Examinations

[Kim__0]

  This is my fifth pregnancy, but I am using a different OB-GYN.  My monthly, and what will soon become twice monthly exams have been very different with this doctor, and I wanted to inquire to see if this is normal.
  First, instead of submitting a urine specimen in a cup each time, the specimen is drawn straight from my bladder using a catheter, which is not painful, but very uncomfortable.  My doctor says that specimens retrieved in the method used previously (in a cup), were not pure, and often misleading.
  My main concern however lies in the examination.  With all other doctors I have always been allowed to wear a gown, which would partially cover my body when other parts of my body were being examined.  At each visit I am instructed to remove all of my clothing, bra and panties included and I am then given a sheet.  While the nurse is inserting the catheter I am allowed to keep my breasts covered, and once she has the urine specimen is collected and the catheter removed, I am allowed to cover my vaginal area.  But once the doctor enters the room for the examination, the sheet is removed and my entire body, breasts and vaginal area are exposed throughout the examination.  He does do a very thorough examination each time, and I have been very pleased with his care but it is highly embarrassing to have ones body exposed during the entire exam.  He checks my breasts and outer vulva and vagina during each visit.  He does not use stirrups as I had been previously used to, which really is much more comfortable, especially when you are pregnant, but the positioning of your buttocks is somewhat more embarrassing.  He bends my knees and spreads my legs apart for each examination, exposing my vulva and vaginal area and doing a complete examination of both.   He also inserts the spectrum into my vagina and opens it up for examination.  After this he does the usual exam by inserting his finger into my vagina, but he also inserts his finger into my rectum, which I do not previously remember.  The exam seems to take quite a while sense he is very thorough, and it is very embarrassing to lie for a long period of time completely unclothed with ones breast exposed and their legs spread, not to mention that I am very cold.
  It has been explained to me by his nursing staff that this procedure for examinination is becomming more and more common due to malpractice and sexual misconduct suits.  To prevent this, no part of the body may obstructed from the view of the doctor, patient or nurse during the exam.  Without reading closely, I signed an agreement in my initial visit that explained the procedure for the examination, so he is very upfront about this.  But some of it seems unecessary and demoralizing to me.  I don't understand why I can't conceal my breasts while my vaginal area is exposed and being examined, and visa versa.  The nurse even weighs you in the nude when she first enters the room, and it is very embarrassing to walk across a room completely naked.
  Have you heard of other doctors who perform examinations in this manner, and is this normal?

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Dear Kim:
The examination you describe is not the standard at this institution or anywhere that I have practiced. The principle of respect for personal privacy and making patients feel as comfortable and "in control" as possible during the examination are the principles that guide most gynecologists.
A breast, vaginal, and rectal examination are not standard and not required at every prenatal visit.
A catheter urine specimen is "cleaner" and has specific benefits when one is concerned about vaginal secretions that give false protein or blood readings or when one requires a urine culture. Otherwise, there is risk of infection each time a catheter is placed.
Since you were informed "up front", the "operating procedures" of this practice are unlikely to be altered. If you are not comfortable with the procedures, switch, even late in pregnancy, to another provider.
Local medical standards are best known to local medical groups. An informal source of information would be the Labor and Delivery nurses at your hospital: they are usually very familiar with local obstetricians and their practices. Ask at the office of another OB/Gyn in your community. Request a copy of the consent you signed and forward this to your city or state medical association, section for obstetrics and gynecology. Forward a copy of the consent to your state medical licencing board. These physician groups and government agencies are consumer advocates and will be pleased to reply to your concerns.
Keywords: examination during pregnancy
This information is provided for education purposes only and is not a medical consultation.