Chapter 20: The pelvic exam
The bimanual exam(2-hand exam)
Feel the womb with 2 hands to check for infections or growths, or to learn how
long a woman has been pregnant. To feel the womb, you will need:
very clean or sterilized
water-based lubricating jelly
like K-Y Jelly, or clean water
(do not use oil or
Ask the woman to urinate before you start.
1. Have the woman lie on her back with a
pillow under her head. As you examine
her, explain everything that you are
going to do before you do it,
remind her to relax, and stop
the exam if she is in pain.
2. When the woman is ready, put on
gloves and put some lubricating jelly on
the first 2 fingers of your right hand (or your
left hand if you are left-handed).
Ask the woman to take a deep breath to help her relax.
Gently open the lips of her genitals with your left hand.
With the palm of your right hand facing up, put your
two lubricated fingers all the way into the woman’s
3. Feel the cervix with your fingertips.
The cervix should be firm, round, and smooth. Normally, it feels about as
hard as the tip of a nose. In the last months of pregnancy it feels soft, like
lips. Sometimes at the end of pregnancy the cervix is a little open. If the
woman has just had a miscarriage or an abortion, her cervix might be open.
The cervix can be hard to find. If you cannot feel the cervix, ask the woman to
cough or push down as if she were passing stool until the cervix touches your
finger. It may also help if the woman lies more flat.
Take care not to touch the woman’s clitoris, which is sensitive, or her anus,
which has germs on it. Your thumb can easily touch the clitoris accidentally,
so keep it to one side.
A Book for Midwives (2010)