Let’s talk about cervical checks! If you’re a first time mom the thought of these can make you squeeze your legs together and cringe. “Does it hurt” is a question that is asked by many moms.
I want to talk to you today about what a cervical check is, the purpose of them and some options you have during labor when it comes to the checks. Read all the way to the end for a freebie!
Before I go further, a cervical check is an examination of your cervix to see how dilated and effaced you are. Dilation is how open your cervix is and effacement is how thin you are. Dilation is measured in centimeters 0cm is completely closed to 10cm which is considered fully dilated. Effacement is measure in percentages. 0% effaced means your cervix is not thin and 100% is fully effaced. Typically your body becomes fully effaced before it dilates completely. These measurements are taken by a nurse, doctor or midwife who will put on a sterile gloves, put gel on their fingers and they will insert their hand and measure with their pointer finger and middle finger.
Typically, cervical checks start around your 37th week of pregnancy. Depending on your physician, you will get them weekly at your prenatal until you go into labor. The thing about cervical checks though is well.. They don’t tell ya much. There is little to no evidence for the benefits of performing cervical checks at prenatal appointments. In fact there was a study done in 1984 that suggested a threefold risk of Premature Rupture of Membranes (PROM) when cervical checks were done weekly starting at 37 weeks. Lenihan et al. (1984). ” Relationship of antepartum pelvic examinations to premature rupture of the membranes.” Obstetrics & Gynecology 63: 33-37.
A benefit of having a cervical check at prenatal appointments is if you’re planning on having an induction it can tell if your cervix would be favorable. The BISHOP score is used as a tool to determine if your cervix is ready for an induction. The BISHOP score checks for:
Cervical Position
Cervical Consistency
Cervical Dilation
Cervical Effacement
Fetal Station
The highest score is a 12. The higher the score the more likely you will have a successful induction, the lower the score the less likely you will have a successful induction.
Most of the time a cervical check is done out of curiosity. Just like any intervention during pregnancy and birth knowing the benefits and risks can help you choose what’s best for you.
Let’s talk about what happens with cervical checks during labor.
Typically a cervical check is done on admission to see where you are at. This is documented and helps the nurses and provider see if you are progressing at the rate they think you should be. Sometimes a doctor will use something called Friedman's Curve to determine if you’re progressing. Dr. Friedman created this curve in 1955 which suggested a woman dilated 1.2cm every hour or starting at 3cm or she would be considered “failure to progress” or “arrest of descent” and a c-section was performed. In 2014 ACOG took a close look at Friedman's curve which was taken as the standard for labor progression and changed the guidelines. Now active labor is considered starting at 6cm and the ACOG published in Obstetric Care Consensus, “Safe Prevention of the Primary Cesarean Section Delivery:
“Cesarean delivery for active phase arrest in the first stage of labor should be reserved for women at or beyond 6 cm of dilation with ruptured membranes who failed to progress despite 4 hours of adequate uterine activity (>200 Montevideo units), or at least 6 hours of oxytocin administration with inadequate uterine activity and no cervical change.”
I want you to imagine for a moment.. You have been laboring at home for hours. You finally decide to go into the hospital because you’re feeling like they are coming closer together. You feel really good about this decision and you go to admit and they want to do a cervical check.
You have 3 options here:
Don’t get the check
Get a check and have the nurse not tell you
Get the check and find out what you are
There are a few pros and cons to each option for the cervical check upon admission.
1. Pros: You aren’t pulled out of your labor groove, less risk of infection, more likely to have a physiological labor
Cons: You don’t know how dilated you are. If you’re admitted and you’re only at a 3cm it can lead to more interventions and longer time in the hospital. You wouldn’t know if you could go home and labor there longer.
2. Pros: Your nurse is satisfied with knowing your dilation and you don’t have to risk disappointment if you’re not as dilated as you hope
Cons: Risk of infection, increased risk of interventions, Jansen L, Gibson M, Bowles BC, Leach J. First do no harm: interventions during childbirth. J Perinat Educ. 2013;22(2):83–92. doi:10.1891/1058-1243.22.2.83
3. Pros: You know and are able to make an informed decision if you’d like to stay at the hospital or if you would like to go home and labor more
Cons: Risk of infection, increased risk of interventions. If you’re not as dilated as you hope you were it may make you feel defeated.
Now I want you to imagine that you’ve been admitted to the hospital, you’re in hard labor, really concentrating through your contractions. You’ve been doing this for what seems like for hours… you’re in a really good groove. Your nurse comes in and says, “let’s check your cervix.”
I want you to look at your 3 options again:
Don’t get the check
Get a check and have the nurse not tell you
Get the check and find out what you are
I have seen and heard so many times that women get a cervical check during active labor, find out how dilated they are and become so defeated. They start believing that their body is broken, they aren’t able to handle the contractions, they can’t keep going on without medication. This is so so common.
My own story with my first was much like this. I was not dilating as fast as I thought I should be. When the nurse checked me and said I was a 4cm and had been going all night long I lost it. It was 20 minutes later I had an epidural. There was no way I could keep going knowing I would have to dilated 6 more cm before I could push!
Labor is more of a head game than we believe. When a laboring woman is allowed to go into her own head, relax into each contraction and find her groove she is much more likely to get the birth that she has imagined. Each time a cervical check is done it pulls her out of labor land and back into her rational brain.
Now the second option is having a cervical check but not knowing how dilated you are. When done for curiosity reasons there are usually more harm than good, when done because of some clinical signs that would indicate a need it can be beneficial. To avoid feeling defeated if you’re not dilated as much as you hoped you can have the nurse check but request that she doesn’t tell you. That way you can get right back into your labor groove.
With my second I had been laboring for hours! (I have long labors) I was showing signs of transition but was going in and out of it. My midwife asked if I felt ok with her checking me. I consented but requested that she keep the number a secret from me. I am SO SO happy I did because I was only at 5cm! If she would have told me where I was at currently I probably would have lost it. Instead I went right back into labor land and let my body do what it was supposed to. 10 hours after the cervical check my baby was born. Protecting your mind from disappointment is key in having a natural birth.
Protecting your mind from disappointment is key in having a natural birth.
The thing about your cervix is that it’s not a crystal ball. There are moms that are completely closed hours before their baby is born and there are moms who walk around dilated to 4cm for weeks before they go into labor. They can change quickly and really doesn’t give you an accurate picture of when baby will be born. Having an experienced provider who listens to sounds, watches your body and tracts contractions are more reliable in telling you how labor is going.
The moral of the story is:
Your cervix is meant to be closed until you’re in labor
Your cervix can change fast or slow
You have options
Your mind needs to be protected if you’re wanting a natural birth
You are strong and capable of making the best decisions for you and your baby. Be empowered mama!
If you are a mama that would like a little extra guidance of what to expect during your pregnancy I have something for you!! I’m so so so excited to be releasing The Intuitive Mama’s Essentials- A guide to help you on your journey to a blissful and empowering birth This downloadable packet will walk you through from the time you find out you’re pregnant to the delivery. There will be a hospital bag check list for the natural mama, a guide of what to expect at each prenatal visit, questions to ask your provider to make sure you’re on the same page, affirmation worksheets, and a birth plan template! I’m so excited and proud of it! You can get on the waitlist by going to bit.ly/intuitivemama now! Put in your name and your email and you’ll know when pre order starts!
You can also have a chance to win this packet on Wednesday the 18th at 2pm. I am having my Blissful Birth Workshop right on your computer! To be invited to go bit.ly/bbbbirth and give me your name and your email
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