possible your contractions could be Braxton Hicks - practise contrations before the real ones start.

My birth experienced were in the UK but I didnt have any internal exams until I was in established labour in the hospital.

If your worried I think then being monitored by those machines where they listen to the heartbeat and also pick up the contractions might put your mind at rest a little. Also less intrusive than an internal examination which can be uncomfortable.

7
I try to remember but I think everything was made by ultrasound. Also when I had early contractions. Remember my doctor was on holiday and the sub made ultrasound saying my cervix was shortened while my regular doctor when back claimed it was not. Went full term in the end :-)

I dont understand why you would even consider changing doctor this late if you've been happy so far.

8
Thanks for all the help. So you did have a manual check around 32 weeks, which seems like normal practice in any other European country and the US too. I have not had any manual check yet, which worries me a bit. I do get an ultrasound performed every time I see the doctor though, but was told by my mom's OB/GYN that only the vaginal ultrasounds would show cervix, not the normal abdominal ones..

I know those contractions are Braxton-Hicks, as I also had quite a few with my daughter but I did have 4 painful contractions (can't mistake those as it took me right back to labor memories ) last month. I just feel odd that nothing has been checked yet...

@Tryintolikech - congrats on the upcoming birth! Good luck to you, enjoy your little bundle! If this is your first one, believe me and try to sleep as much as you can until he/she gets there. It could be a while until your next full night of sleep

9
If you are having real contractions, then this should be monitored. Near the end of pregnancy, i.e. from about 34 weeks, it was standard procedure by my doctor to be hooked up to these straps that monitored contractions and fetal heartbeat. By no means was it physical or interventional, just laying down and strapped up to this machine for about 15 minutes. But I was monitored. However, cervix length was measured by ultrasound.

10
I should have clarified that I did have a manual check, but no ultrasound (I guess because I am with Grundversicherung and healthy, they don't do scans at every appointment). Also, during my last (abdominal) ultrasound I remember the doctor saying that the cervix looks ok. I bet they can at least see the length of the cervix...?

Thank you very much

11
I never had any manual checks during either of my pregnancies that I remember & both of those were high risk. I did have a lot of ultrasounds though. If at any time you are worried you can go to the maternity unit of your nearest hospital to be checked out or monitored. I did this when I started having early contractions and my blood pressure went up (again). They will always be willing to help you & put your mind at rest, I would only suggest you trust your instincts on this & if you feel you need it then go.

12
Thank you Lou, that is very helpful! I guess this is just the way of doing here in Switzerland then! I am actually visiting the maternity ward tonight and talking with a midwife while there, so I will see if someone can maybe check me!

13
If I recall correctly, my Mrs had regular "full" checks during pregnancy, especially in the last trimester.

However, it is possible that this was because she had c-sections for the first couple, so by the time #3 and #4 came along, they wanted to keep close tabs on any scar issues.

14
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15
I think the take home message is that different OBS/GYN throughout CH have different opinions on the necessity and frequency of internal examinations.

16
From what I understand an internal exam tells the doctor nothing, or next to nothing.

If you feel that you are having contractions, then you can go to the hospital and they will put a monitor on and check.

I seem to remember reading that the risk of infection to the mother probably outweighs any useful information that a doctor may get from an internal exam, and in fact, if you waters are broken or there is the chance of premature labour, an internal exam should be avoided.

What do you expect the internal exam to tell you ? I have three children and chose to have midwife&GP care rather than an obstetrician, and I did not have internal exams through any of my pregnancies.

My second pregnancy, I was part of a study to look at the usefulness of routine urine testing and weighing of the mothers, and by the third pregnancy, 5 years later, the hospital had stopped doing those as 'routine' either - they found from their research (it was a very big maternity teaching hospital) that urine infections and weight loss issues were screened effectively by simply asking the mother if she had noticed any pain, stinging or tingling sensations when urinating, and the mothers were certainly well-aware if they had lost or gained weight, and either way, making mums feel embarrassed for weight gain did not achieve anything, and gestational diabetes was screened for with a glucose-tolerance test.

Anyway, either way, I think you will find that internal exams were 'routine' 20 years ago or 50 years ago, but not now, and as pointed out, with fetal heartbeat monitors, contraction monitors and ultrasound, there's nothing to be gained from the internal exam, and plenty to be lost if it an invasive experience for the mother, causes premature labour, or introduces an infection...

17
I went through two pregnancies here in CH. My OB does an ultrasound each month, but only two are the long 'official' ones where she spent 30 minutes looking closely at every organ and body part. The others were just to check the size of the uterus and that stuff.

In my second pregnancy I had numerous contractions, so she checked my cervix via an endo-vaginal ultrasound. She never checked it otherwise.

I gave birth at the CHUV, and they check your cervix for your last appointment there, close to your due date.

I would say it's not standard here to check the cervix every month, except if there's a good reason to do it, such as contractions.

18
We are just going through pregnancy no. 2 in Geneva, with a very experienced/respected gynaecologist, and he doesn't do any manual checks as he can clearly see the length of the cervix on the ultrasound scan (he measures it each time and explains what it is on the screen). He is known to be excellent at doing ultrasounds, but it doens't look too difficult to find.

He also monitors heart beat etc on the ultrasound to check that the baby is doing OK.

I guess it depends on who confident your gynaecologist is with ultrasound - I know in other countries (UK and NZ at least) you get a lot less scans, so they will probably have to rely on more manual checks.

In your situation I would start by talking to your current doctor and ask him to explain what checks he is doing. If you aren't happy then you can always try someone else. In any case, best of luck!

19
As far as I remember, when I had my first kid (2 years ago) in Basel my doctor did only ultrasound checks. I was very happy with her. The manual checks were only done in the hospital durinig labor. I think in Switzerland in general they take a more relaxed approach towards pregnancy (which I liked)

A friend of mine had some tough contractions in the last trimester and she went for checks in the University Hospital in Basel and they did all kinds of tests, so if it would make you more relaxed you can as well visit the hosital in your place.

Good luck!

20
I am not a Gyn/Obstetrician, but I helped 15 babies into this world during med school, and accompanied my wife on several occasions during her pregnancies, including the last one here in Switzerland.

A pelvic exam is usually done to get an idea of your internal organs, whether it is painful or not, and to obtain cell samples of your cervix, to exclude or diagnose cervix cancer (using a PAP smear). Regarding pregnancy, your doc should have done at least one pelvic examination to exclude any obvious abnormalities that would have an impact on your pregnancy.

However, after that initial examination, the value of additional pelvic exams is in my view quite limited. Your pregnancy significantly changes the anatomy down there, so it is extremely difficult to separate the "normal" pregnancy changes from whatever real pathological change may happen. This is why current echo's are so useful, because with the imaging, you can actually see if any change is due to the pregnancy or not.

Also take into account that here in Switzerland, a pelvic examination is considered quite invasive with a moderate to large impact on the patient. No Gyn here will shy away from it, but at the same time they have a healthy reluctance. As in any country, in academic hospitals there will be more of these examinations as compared to private practices, due to the learning curve of the MD's in training.

Things are different if you actually have complaints down there. Itching or pain can point to an infection, which may need another pelvic examination to fully diagnose. An abnormal weakening of the vaginal walls (prolaps) should also be "investigated" with a pelvic exam. These are just some examples.

During labour, pelvic exams are performed more frequently in order to measure the opening of the cervix. For example, if despite hours of contractions, the cervix does not open up, this may be an indication of a problematic delivery, which means considering a C-section. Most of the time, the cervix can be "observed" to smoothen out and open up over a specific time period of several hours to a day, and at the end (once there is approximately 10cm opening), you will deliver your baby.

I would strongly suggest you voice your worries directly to your Gyn. First tell him or her about your worries. If you worry about specific diseases, ask directly about it, and ask what the Gyn can do to detect / prevent / and treat these conditions.

Hope this helps.