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Understanding Cervical Checks During Labor: You Get to Choose

Cervical checks (or vaginal exams) are a routine part of labor in some birth settings. In this blog post, I explain the what, why, and when of cervical checks. I also go over the pros and cons of cervical checks and why you always have a choice about whether to have one.

woman in labor with legs up

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The onset of labor can be both exciting and nerve-wracking for women, especially first-time moms. One of the many things a laboring woman might experience during labor is cervical checks.

Cervical checks are a routine part of labor if you give birth in the hospital. They also happen, though less frequently, in birth centers and homes.

It’s important for birthing mothers to understand the reasoning behind cervical checks so each woman can make an informed choice for herself and her unique circumstances.

What Are Cervical Checks?

Cervical checks, also called vaginal exams, are when a care provider inserts two gloved fingers into a woman’s vagina to assess the condition of her cervix. The cervix is the tunnel-like passageway that connects the vagina to the uterus.

During labor, care providers perform cervical checks in between contractions.

A care provider is seeking five bits of information when they perform a cervical check:

  • Position of the cervix,
  • Softness of the cervix,
  • Thickness of the cervix (also called effacement),
  • Openness of the cervix (also called dilation), and 
  • The baby’s station.

Each one provides a slightly different picture of how labor is progressing.

Position of the Cervix

During pregnancy and early labor, a woman’s cervix changes position relative to the baby’s head. The cervix doesn’t actually move, it just appears to as your baby changes position and moves farther down into your pelvis.

Initially, your cervix will feel closer to your spine and harder for a care provider to locate. As labor progresses and your baby pushes down more, it will feel like your cervix has shifted forward toward your pubic bone.

Softness of the Cervix

Another change that your cervix experiences during labor is a change in softness. The muscles and tissues of the cervix become more flexible as labor progresses. This change is easiest to understand with a comparison to other parts of the body.

Start by touching the tip of your nose. It feels pretty firm, right? That’s what your cervix feels like before labor. 

Now touch your lip. It’s a little softer but still has some firmness to it. That’s about what your cervix feels like when it’s halfway through the first stage of labor

Finally, let your jaw hang open and touch your cheek with your tongue. It’s soft and moves easily. That’s how your cervix feels when it’s fully softened and ready for birth.

how the cervix feels during labor explanation

Thickness of the Cervix (Effacement)

Similar to changes in the softness of the cervix is another change, called effacement, or the thinning and shortening of your cervix. When you’re not in labor, your cervix is small and tunnel-like, measuring about 1 to 1.5 inches.

During labor, your cervix thins and shortens as your baby’s head presses on it. The clearest way to understand what’s going on is the analogy of a ping pong ball in a balloon, like in the video below. 

The neck of the balloon gets shorter and thinner as the ping pong ball is pushed through it until it seems to disappear. That’s exactly what happens with your cervix.

Because the tissues of the cervix are also getting softer, like we just talked about, they can move and expand without being damaged. 

Openness of the Cervix (Dilation)

Connected to effacement of the cervix is dilation, or the opening and widening of the cervix. While getting softer, thinner, and shorter, your cervix is also opening wider so your baby can fit through. 

As you saw in the balloon example, the opening gets wider as contractions push your baby’s head against it. This is the measurement most people think of when they hear about cervical checks.

Dilation is measured in centimeters, from 0 to 10. Ten centimeters is considered full dilation, and you will likely be expected to reach full dilation before beginning to push. During cervical checks, care providers will use their fingers, stretched out in a V-shape, to check how dilated your cervix is.

v-shape fingers is 10 cm

The Baby’s Station

The last measurement cervical checks provide is how far into your pelvis your baby’s head has descended, which is called “station.” The base reference or “0 station” is where your ischial spine is. Your ischial spine is part of your pelvis that sticks out like a triangle on either side of your vagina. 

Care providers can feel these bones through the walls of the vagina. They use that as reference to know if your baby is high or low in your pelvis. If you hear a doctor or nurse say that “the baby is high” or “the baby isn’t in the pelvis yet,” they are talking about station, and they mean that your baby hasn’t reached your ischial spine yet.

Fetal station is described in negative or positive numbers, from -3 to +3. Negative numbers mean your baby hasn’t reached your ischial spine yet. Positive numbers mean your baby is about to crown.

Why Are Cervical Checks Used?

Care providers use cervical checks, and the five measurements I just explained, to understand how labor is progressing.

In hospitals, it’s important for doctors to know how labor is progressing so they can make decisions about how and when to use interventions. Once an intervention has been used, cervical checks can help a doctor know if it is working as hoped.

Midwives who attend births in birth centers and homes still use cervical checks but they use them less often. Because interventions are rare in these settings, midwives perform cervical checks only when they or the mother wants to be sure labor is progressing.

Knowing When to Push

The use of cervical checks largely comes down to one main issue: when is it safe to start pushing?

It is common to hear that a woman must wait until she is fully dilated (10 cm) before beginning to push. And while that’s generally true – you do need to be open enough for your baby to come out – it’s not as cut and dry as it may seem.

Some women may not need a full 10 centimeters for their baby to fit through, so they could safely push their baby out before reaching “full dilation.” Others may feel an urge to push before reaching 10 centimeters and their first pushes finish the dilation process so it isn’t an issue.

Some care providers worry that pushing before reaching full dilation will cause swelling and other problems. But one comprehensive study found that women who had an urge to push – and did push – before reaching full dilation didn’t have an increased risk for any negative outcomes for mom or baby.

Put simply, you don’t have to have a cervical check before pushing. Your body knows how and when to tell you it’s ready.

How Often Are Cervical Checks Done?

The frequency of cervical checks during labor depends on where you give birth, your care provider’s preferences, and your preferences.

In hospitals, doctors perform cervical checks routinely every 2-4 hours. You may be checked more often than that if you are high-risk or are using many medications and interventions. At home or in birth centers, you’ll likely experience a more hands-off approach to labor in general, including cervical checks.

My midwife let me decide when or if I wanted cervical checks. I had one in all of pregnancy and labor combined. My midwife came to my home after I had been in labor for more than 12 hours and I asked her to check me. I was fully dilated.

Pros and Cons of Cervical Checks

Like most things, cervical checks have pros and cons. Each woman should weigh the benefits and risks for herself and her situation so she can make an informed decision about whether or not, and how often, she wants cervical checks.

Pros

The most obvious benefit of cervical checks during labor is that they can tell you how far labor has progressed. Measurements of dilation and effacement, especially, can reassure both care providers and moms that labor is moving forward.

Cervical checks can be encouraging to mothers. Labor is hard work so hearing tangible proof that that work is accomplishing something can be satisfying and motivating.

Frequent cervical checks also help doctors know when and how to use interventions during labor. For example, if you have not had much change between two cervical checks, your doctor may give you Pitocin (or increase your dose) to encourage contractions to strengthen. 

Finally, the information obtained through cervical checks can help mom make better choices about labor. Knowing how far she has progressed can help a woman know if she wants to accept certain interventions. It also might help a woman know what positions to use to help labor progress better.

Cons

One of the biggest risks of cervical checks is that they increase your risk of infection. The cervix isn’t supposed to be exposed to anything external. The more often it is touched, the more likely it is that it will get infected.

While cervical checks can be encouraging if labor is progressing, they can also be discouraging for the opposite reason. If two cervical checks show that not much has happened in the intervening hours, a woman may begin to feel overwhelmed by the difficulties of labor because her efforts seem to be accomplishing little.

Another reason some women may not want cervical checks is that they can be physically painful. Your cervix is a sensitive area so it might be uncomfortable to have it touched. Some women also experience cramping or a sharp pain during checks. 

In addition to physical pain, cervical checks can feel emotionally invasive. Especially during labor, you may want to be left alone and not be touched at all. It can be especially uncomfortable to be checked by someone you are unfamiliar with (which might be the case in hospitals, where doctors are often on call or leave when their shift is over).

Another part of the problem with cervical checks is that all measurements are estimates. Care providers perform cervical checks blindly, by touch, so the numbers are somewhat inaccurate.

It’s also worth pointing out that two people will estimate differently, making the measurements somewhat arbitrary.

Finally, even if the numbers are fairly accurate, neither you nor your doctor have any way of knowing how fast you will progress going forward. You could go from 0 to 5 centimeters in just two hours but then take three hours to progress from 5 to 6.

chart showing pros and cons of cervical checks

Are Cervical Checks Required During Labor?

Knowing everything you now know, you’re probably wondering if you have to have cervical checks during labor. 

Let me be as clear as possible: NO, YOU NEVER HAVE TO HAVE CERVICAL CHECKS.

Whether or not you want to be checked, and how often, is entirely up to you. You can always refuse a check, even if your doctor wants to do one.

That said, hospitals have policies and routines. It will be far harder to decline cervical checks in the hospital than it will at home or at a birth center. Doctors and nurses are trained to view birth as a medical event which means they like to monitor birth closely in case of emergency.

And while cervical checks can provide some useful information, they really aren’t any better at indicating a problem than anything else. Length of labor varies from woman to woman and birth to birth. There is no ideal timeframe for progression of labor. 

Cervical checks can’t tell you how much longer labor will be. And they certainly aren’t proof that your body is incapable of birthing a baby.

If you want to know how far you’ve progressed, by all means, ask for a cervical check. But if you’d rather not know or you prefer to not be touched, you can absolutely ask to not be checked at all.

Summary

To sum up, cervical checks are a way for care providers to know the condition of your cervix during labor. Your doctor or midwife will insert two gloved fingers into your vagina and feel your cervix.

Cervical checks can provide 5 pieces of information:

  • position of the cervix,
  • softness of the cervix,
  • thickness of the cervix (effacement),
  • openness of the cervix (dilation), and
  • the baby’s station (how far into the pelvis he or she has descended).

Cervical checks have both pros and cons, and each woman needs to decide for herself if she wants to be checked and how often. You can ALWAYS decline a cervical check.

Like all things, when you know more, you are better able to make good choices. You know your body best and you always have the final say when it comes to your body, your baby, and your birth.

With what you now know, you can make more informed choices about cervical checks during labor.

Until next time,

Allison

READ MORE:

Cervical Checks During Pregnancy: It’s Up to You

The Cascade of Interventions [Explained]

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