Don't Trust The Cervix
Most women in America quickly learn what it is like to get a cervical exam (or vaginal exam) once they become pregnant and are in labor. Many women assume it is part of the process and that it is not something to discuss or think about. However, over the years, I have learned that the cervix can not be trusted!
Depending on who you choose as your medical medical care provider, you may receive a vaginal exam to check for cervical change towards the end of your pregnancy. For some women, these exams start at 36 weeks and continue weekly until the birth. For some women, they do not receive any exams until in labor or absolutely none at all. So, there are options! But how do you know what your options are and what is best for you?
Reasons to get a vaginal exam:
To know if there is an dilation or effacement
To make a decision (medication, next steps, induction, staying at birth location)
To judge labor progress
Reasons not to get a vaginal exam:
Can feel or be very violating to some women
Some women have reported that they consented to a vaginal exam, but then their care provider also did a membrane sweep or stripping without asking first
Increased risk of infection especially if the bag of water has broken
Slight possibility of irritating and break bag of water prematurely
The information of dilation/effacement can cause mom or others on her birth team to assume where they are in the process, get discouraged, or become very anxious
My desire for anyone in pregnancy or labor is for them to feel supported, comfortable, and safe. If you are unsure why your care provider is suggesting a vaginal exam, just ask! Think for a moment how you feel about their answer. If you need more information you can ask:
What is the benefit for me or my baby?
Are there any risks?
What will change in the course of my care if we do an exam?
What if we do not do it?
I mentioned before that some women do not get any vaginal exams. And…..they all still have babies! Getting a vaginal exam does not change when your baby will be born.
Once, I arrived at the hospital with a mother in very active labor. Upon arrival she had an exam and was 1.5cm dilated with less than 50% effacement. This wise mother asked prior to the exam to not be told what the result from the exam were. She only wanted to be told if she should be admitted or she should go back home. Normally, the advice would be to return home. Currently, many hospitals are encouraging moms to go back home if they are less than 4cm dilated. This has been shown to lower the risk of a cesarean birth. However, this mom was in such active and intense labor that it was suggested she wait an hour and then get another exam to see if there was progress. However, after just 30min she was showing signs of further progression. She was checked and found out she was 6cm dilated (just 30 min later!!), she was admitted and had her baby 30 min or so after that! That cervix was not to be trusted! I am so glad this mother did not know her dilated, it actually could have altered the process of peacefulness of her labor!
There are also mothers who find out they are dilated and aren’t actually in labor yet. We have seen a mother be 6cm dilated with no other signs or symptoms of labor. Every member of her birth team was on extra high alert and perplexed as to why her body was not in labor yet! It caused unnecessary anxiety and almost a feeling of distrust in the process that lasted over a week. This little baby was going to come no matter what the cervix said. The only thing that changed was that there was a week of anxiety that wasn’t necessary. Once that baby arrived, I was again humbled and reminded myself that we really can’t trust the cervix.
So, I have seen first hand how a vaginal exam can be frustrating, misleading, or discouraging. However, there are times I have seen it be very beneficial. One of these times are when a major decision needs to be made during pregnancy or labor. For example, some couples are not quite sure if they want to stay at their birth location. Checking a mom’s cervix and then rechecking an hour or two later can be a way to make that decision. If mom has dilated more, they might feel more confident in staying at the hospital or birth center.
I have seen it be beneficial to get a vaginal exam when making a decision to induce labor, augment labor, or when deciding to get another medical intervention. Whenever a decision is to be made it labor it is so important to ask questions and gather as much information as you can to make an informed decision. If a mom has been laboring a very long time and is considering an epidural, she can get her cervix checked first and might find she has progressed and is so encouraged she wants to continue with her goals of a non-epidural birth. Similarly, if a laboring mom wants to get an epidural and finds out she has not progressed in her labor, she is struggling mentally and physical, then she might feel confident that it is the right choice for her!
Whichever path your birth takes, the uterus is an amazing thing and in most cases it does a perfect job of protecting and then birthing babies! Consider when vaginal exam is offered or suggested if you 1) want to do that (it is always your choice) and 2) what you will do with the information! But remember…you still can’t 100% trust it!!
(Dilation of the cervix is measured in centimeters.
One centimeter is the size of a Cheerio and ten centimeters is the size of a bagel.)