In my experience as a doula and childbirth educator, I have found that there are many incorrect beliefs in regard to exams of the cervix in late pregnancy and labor. For this reason, I have put together this list of the 10 things that all pregnant people should know about these exams.
- A cervical exam done prior to labor will not accurately predict when labor will begin
It is very common for midwives and OB/GYNs to do a cervical exam late in pregnancy during a routine prenatal appointment. The reason stated for this exam is usually to check if “anything has been happening” or to see if “labor is close”. Both reasons aren’t based in research. The truth is that the cervix can change at any time. This means that if a cervical check returns the results of not dilated, not effaced and posterior one can’t be assured that labor won’t start in a few hours. I’ve witnessed this myself with doula clients who get so disappointed after a 0cm dilated 0% effaced exam only to go into labor later that night. Their doctor had assured them that they were days away from later based on the exam, but that was incorrect. On the other hand, when someone has a cervical exam with much different results, showing that their cervix has already begun to dilate and effaced they might be told that labor is imminent when in truth it might be days away.
- A cervical exam will not accurately predict how long it will be before you will birth your baby
Like the cervical exams that are done prior to labor, exams done during labor don’t always predict how long it will be before the birth. It would seem like an exam of 9cm would mean that a baby is arriving shortly, but labor could suddenly slow or the pushing stage could take hours.
- Cervical exams are estimates
When I explain cervical exams in class, I often get a question about the accuracy of the measurement. Cervical exams are done by humans without visual reference and guided by touch. Which means that they are always just estimates and can be subjective.
- Cervical exams can vary depending upon the person giving the exam
As a follow-up to the 3rd point, exams can vary from provider to provider. A nurse can do an exam on a laboring person and find them to be dilated to 3cm and an hour later the doctor can do an exam on the same person only to find 2cm dilated. I’ve even witnessed a conversation with a group of nurses about how one nurse with long fingers can give the most accurate exam.
- Cervical exams are not required during your prenatal appointments (Cervical exams are optional)
If there is only one thing that I would like everyone to know about cervical exams it is the fact that cervical exams during your prenatal appointments are optional. There are very few medical reasons for doing a cervical exam prior to labor. Many providers perform the exams as a routine but are quick to declare the procedure optional when asked. I have found that an easy way to avoid an exam during prenatal appointment is to keep on your clothes. When your care provider see you in your clothes they can have a conversation about your preferences.
This is an unfortunate truth about cervical exams. They sometimes result in a report of less dilation and effacement during labor. On occasion the cervix can swell in labor making it thicker and more closed.
Cervical exams done prior to labor usually are more painful than exams done during labor
During pregnancy the cervix is usually in a posterior position or facing your back. Because of this, the cervix is further back and often more difficult to reach before labor has begun. This means that cervical exams done during a prenatal appointment are often quite painful. As the cervix moves to a midline or anterior position in labor many people report less discomfort in the exam.
8. Your care provider should ask for and get your consent prior to doing a cervical exam
Consent during all medical procedures should be standard practice for all care providers. If your provider does not speak with you and get your consent for this exam prior to it happening you can absolutely ask them to stop.
9. Light bleeding or spotting can occur after a cervical exam
When you are pregnant there is an increase in the amount of capillaries on your cervix and during a cervical exam these capillaries might break. This breakage can cause a small amount of blood to be expelled resulting in light bleeding or spotting after the exam.
10. The risk of infection increases when you perform a cervical exam
There is clear research that multiple cervical exams can increase the risk of both maternal and fetal infections.