What Happens at a Well-Woman Visit With a Midwife?

Author: Igel Cudiera

Many people think of midwives only in connection with pregnancy and birth. Midwives also provide routine reproductive and gynecologic care, and a well-woman visit is one of the most common reasons to see one. This guide walks through what usually happens, which parts depend on your age and history, and how to get ready.

Key Takeaways

• A well-woman visit is a preventive visit. Screening, counseling, and immunizations are based on your age and risk factors, so no two visits are exactly alike.
• The American College of Nurse-Midwives (ACNM) describes gynecologic health, sexual and reproductive health, and family planning, including preconception care, as part of midwifery care.
• The American College of Obstetricians and Gynecologists (ACOG) recommends pelvic exams when your medical history or symptoms call for one, or if you prefer to have one. The decision is shared between you and your provider.
• Cervical cancer screening follows set intervals, so you may not need a Pap or HPV test at every visit.
• Under the Affordable Care Act, insurance plans must cover at least one well-woman visit a year at no cost to you, though coverage can vary.
• You can ask questions, ask to stop, or decline any part of the exam.

What Is a Well-Woman Visit?

A well-woman visit is a routine preventive checkup focused on your overall and reproductive health. ACOG describes it as a visit that should include screening, evaluation and counseling, and immunizations based on age and risk factors. The Women's Preventive Services Initiative (WPSI) recommends at least one preventive care visit per year, beginning in adolescence and continuing throughout life, and notes that the services you need are determined by your age and risk factors.

The U.S. Office of Disease Prevention and Health Promotion (ODPHP) lists three main goals for the visit: documenting your health habits and history, getting a physical exam, and setting health goals. It also notes that the visit is usually done by an obstetrician or gynecologist, a midwife, a nurse practitioner, or another health care professional with training in women's health.

ACOG also points out that some parts of the visit, such as cervical cancer screening, may not be needed every year, while the visit itself still is.

Can a Midwife Provide Your Well-Woman Care?

Yes. ACNM's definition of midwifery includes care during pregnancy, childbirth, and the postpartum period, as well as sexual and reproductive health, gynecologic health, and family planning services, including preconception care. ACNM also notes that midwives provide primary care from adolescence throughout the lifespan.

In New York, Education Law Section 6951 defines the practice of midwifery to include primary preventive reproductive health care of essentially healthy women. The same law requires midwives to have collaborative relationships that provide for consultation, collaborative management, and referral to address the health status and risks of their patients.

Birthing Center NYC states that its practice is staffed by midwives, that it performs routine pelvic exams and Pap smears and reviews lab work, and that when something falls outside its scope, it refers patients to specialists and helps coordinate their care. You can read more about well-woman and gynecologic care at our practice.

What Happens During the Visit, Step by Step

1. A Conversation About Your Health

ACOG calls a comprehensive history one of the most important parts of a well-woman visit. Expect questions about symptoms, medications, allergies, and your medical, surgical, family, social, and gynecologic history, including reproductive, sexual, and mental health. Birthing Center NYC describes the first appointment as mostly conversation about your health history, what brought you in, and what you want from your care.

2. Blood Pressure and Other Basic Checks

The U.S. Preventive Services Task Force (USPSTF) recommends screening adults 18 and older for high blood pressure with an office blood pressure measurement. ODPHP notes that the physical part of the visit may include measuring your height and weight along with other checks.

3. A Physical Exam Based on What You Need

ACOG recommends that pelvic and breast exams be performed when indicated by your medical history or symptoms. ODPHP describes the exam as something done if you are comfortable with it. If an exam is part of your visit, your midwife can explain each step before it happens.

4. Screenings for Your Age and Risk Factors

Depending on your age and history, your visit may include screening for cervical cancer, sexually transmitted infections, depression, or other conditions. These are described in more detail below.

5. Counseling and Planning

This part of the visit covers whatever matters to you right now. WPSI describes contraceptive care as including screening, education, counseling, and provision of contraceptives. ACOG encourages discussing a reproductive life plan, so that the care you receive fits your current and future plans for pregnancy. Your midwife can also review which immunizations may be recommended for your age and health history.

Understanding the Pelvic Exam and Pap Test

Do You Always Need a Pelvic Exam?

No. ACOG recommends pelvic exams only when you have symptoms or a medical history that requires one, and says that you and your provider should make the decision together. ACOG adds that a pelvic exam may also be done if you prefer to have one. It also notes that a pelvic exam is not necessary before starting most forms of birth control, other than an intrauterine device (IUD), or to screen for sexually transmitted infections.

What Happens During a Pelvic Exam?

ACOG explains that a typical pelvic exam lasts only a few minutes. It can include a look at the outside of the genital area, a speculum exam, in which a tool gently holds the vaginal walls open so the vagina and cervix can be seen, and a gloved-hand exam to feel the reproductive organs. If you need cervical cancer screening, a Pap or HPV test is done during the speculum part of the exam.

How Often Do You Need a Pap or HPV Test?

Cervical cancer screening follows set intervals. The current USPSTF recommendation is:

• Ages 21 to 29: a Pap test (cervical cytology) every 3 years.
• Ages 30 to 65: a Pap test every 3 years, an HPV test every 5 years, or both together (co-testing) every 5 years.

ACOG's patient guidance adds that screening starts at age 21 regardless of when you start having sex, and that HPV self-collection kits are approved for use by women age 25 to 65. The USPSTF has noted that this topic is being updated. Your midwife can tell you which test and schedule apply to you based on your age and past results.

To help avoid inaccurate results, ACOG suggests avoiding douching, vaginal sex, and vaginal medications or hygiene products for 2 days before a Pap or HPV test.

Your Comfort and Consent

You stay in control of your exam. ACOG states that your provider should always ask permission before touching you, and that you can ask to stop the exam at any time. ACOG also notes that you may want a partner, friend, or family member in the room, and that there may be a chaperone present. Birthing Center NYC states that nothing is done without your consent and that you can decline any part of the visit.

Which Screenings Depend on Your Age and Risk?

Not every screening applies to everyone. Current USPSTF recommendations include:

• Breast cancer: a screening mammogram every 2 years for women age 40 to 74.
• Chlamydia and gonorrhea: for sexually active women 24 and younger, and for women 25 and older who are at increased risk.
• HIV: for adolescents and adults age 15 to 65, and for people outside that range who are at increased risk.
• Hepatitis C: for adults age 18 to 79.
• Hepatitis B and syphilis: for people at increased risk of infection.
• Depression: for adults, including pregnant and postpartum people.
• Intimate partner violence: for women of reproductive age, including those who are pregnant or postpartum.

Your midwife can talk with you about which screenings apply to you and where any tests or imaging, such as a mammogram, will be done.

Well-Woman Care Through Different Stages of Life

Well-woman care is not only for people planning a pregnancy. ACOG states that periodic well-woman visits are appropriate and necessary for perimenopausal and postmenopausal women as well. Birthing Center NYC notes that its patients include women who are not pregnant and have no plans to give birth with the practice, and that virtual consultations are available for many concerns, although some visits require an in-person exam.

Planning a Pregnancy?

A well-woman visit is a natural time to talk about pregnancy plans. ACOG describes a prepregnancy checkup as the first step in planning a healthy pregnancy. The USPSTF recommends that anyone planning to or able to become pregnant take a daily supplement containing 0.4 to 0.8 mg (400 to 800 mcg) of folic acid.

If you do become pregnant, you can learn more about our midwifery services, what to expect at your prenatal appointments, and the prenatal tests and screenings offered during pregnancy.

How to Prepare for Your Visit

• Your insurance card.
• A list of medications and supplements you take.
• Recent lab or imaging results, if you have them.
• Your medical and family health history, which ODPHP suggests gathering before the visit.
• Notes on any concern you want to discuss, including when it started and what makes it better or worse.
• Your questions, such as the ones listed below.

The first three items are what Birthing Center NYC asks patients to bring. If your visit may include a Pap or HPV test, keep ACOG's 2-day guidance above in mind.

Is a Well-Woman Visit Covered by Insurance?

ODPHP explains that, under the Affordable Care Act, insurance plans must cover at least one well-woman visit a year at no cost to you. HealthCare.gov lists well-woman visits and contraception among the preventive services for women that are generally covered at no cost when provided by an in-network provider, while noting that coverage may vary and that $0 cost is not guaranteed in all cases.

Birthing Center NYC operates out-of-network with most insurance plans, so it is worth taking a moment to check your coverage before your visit.

Questions to Ask Your Midwife

1. Which screenings do you recommend for me at this visit, and why?
2. Do I need a pelvic exam today, and what will it involve?
3. Am I due for a Pap or HPV test, and which test is right for me?
4. Which birth control options fit my health and plans?
5. Am I due for any vaccines?
6. Should I start a folic acid supplement?
7. Where will any lab tests or imaging be done?
8. When and how will I get my results?
9. When should I schedule my next visit?

Frequently Asked Questions

Can a midwife do a Pap smear?

Midwifery care, as defined by ACNM, includes gynecologic health, and ACNM notes that midwives conduct physical examinations and order and interpret laboratory tests. Birthing Center NYC states that it performs routine pelvic exams and Pap smears.

How often should I have a well-woman visit?

WPSI recommends at least one preventive care visit per year, and ACOG states that women should have well-woman care at least once a year, whether or not a pelvic exam is performed. Some screenings within the visit, such as cervical cancer screening, follow their own schedule.

Do I need a pelvic exam to get birth control?

For most methods, no. ACOG states that a pelvic exam is not necessary before starting or prescribing birth control, other than an IUD.

Can I see a midwife for well-woman care if I am not pregnant?

Yes. ACNM's definition of midwifery includes gynecologic health and family planning, and Birthing Center NYC states that its patients include women who are not pregnant and have no plans to give birth with the practice.

Taking the Next Step

A well-woman visit is built around you: your history, your questions, and your plans. Bring your list, ask about anything that is on your mind, and remember that you can take each part of the visit at your own pace.

Sources and References

• Well-Woman Visit, Committee Opinion No. 755 and The Utility of and Indications for Routine Pelvic Examination, Committee Opinion No. 754. American College of Obstetricians and Gynecologists.
• Pelvic Exams, Cervical Cancer Screening, and Good Health Before Pregnancy: Prepregnancy Care. American College of Obstetricians and Gynecologists.
• Definition of Midwifery and Scope of Practice of Certified Nurse-Midwives and Certified Midwives. American College of Nurse-Midwives.
• Midwifery Laws, Rules and Regulations: Education Law Article 140. New York State Education Department, Office of the Professions.
• Cervical Cancer: Screening and Breast Cancer: Screening. U.S. Preventive Services Task Force.
• Chlamydia and Gonorrhea: Screening, HIV Infection: Screening, Hepatitis C Virus Infection: Screening, Hepatitis B Virus Infection: Screening, and Syphilis Infection in Nonpregnant Adults and Adolescents: Screening. U.S. Preventive Services Task Force.
• Hypertension in Adults: Screening, Depression and Suicide Risk in Adults: Screening, Intimate Partner Violence and Caregiver Abuse: Screening, and Folic Acid Supplementation for the Prevention of Neural Tube Defects. U.S. Preventive Services Task Force.
• Well-Woman Preventive Visits and Contraception. Women's Preventive Services Initiative.
• Get Your Well-Woman Visit Every Year. MyHealthfinder, U.S. Office of Disease Prevention and Health Promotion.
• Preventive Care Benefits for Women. HealthCare.gov.

About the Author

Igel Cudiera

Igel Cudiera wrote this article for Birthing Center NYC. It draws on guidance from the American College of Obstetricians and Gynecologists, the American College of Nurse-Midwives, the U.S. Preventive Services Task Force, the Women's Preventive Services Initiative, and the other sources listed above.

This content is intended for educational purposes only and does not replace personalized medical advice from a qualified healthcare provider. Your health, history, and needs are your own, so talk with your midwife or other health care provider about which screenings and exams are right for you.