Can a gynaecological examination determine how many children a woman has given birth to?

Torill · May 14, 2013

Hello my dearest AW experts, who have helped me so often before :Hug2:

- I have another question.

I know you can tell by a gynaecological examination whether a woman has given birth or not. But can you actually determine whether she has given birth to more than one child? In my story, a woman who has recently given birth to her first child is accused of having given another baby up for adoption five years earlier. This is not true, but in my story, the woman is supposed to have a hard time disproving this.

Is this at all likely? I mean, if a gynaecological examination could determine that no, this woman has given birth to one child only, my plot would sort of unravel at this point. I wouldn't like that - so, if anyone with gynaecological expertise could tell me?

Thanks so much in advance!

mirandashell · May 14, 2013

AFAIK, there is no way to tell how many children a woman has had through a gynae exam. Or any other way.

GeorgeK · May 14, 2013

You'd only be able to make generalized statements that would be circumstancial at best. A nulliparous uterus is unlikely to have a fibroid (leiomyoma). So having a fibroid suggests current or recent pregnancy. Having a calcified fibroid suggests a remote pregnancy. On a physical exam it is unlikely that anyone would notice these, but during a C-Section for one child an OB might notice a calcified fibroid suggestive of a remote previous pregnancy.

Foolproof? No. Like I said, circumstantial.

Torill · May 14, 2013

You really sound like you know what you're talking about, GerogeK. so thanks for taking the time to answer me! But - I'm afraid I don't quite understand the latin. Could you explain in more layman terms?

What I think I understand from your post, is that you wouldn't see anything on an ordinary gyn exam - at least not anything you could use as proof - for that you would need something like a C-Section, and even then it would be only tentative, nothing certain?

melindamusil · May 14, 2013

Disclaimer: Not a medical professional. GeorgeK and some of the other doctors on this forum can give you a better answer than me.

I would imagine that a doctor could maybe tell the difference between a woman who has had just one pregnancy and a woman who has had a very large number of pregnancies (like 10+). However part of that may just be age and gravity.

AFAIK there are no major differences between women who have had only one or two pregnancies. Like GeorgeK said, I can imagine a few medical conditions that might *suggest* a prior pregnancy, but nothing definitive.

Drachen Jager · May 14, 2013

What Melinda said, with the addition, no doctor can give you any kind of certainty. They can say a woman probably had lots of children, probably had a few, or probably hasn't had any, but there are no definitive right/wrong indicators that can tell you anything for absolute certain.

GeorgeK · May 14, 2013

Torill said:
You really sound like you know what you're talking about, GerogeK. so thanks for taking the time to answer me! But - I'm afraid I don't quite understand the latin. Could you explain in more layman terms?

What I think I understand from your post, is that you wouldn't see anything on an ordinary gyn exam - at least not anything you could use as proof - for that you would need something like a C-Section, and even then it would be only tentative, nothing certain?

The only thing you could say based on a normal exam is if the hymen was intact in which case she's obviously never borne a child before. However it is theoretically possible for her to have gotten pregnant and had an early miscarriage while still having the hymen intact. Theoretically, not in practice, that is. Not having an intact hymen pretty much means nothing. They used to think it meant that she was not a virgin, but the hymen is designed to tear easily and vigorous exercise, horseback riding, use of tampons are all things known to potentially tear it. It doesn't hae to be sex.

During a C-Section you open the pelvis and actually see the Uterus which is where leiomymomata aka fibroids form, generally on the outside of the uterus. pregnancy induces them to form but significant hormonal fluxes outside of pregnancy can also perhaps induce them. They are benign muscle tumors. Old ones tend to calcify, so if you see an old calcified fibroid on the uterus it is a strong, but not definitive indication of a prior pregnancy. Some women can form a fibroid with each pregnancy, but most do not and somewhere between many and most women don't form any fibroids ever.

I've known of estranged family members asking about an autopsy report, trying to figure out if their aunt or sister maybe did have a child out there that they didn't know about but invariably the report may or may not mention an old calcified fibroid and then simply say, "No evidence for recent pregnancy."

Now, just like some lawyers are shysters, some accountants are bean counters, some doctors are quacks and you could believeably have some quack say and announce to the operating room during a C-Section when the mother has an epidural and so is awake, "There's an old fibroid on your uterus. How long ago did you have your first baby?" He'd be easily making a wrong assumption, but I could see it happening. I've seen worse wrong assumptions.

wendymarlowe · May 14, 2013

Not a doctor, but I'm guessing there are probably at least a few things which would prove there HAD been a previous pregnancy (C-section scar being one!) but nothing that would prove there had NOT been a previous pregnancy (once the woman had already had another child).

cornflake · May 14, 2013

Torill said:
Hello my dearest AW experts, who have helped me so often before - I have another question.

I know you can tell by a gynaecological examination whether a woman has given birth or not. But can you actually determine whether she has given birth to more than one child? In my story, a woman who has recently given birth to her first child is accused of having given another baby up for adoption five years earlier. This is not true, but in my story, the woman is supposed to have a hard time disproving this.

Is this at all likely? I mean, if a gynaecological examination could determine that no, this woman has given birth to one child only, my plot would sort of unravel at this point. I wouldn't like that - so, if anyone with gynaecological expertise could tell me?

Thanks so much in advance!

Recently, sure, but I don't think that's true in a general sense. I know that's not your question but...

lolchemist · May 14, 2013

I really have nothing more to add except to say wow, that seems extremely intrusive for people to get all up in her vagina like that, literally! I hope she tells them to fuck off!

ClareGreen · May 14, 2013

Fibroids can definitely form without pregnancy. My mother's fibroids tried to kill her before she realised she wanted children.

GeorgeK · May 14, 2013

ClareGreen said:
Fibroids can definitely form without pregnancy. My mother's fibroids tried to kill her before she realised she wanted children.

Right, but historically they didn't always know that and some doctors do their CME courses in Aspen in the winter, instead of Chicago in the winter.

Torill · May 15, 2013

Thank you so much, everyone! I knew I would get help here - this place is the best! Now I can safely keep my plot as is, what a huge relief...

lolchemist said:
I really have nothing more to add except to say wow, that seems extremely intrusive for people to get all up in her vagina like that, literally! I hope she tells them to fuck off!

Oh, the people behind these lies are definitely painted as the bad guys. No worries! Glad that you find it so shocking - it's supposed to be seen as despicable.

Thanks again everyone - much more confident about my project now.

LA*78 · May 15, 2013

A little too late to the conversation, but I was going to say depending on the births a Dr can determine if there has been more than one in some cases, but couldn't prove the opposite (that there hadn't been more than one).
In my personal experience, when I was preggers with my 3rd I had a different Ob. to my first two. He was able to tell I'd had at least 2 from the scarring left from them tearing their way out. My 3rd didn't tear at all, so from examination it could be proven I'd had at least 2, but not necessarily the 3rd.

Torill · May 15, 2013

Thank you for weighing in, LA*78. Yes, what I needed to know is that they can't prove the negative - that there was never any earlier pregnancy. This is what the woman in my story needs to prove. She doesn't need to prove the positive - that she was pregnant before. That's what the bad guys say. So - from what you're all saying, I know my plot works - at least this particular aspect of it. Thanks again, everyone!

shaldna · May 16, 2013

You can also look for other signs such as old stretch marks - they will be pale and white, slightly shiny/transparent compared with new stretch marks which tend to start off as purple/red and take some time to fade.

Also, scarring from previous birth - if she ripped or was cut then she could have some scar tissue that is clearly not related to the current pregnancy.

GeorgeK · May 16, 2013

shaldna said:
You can also look for other signs such as old stretch marks - they will be pale and white, slightly shiny/transparent compared with new stretch marks which tend to start off as purple/red and take some time to fade.

.

However stretch marks can be the result of any rapid weight gain

Paris Love · May 16, 2013

GeorgeK said:
The only thing you could say based on a normal exam is if the hymen was intact in which case she's obviously never borne a child before. However it is theoretically possible for her to have gotten pregnant and had an early miscarriage while still having the hymen intact. Theoretically, not in practice, that is. Not having an intact hymen pretty much means nothing. They used to think it meant that she was not a virgin, but the hymen is designed to tear easily and vigorous exercise, horseback riding, use of tampons are all things known to potentially tear it. It doesn't hae to be sex.

During a C-Section you open the pelvis and actually see the Uterus which is where leiomymomata aka fibroids form, generally on the outside of the uterus. pregnancy induces them to form but significant hormonal fluxes outside of pregnancy can also perhaps induce them. They are benign muscle tumors. Old ones tend to calcify, so if you see an old calcified fibroid on the uterus it is a strong, but not definitive indication of a prior pregnancy. Some women can form a fibroid with each pregnancy, but most do not and somewhere between many and most women don't form any fibroids ever.

I've known of estranged family members asking about an autopsy report, trying to figure out if their aunt or sister maybe did have a child out there that they didn't know about but invariably the report may or may not mention an old calcified fibroid and then simply say, "No evidence for recent pregnancy."

Now, just like some lawyers are shysters, some accountants are bean counters, some doctors are quacks and you could believeably have some quack say and announce to the operating room during a C-Section when the mother has an epidural and so is awake, "There's an old fibroid on your uterus. How long ago did you have your first baby?" He'd be easily making a wrong assumption, but I could see it happening. I've seen worse wrong assumptions.

I think enough non-mothers probably have fibroids that this won't hold up to reader scrutiny.

Before pregnancy the uterus has a different shape than after. Maybe your MC could have medical records from just prior to her pregnancy to show there was no way she had a baby before?

cornflake · May 16, 2013

shaldna said:
You can also look for other signs such as old stretch marks - they will be pale and white, slightly shiny/transparent compared with new stretch marks which tend to start off as purple/red and take some time to fade.

Also, scarring from previous birth - if she ripped or was cut then she could have some scar tissue that is clearly not related to the current pregnancy.

Tons of people have stretch marks - preteens can get stretch marks from growth, people can get them from gaining weight or muscle, it's more about your individual skin than almost anything. Same as how some pregnant women get wicked stretch marks, some get like none.

Chekurtab · May 17, 2013

Torill said:
Hello my dearest AW experts, who have helped me so often before - I have another question.

I mean, if a gynaecological examination could determine that no, this woman has given birth to one child only, my plot would sort of unravel at this point. I wouldn't like that - so, if anyone with gynaecological expertise could tell me?

Thanks so much in advance!

I think you already know you're safe, no one can prove she had another child based on exam. To make things interesting you can put a Pfannensteil incision on her belly. The incision is used for most gynecological procedures including C-section. If she had a vaginal delivery, then the presence of Pfannensteil scar may indicate the previous child birth and serve as a ground for the false accusations.

Just a thought. I hope it will help your plot.

GeorgeK · May 17, 2013

Chekurtab said:
I think you already know you're safe, no one can prove she had another child based on exam. To make things interesting you can put a Pfannensteil incision on her belly. The incision is used for most gynecological procedures including C-section. If she had a vaginal delivery, then the presence of Pfannensteil scar may indicate the previous child birth and serve as a ground for the false accusations.

Just a thought. I hope it will help your plot.

The Pfannenstiel is a nice incision for many Urologic procedures. It's almost impervious to hernias

Torill · May 18, 2013

Thanks for your new thoughts and suggestions Shaldna, Paris Love, cornflake and Chekurtab, and again GeorgeK! I have what I need now - I don't need to go into too many details about medical exams for my plot to work - I just needed to know there wouldn't be a simple procedure the woman could have done to prove the villains wrong. Now that I know there isn't, I can let things be as I have written them already. Huge relief. So, hugs and kisses everybody!

Chekurtab · May 18, 2013

You're welcome. Good luck to you!

Can a gynaecological examination determine how many children a woman has given birth to?

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