Today, we’re talking all about the pros and cons of cervical exams during labor. If you have a uterus, you are already familiar with cervical exams. Your cervix plays a vital role during pregnancy and labor.
This topic was recently covered on my podcast, Rock Your Birth. You can watch the episode on YouTube below.
I like to think of the cervix as the cork to the bottle. It stays thick and closed during pregnancy to protect your baby from infection, and once early labor begins, your body starts to do the hard and important work of dilation and effacement. As your cervix effaces, it thins out and as it dilates, it opens, allowing your baby to move downward into the birth canal.
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What is a Cervical Exam
There are three different ways doctors and midwives perform the checks. One way, typically used during annual checkups to do pap smears, is to use a speculum to open the vagina and look at the cervix. Next is to use fingers to manually feel the cervix (a digital exam). And, lastly your care provider could use ultrasound to look at the cervix.
When conducting checks during labor, we are generally talking about digital exams, aka using their fingers manually to feel the cervix. So that is what we are focusing on today.
Exams can be done at any time during pregnancy for various reasons, but they are typically done toward the end of pregnancy through weeks 37-40 and, of course, during labor.
Informed Consent
I want to be perfectly clear here – a cervical exam should only be done for a specific reason and only if you consent to having one. Your provider should ALWAYS:
- Explain why they think a cervical exam is necessary
- What they’re looking for during the exam
- Use a gloved hand to prevent the risk of infection
- Ask your permission before starting.
With that said, let’s discuss the reasons why your doctor or midwife would do a cervical exam during labor and what information they can ascertain from doing one.
The Purpose of Cervical Exams During Labor
Your doctor will be performing a cervical exam when you first arrive at the hospital to determine the dilation and effacement. This helps them gain a better understanding of where you are in your labor. Those who are dilated between 0-6 centimeters are in early labor. Many hospitals have a policy that they do not admit moms into Labor & Delivery if they are less than 4 centimeters dilated, so this will help determine if they want to send you back home to continue laboring.
Dilation & Effacement
They are also looking for how effaced or thinned, your cervix is on a scale of 1-100%, with 0 meaning no thinning and 100 percent meaning your cervix is very thin. In addition to effacing, your care provider will be feeling how firm or soft the cervix is, as well. It becomes softer as labor progresses to allow the cervix to stretch to 10cm and accommodate for the diameter of your baby’s head and body.
Fetal Station
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Once the baby reaches 0, this is the midway point, and what we call being “engaged” in the pelvis. You may feel the sensation of your baby dropping or getting heavier in your pelvis before or even during labor. This is when your baby becomes engaged in the pelvis. From stations 0-5, your baby is making its way through the pelvic outlet to be born.
Baby’s Position
By feeling for your baby’s head, your care provider can also determine the position of the baby, whether your baby is facing anterior (with its back facing your belly), posterior (with its back facing your back), or if your baby is breech.
As you can see, there’s a lot going on at your cervix during labor. So it makes sense that your care provider wants to perform a cervical exam when you first arrive at the hospital.
All of these elements are important for your doctor to know and gage when you first arrive at the hospital. This provides a baseline for comparison should any complications arise.
Are Frequent Cervical Exams Necessary During Labor?
Although, ACOG, American College of Obstetricians and Gynecologists, states they are the best way to monitor progress during labor, performing multiple exams during labor is often overkill and could lead to unnecessary interventions.
Here’s why:
Firstly, cervical exams suck. They are very uncomfortable and can be painful, especially while you’re in labor and already in pain. Having to go through multiple cervical exams can add more stress and discomfort to your body. This is only going to tighten up your muscles. When we are in pain and dreading the next cervical check, we are going to stay in flight or fight mode.
So our cortisol levels, which are our stress hormones, are going to rise, preventing our bodies from relaxing and opening. Plus if your care provider is constantly doing checks, you have less time to get rest or stay in the rhythm of your labor. You’ll need to find your groove again after each check. All of this could potentially cause your labor to slow down.
And if your doctor sees how long labor is taking without any or much progress in dilation, they may want to start using an intervention.
Another thing that could happen regardless of frequent cervical exams, is that you experience something called a cervical plateau. This occurs when your body is busy waiting for or doing something else, so dilation halts for a while before picking back up. For example, your baby’s position isn’t optimal. Your baby may need to turn or descend more, which could then put more pressure on your cervix to release the labor progressing hormone – oxytocin.
We can’t 100% pin down a reason for why this happens, but birth workers often see cervical plateaus used as an excuse for induction or c-section.
The Mental Impact
Another negative, in addition to an increased risk of infection, is the mental impact this could have on you. Some moms really want to know how dilated they are all throughout labor. However, it could feel self-defeating and cause you more stress.
Remember in the last episode when we talked about early labor contractions and how constantly timing your contractions could make you feel panicked? Well, it’s the same thing with dilation.
Labor is a process and your body is going to take the time it needs to do all of these amazing things to birth your baby. But it’s normal for it to take a longer time than expected and no one should make you feel rushed or like your body is doing something wrong.
There are absolutely instances where a lack of progress in dilation throughout a labor that’s lasting over 24 hours may be a sign that intervention is necessary. But in most cases, you have time. If hearing that you’ve only dilated one more centimeter after laboring for three hours is going to stress you out (and believe me, that would stress me out), then it’s not a good idea. It’s just not necessary unless there’s a specific reason or unless you feel something has changed and you request one.
Advocate for Your Right to Refuse a Cervical Exam
If your care provider wants to do more frequent cervical checks, you, your partner and your doula can advocate against it. First off – it’s your body and you have the right to say no and refuse it. You and your support team also have the right to ask why your care provider wants to do more cervical exams, and then you can assess if that’s a necessary reason for you.
If the doctor says that labor has been going on for a long time you can say thing like:
“Well, I’m a first time mom and it’s typical to have a longer labor. Are there any issues with my or my baby’s vital signs that indicate an issue? If not, then I’d like to hold off on the cervical exam for now.”
Cervical exams certainly have their benefits and drawbacks, particularly when they are conducted frequently. But by working with your birth team and being informed, you will have the tools and the power to make informed decisions that are right for your birth.
You know I’m a giant advocate of creating your birth plan so you can have a birth experience that makes you feel safe, heard, and respected. Download my free birth plan template and workbook below!
