by Anne Ferguson
During pregnancy and during a person's birthing time (labor), care providers (nurses, doctors and midwives) may offer to check a birthing person's cervix. It may not always be presented as your choice but it is! And, more and more, I find that families I support are choosing few if any cervical checks during pregnancy and to not find out what their cervix is doing when they do consent to a cervical check during labor. Read on to find out why!
During pregnancy and during a person's birthing time (labor), care providers (nurses, doctors and midwives) may offer to check a birthing person's cervix. It may not always be presented as your choice but it is! And, more and more, I find that families I support are choosing few if any cervical checks during pregnancy and to not find out what their cervix is doing when they do consent to a cervical check during labor. Read on to find out why!
What is a cervical check? Also called a vaginal exam, this is when a care provider uses sterile gloves and lubricant and inserts two fingers into a person's vagina to feel their cervix which is the opening of the uterus. They feel for
1. The position of the cervix...is it more towards the back or the front?
2. How effaced (shortened or thin) is it? This is measured from 0% (not effaced and still 3-4 cm long) to 100% effaced or completely thinned out.
3. How dilated or open is the cervix from 0 centimeters to 10 cm or fully dilated, which means the cervix has been completely pulled up into the uterus and can't be felt any more.
4. How low in the pelvis the baby is (this is called the station).
5. Sometimes they can feel the baby's presenting part (hopefully their head!) and which direction the baby is facing.
This last thing can be valuable information that helps us know if baby needs to rotate to fit better through the pelvis. But not all cervical checks are helpful and some can actually be harmful.
Both during pregnancy and during a person's birthing time, cervical checks have some risks that are not always disclosed. Any time a cervical check is performed there is a small risk of accidentally breaking the water (amniotic sac). This can lead to an induction if pressure waves (contractions) don't kick in. Cervical checks also increase the risk of infection. Even though sterile technique is used, "bad" bacteria can be pushed from the outside of the body up into the vagina and reach the uterus, amniotic sac, and eventually baby. Infection during labor can have many consequences which I've detailed in this article "The PROM (during birth) You Don't Want to Attend."
During pregnancy just know that you can decline those routine cervical checks starting around 36 or 37 weeks. They don't tell us when baby will arrive, how long labor will last or if baby will fit through the pelvis. They can be uncomfortable. And, they can really mess with your head. Someone can be 0 centimeters dilated with no changes at all to their cervix, go into their birthing time and have a baby within a few hours. OR, someone can walk around 4, 5 or even 6+ centimeters for many weeks, not even in their birthing time yet. If you choose to have a check, make sure you understand the risks and know that the numbers don't mean anything.
During labor things can vary even more, especially based on your provider. It is possible to give birth without a single cervical check! We see it a lot at home birth and at some birth center births as well. I've even attended a few hospital births with no cervical checks!
With most hospital births there are typically at least two checks. One upon a person's arrival to make sure they are a "keeper" and should stay and have a baby. This can be declined if a person is clearly in their active birthing time or if their water has definitely broken. In fact if their water has broken it is better to avoid a check to minimize that infection risk. The second routine check is when a person feels pushy to make sure she is completely dilated. Beyond this how many checks a person has is very linked to how the care provider operates and what the birthing person wants. I've seen very few but I've also seen MANY checks. Especially when someone gets an epidural, checks can get pretty out of control. Make sure your care team knows your wishes and follows through to support them.
Cervical checks can be declined any time but depending on who is caring for you they may be more or less comfortable doing this. Providers tend to like to have a baseline to know where things are. And of course if decisions are being made to intervene (break someone's water, induce, use medication, etc.) it is probably best to know the numbers to make a fully informed decision. But the bottom line is this is YOUR choice.
So, what about not finding out your numbers? As I mentioned above the numbers don't matter. Earlier this year I attended a birth (fourth baby) where the mom went from 6 centimeters to baby in arms in 43 minutes. I've seen people go from 6 or 7 cm to baby in arms in as short as 10 minutes! I also had a mom who was 8 centimeters for many hours. Her baby needed to rotate and she tried all kinds of positions to help him along. Eventually everything we tried worked and she quickly dilated all the way and only pushed for 20 minutes which is fast for a first baby! Once I had a client who declined to find out her numbers when we arrived at the hospital. She was only 1 centimeter dilated but seemed to be further along than that based on her waves and her emotional state. Her cervix just wasn't caught up yet! Due to an ice storm they didn't send us home. Eventually her cervix got the message and progressed from 2 cm to 10 cm in just a matter of maybe 4 hours. This mom told me later she was grateful that she didn't know the numbers because she might have been discouraged and asked for an epidural which she didn't want and in the end, didn't need.
I support my clients on the journey they have chosen to take. I want them to make all decisions from a place of fully informed consent. It is always OK to say no to a cervical check. You can ask for an extra 20 minutes, or maybe ask them to check in again and see if you feel differently in an hour. Especially when planning an unmedicated birth, there are many advantages to minimizing checks, not finding out the numbers unless choices need to be made, and trying to avoid the whole numbers game all together. When your body is spontaneously pushing and you can feel a head in your vagina you'll know what to do! Birth is about turning off the thinking brain and just being in your body, connecting with your baby and letting your birth take its intended path. When we make it about numbers and math we get way to into our thinking brains and can actually hinder the natural process.
1. The position of the cervix...is it more towards the back or the front?
2. How effaced (shortened or thin) is it? This is measured from 0% (not effaced and still 3-4 cm long) to 100% effaced or completely thinned out.
3. How dilated or open is the cervix from 0 centimeters to 10 cm or fully dilated, which means the cervix has been completely pulled up into the uterus and can't be felt any more.
4. How low in the pelvis the baby is (this is called the station).
5. Sometimes they can feel the baby's presenting part (hopefully their head!) and which direction the baby is facing.
This last thing can be valuable information that helps us know if baby needs to rotate to fit better through the pelvis. But not all cervical checks are helpful and some can actually be harmful.
Both during pregnancy and during a person's birthing time, cervical checks have some risks that are not always disclosed. Any time a cervical check is performed there is a small risk of accidentally breaking the water (amniotic sac). This can lead to an induction if pressure waves (contractions) don't kick in. Cervical checks also increase the risk of infection. Even though sterile technique is used, "bad" bacteria can be pushed from the outside of the body up into the vagina and reach the uterus, amniotic sac, and eventually baby. Infection during labor can have many consequences which I've detailed in this article "The PROM (during birth) You Don't Want to Attend."
During pregnancy just know that you can decline those routine cervical checks starting around 36 or 37 weeks. They don't tell us when baby will arrive, how long labor will last or if baby will fit through the pelvis. They can be uncomfortable. And, they can really mess with your head. Someone can be 0 centimeters dilated with no changes at all to their cervix, go into their birthing time and have a baby within a few hours. OR, someone can walk around 4, 5 or even 6+ centimeters for many weeks, not even in their birthing time yet. If you choose to have a check, make sure you understand the risks and know that the numbers don't mean anything.
During labor things can vary even more, especially based on your provider. It is possible to give birth without a single cervical check! We see it a lot at home birth and at some birth center births as well. I've even attended a few hospital births with no cervical checks!
With most hospital births there are typically at least two checks. One upon a person's arrival to make sure they are a "keeper" and should stay and have a baby. This can be declined if a person is clearly in their active birthing time or if their water has definitely broken. In fact if their water has broken it is better to avoid a check to minimize that infection risk. The second routine check is when a person feels pushy to make sure she is completely dilated. Beyond this how many checks a person has is very linked to how the care provider operates and what the birthing person wants. I've seen very few but I've also seen MANY checks. Especially when someone gets an epidural, checks can get pretty out of control. Make sure your care team knows your wishes and follows through to support them.
Cervical checks can be declined any time but depending on who is caring for you they may be more or less comfortable doing this. Providers tend to like to have a baseline to know where things are. And of course if decisions are being made to intervene (break someone's water, induce, use medication, etc.) it is probably best to know the numbers to make a fully informed decision. But the bottom line is this is YOUR choice.
So, what about not finding out your numbers? As I mentioned above the numbers don't matter. Earlier this year I attended a birth (fourth baby) where the mom went from 6 centimeters to baby in arms in 43 minutes. I've seen people go from 6 or 7 cm to baby in arms in as short as 10 minutes! I also had a mom who was 8 centimeters for many hours. Her baby needed to rotate and she tried all kinds of positions to help him along. Eventually everything we tried worked and she quickly dilated all the way and only pushed for 20 minutes which is fast for a first baby! Once I had a client who declined to find out her numbers when we arrived at the hospital. She was only 1 centimeter dilated but seemed to be further along than that based on her waves and her emotional state. Her cervix just wasn't caught up yet! Due to an ice storm they didn't send us home. Eventually her cervix got the message and progressed from 2 cm to 10 cm in just a matter of maybe 4 hours. This mom told me later she was grateful that she didn't know the numbers because she might have been discouraged and asked for an epidural which she didn't want and in the end, didn't need.
I support my clients on the journey they have chosen to take. I want them to make all decisions from a place of fully informed consent. It is always OK to say no to a cervical check. You can ask for an extra 20 minutes, or maybe ask them to check in again and see if you feel differently in an hour. Especially when planning an unmedicated birth, there are many advantages to minimizing checks, not finding out the numbers unless choices need to be made, and trying to avoid the whole numbers game all together. When your body is spontaneously pushing and you can feel a head in your vagina you'll know what to do! Birth is about turning off the thinking brain and just being in your body, connecting with your baby and letting your birth take its intended path. When we make it about numbers and math we get way to into our thinking brains and can actually hinder the natural process.
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