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Cervical Checks During Pregnancy: It’s Up to You

Cervical checks are routine during late pregnancy…but are they necessary? The truth is, it’s up to you. In this blog post, you’ll learn all about cervical checks during pregnancy, including pros and cons and why you need to know about membrane sweeping.

pregnant woman at prenatal appointment

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As you near the end of your pregnancy, prenatal appointments may start to look a little different. Depending on your care provider, you may start to get cervical checks at each appointment.

And while cervical checks can tell you something, they aren’t without harm and they can’t tell you everything.

So before you reach that point, let’s go over everything you need to know about cervical checks during pregnancy.

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.

What Do Cervical Checks Check For?

A care provider is seeking five bits of information when they perform a cervical check. Let’s go over each one.

Position of the cervix

The cervix doesn’t actually move but it appears to in relation to your baby’s head. When the cervix feels close to your pubic bone, the first stage of labor is likely nearing its end.

Softness of the cervix

The muscles and tissues of the cervix become more flexible as labor progresses. When the cervix feels similar to the inside of your cheek, it is ready for birth.

Thickness of the cervix (effacement)

One of the more commonly known cervical measurements is effacement, or how thin and short your cervix is. Throughout the first stage of labor, your cervix changes from a tunnel-like passage with a thick wall to a thin opening like a ring.

You can see what this is like in the analogy of a balloon and ping-pong ball, as shown in the video below.

Openness of the cervix (dilation)

Dilation, or how open the cervix is, is probably the most well-known cervical measurement. While it gets softer and thinner, your cervix is also opening. In the course of labor, your cervix goes from sealed off completely to about 10 centimeters open. 

When you reach 10 centimeters, you are said to be “complete” and you can begin to push.

v-shape fingers is 10 cm

The baby’s station

While 4 of the 5 pieces of information gathered through cervical checks are about your cervix, one is about your baby. As your baby moves down through your pelvis and vagina, your care provider will check how high or low he or she is compared to the midpoint of your pelvis.

A negative number means they are still above the midpoint of your pelvis. A positive number means they are more than halfway through. Ideally, a mother should wait until her baby is at 0 or a positive station before beginning to push.

When Do Care Providers Start Checking?

Many care providers start to perform cervical checks around week 36 of pregnancy. It is routine at many clinics to check at each appointment from then until you give birth.

Are Cervical Checks Necessary During Pregnancy?

To be perfectly blunt, no. Cervical checks are almost never necessary during pregnancy (or during labor for that matter.) As I explained above, cervical checks can provide you and your care provider with some information.

But that information gives you a snapshot, a picture of where you are at one moment in time. None of it can tell you when labor will begin or how fast it may or may not progress for you.

A cervical check also cannot tell you whether or not you are a good candidate for vaginal birth, as some care providers may suggest. Women’s bodies were designed to give birth. Babies’ bodies develop to just the right degree to be able to be born vaginally.

Except in rare cases, such as accidents that break a woman’s pelvis, all women are candidates for vaginal birth.

The only time cervical checks may be necessary during pregnancy is when induction is medically necessary (which is rare). Some common reasons for medical induction are infection in the uterus and going past 42 weeks of pregnancy.

In these cases, knowing the conditions of a woman’s uterus can help her doctor know how best to induce her labor.

So if cervical checks aren’t usually necessary, why are they done regularly during late pregnancy?

To answer that, let’s look at the pros and cons of getting a cervical check.

Pros and Cons of Cervical Checks During Pregnancy

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

Pros

The most basic benefit of getting a cervical check during pregnancy is knowing whether your cervix has started to change at all. Some women may be curious. If that is you, you may choose to get cervical checks to indulge your curiosity.

The other benefit of cervical checks in late pregnancy is that they can tell you whether or not induction might work well. If you are considering getting induced, your doctor will want to know the condition of your cervix. He or she will check the 5 characteristics I described above and determine your “Bishop Score.”

What is a Bishop Score?

A Bishop Score is a way to combine all five characteristics of a pregnant woman’s cervix into one number. Each measurement – position, softness, effacement, dilation, and baby’s station – is given a number between 0 and 3. Then all of those numbers are added up.

The numbers are assigned according to this table:

chart showing how to determine bishop score

Generally, doctors consider a score of 9 or more to be an indicator that induction would likely be successful and end in a vaginal birth.

What a Bishop Score Is Not

To be clear, your Bishop Score is NOT an indicator of anything except for the condition of your cervix at the time of the check. It can inform a guess about whether or not induction would be successful. But it cannot guarantee a successful induction.

It also CANNOT prove that labor will not begin on its own. Your body was meant to give birth. If it can grow a baby, it can give birth to a baby, without requiring something to kickstart you into labor.

Finally, it’s worth pointing out that if your Bishop Score is high, that likely means your body is already gearing up for labor. You may see that as proof that you DON’T need an induction because your body clearly knows how to do what it needs to do.

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 satisfy your curiosity, they can also be discouraging if your cervix hasn’t changed much between two appointments. The lack of change could contribute to you feeling like your body isn’t going to do what it needs to do, or that it won’t do it soon, when neither is true.

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 and after checks. 

In addition to physical pain, cervical checks can feel emotionally invasive. It can be especially uncomfortable to be checked by someone you are unfamiliar with, which might be the case if you go to a clinic where several doctors are employed.

To reiterate what I’ve said in other places, a cervical check cannot tell you how soon labor may begin. You could be dilated to a 3 the first time your care provider checks you but then not change at all for weeks. Or you could go from a 0 one week to a 4 the next week and have labor start that night.

Finally, cervical checks present a slight risk of your amniotic sac being broken. Though rare, sometimes the pressure of a care provider’s fingers can accidentally rupture the sac (i.e. “break your water”).

If that happens, you may need to get an induction if labor does not start within a few days (to avoid the now-increased risk of infection).

Cervical Checks and Membrane Sweeping

The other thing you should know about cervical checks during pregnancy is the possibility of something called a membrane sweep. Care providers perform this procedure, sometimes called a “stretch and sweep,” by sliding a finger or two around the edge of your uterus, separating it from the amniotic sac.

Separating the uterus and amniotic sac may stimulate the cervix and encourage the release of various hormones that trigger labor and help it to progress. It is a form of induction.

Membrane sweeping (sometimes called membrane stripping) is often done to encourage labor to start before medical means of induction are recommended. It may also be used as a precursor to other forms of induction to help those methods be more effective.

I explain what the research says and the risks of membrane sweeping in Membrane Sweeping: The Research and the Risks.

In summary, membrane sweeping is relatively safe and may be a good option for women who have reached full term and want to encourage labor to start a little earlier than it may have on its own.

The reason I want you to know about membrane sweeping before you get a cervical check is that some care providers perform a sweep without asking for your consent, considering it a normal part of a cervical check.

But it is not. You have the right to decline a membrane sweep.

To avoid a routine membrane sweep, have a clear conversation with your care provider before 36 weeks and communicate that you do not want a membrane sweep done without your consent.

Can I Refuse a Cervical Check During Pregnancy?

I have tried to cover everything you need to know about cervical checks during pregnancy. Knowing what you now know, I hope one thing is obvious: 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.

Cervical checks can’t tell you how soon labor will begin. They cannot prove that your body is incapable of birthing a baby. They can’t even guarantee that an induction will be successful. 

If you want to know if your cervix has started to change, 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 pregnancy (or 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).

This information can be combined into one number called a Bishop Score.

Care providers often start routine cervical checks around week 36 of pregnancy. Cervical checks have both pros and cons, and each woman needs to decide for herself if she wants to be checked and how often.

Cervical checks are rarely necessary, and you can ALWAYS decline to have one done.

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 know now, you can make more informed choices about cervical checks during pregnancy.

Until next time,

Allison

READ MORE:

Understanding Cervical Checks During Labor: You Get to Choose

The Brewer Diet: What, Why, and How (+ free checklist)

The Cascade of Interventions [Explained]

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