Updated: Jul 13, 2022
Oh the dreaded cervical exam... One of the more universally annoying parts of the late pregnancy doctor visits is the cervical checks. No one is a fan of having their cervix checked. Get into labor, and it's even MORE annoying to have someone check your cervix for dilation. But as we women do, we suck it up and deal, "because we have to". Eventually I found myself wondering, "Do I really have to get my cervix checked?" What would you think if I told you the answer is, NO, you do not HAVE to have cervical exams during pregnancy or even labor!
In this post we are going to answer questions like "What is your cervix?" "How are cervical exams performed" "Why do I need a cervical exam" and what are the risks to cervical exams.
What is your cervix?
Your cervix is the opening between the womb and birth canal (ie. Uterus and Vagina). During pregnancy, your cervix is thick, high, and closed tight to protect your baby. Some people would describe it as feeling similar to the cartilage at the tip of your nose. However, as your body prepares to birth, the cervix becomes softer, thinner, and begins to open.
What is a cervical exam in pregnancy or labor and what do cervical exams tell you?
If you've never been pregnant before, you might be wondering how a doctor checks the cervix. Providers will often do an internal exam using their fingers to measure the cervical opening diameter (dilation), thinness (effacement) and baby's station (location in pelvis). Your doctor or midwife will often have you lay back on the bed and put your feet together, knees out to the side to have the most direct access to your cervix. As an alternative, I have heard of some skilled midwives performing cervical exams while the laboring mother is standing at the bedside.
Even more alternatively, there are many women who regularly check their own cervix to determine fertility, and choose to check their own cervix during labor as opposed to allowing a provider to do an internal exam. This is frequently done in a standing position, with one leg raised on a stool or the toilet, allowing easier reach around the belly, although every woman has to figure out what is comfortable for her.
A lot of people do get excited for a cervical check, don't get me wrong. It can be exciting to hear if your cervix is dilated or effaced at all. But knowing that data doesn't actually mean ANYTHING in the majority of situations. Your Cervix Is Not A Crystal Ball. A closed and tight cervix does not mean you won't go into labor any minute. An open and soft cervix does not mean you will go into labor any minute.
Do I need to get a cervical exam in pregnancy?
It is important to maintain open communication with your provider and determine if a cervical exam is medically necessary or just "preferred". In a healthy, low risk, term pregnancy, a cervical exam is not typically medically necessary. The data from a cervical exam can be useful when discussing options for medical induction (we call this the Bishop's Score)
During labor, a cervical exam can be helpful in deciding if you are ready to be admitted to the hospital (although it is absolutely not necessary for admission. Observing the pattern of labor and woman's behaviors can be more indicative of labor progress than cerivcal exams). Cervical data can also be helpful when determining if you want to utilize pain medications. If your baby seems to be in a "funky" position, your provider can sometimes better determine position by feeling your baby's head during a cervical check. Knowing if your baby is in a difficult position can provide insight to position changes that can make laboring easier and potentially even shorter. But, as with everything, it is ultimately your decision to proceed with cervical checks or not. So in order to make an informed decision, you need to know the Benefits and Risks!
Benefits of Cervical Checks
Data could be helpful if you need to make a decision regarding certain interventions
Could help understand baby's position
May be encouraging to hear how much progress you have made with all of your hard work
Risks of Cervical Checks
Increased Risk of infection, especially if waters are broken
Accidentally breaking your water
Could be discouraging if you haven't progressed as much as you had hoped after lots of hard work
Cervical checks can be very uncomfortable and can mess with your safety/stress cycle that helps or inhibits labor
Things to consider
If you have a history of sexual trauma, how would cervical exams make you feel during this vulnerable time?
Cervical exams can trigger bleeding and contractions. This is typically not considered dangerous, however it is important information to be aware of. If you're coping really well with labor, how will you feel getting a routine cervical check
What if you've been laboring "in the zone" for hours and get a cervical check and your provider discloses that after all your hard work you're "only" 3 centimeters, when you were hoping to be 9 centimeters?
How often will your provider want to check your cervix during pregnancy? During labor?
Cervical dilation does not happen at a specific "pace". Some people could dilate from 0cm to 10cm in 2 hours, while others could take 4 hours to get from 2cm to 4cm.
Being 10cm dilated does NOT mean it is necessarily time to push. How would you feel if you were instructed to expend energy pushing when your baby and body may not be ready?
Questions for your provider:
How would you feel if I declined a cervical exam during pregnancy?
What would happen if I declined a cervical exam during labor?
As always, remember, you are in the driver's seat. You can make the decisions about what happens to your body during pregnancy and birth. Talk to your provider about your wishes and concerns during pregnancy to avoid any frustrating or unnecessary conversations during labor. Don't forget to practice thinking with your BRAIN (Benefits, Risks, Alternatives, Intuition, Now/Never)
Now that I've answered a lot of the common questions about cervical exams in pregnancy and during labor, do you have any more questions? If so, you can ask your questions about cervical exams in the comments below, or you can email me. Have more questions about your birth plans? Feel free to ask them below or reach out to me directly!
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As always the information in this blog is intended for information and education purposes only. This information is intended to be used as a starting point for more research and discussion with your provider. This is not intended for medical purposes. Please direct all questions and concerns to your healthcare provider.
Jaimie Zaki, owner of Little Bear Services, LLC is a Birth Photographer, Labor Doula, & IBCLC serving families in South Jersey and Central New Jersey. Mother of three, military wife, and lover of coffee, Jaimie enthusiastically supports hospital and home births in Burlington County, Camden County, Mercer County, Atlantic County, Ocean County in New Jersey. If you reside outside of this service area, there are online courses and virtual support packages available! Jaimie is excited to serve your family! Learn more about Jaimie and the services she offers!
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