Cervical checks during pregnancy and labor can be a bit of a hot-button issue – but not after you read this!
Your cervix is an indicator of how “prepped” your body is for labor but for some, knowing how dilated (or not dilated) you are, might do more harm than good.
Curious to learn more about cervical exams, how they are done, and their pros and cons? I’m breaking it all down for you below, mama!
- What is a cervical check?
- How long does a cervical check take?
- What is your provider assessing when they do a cervical check?
- How are cervical checks done?
- Are cervical checks painful?
- Bishop score
- Cervical checks during pregnancy
- When do cervical checks start?
- Pros and cons of cervical checks during pregnancy
- Can cervical checks induce labor?
- Cervical check vs. membrane sweep
- Pros and cons of cervical checks during labor
- Are cervical checks necessary?
- Refusing cervical checks during labor
- Wrapping up
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What is a cervical check?
A cervical check is a manual exam performed by a medical provider. The provider uses their sterile, gloved hand to insert two fingers through the vagina into the cervix.
Once into the cervix, the provider will assess how dilated, or open, the cervix is by seeing how many fingers they are able to insert into the cervix and how far apart they are able to spread their fingers.
In addition, they will be able to evaluate cervical effacement (thinning) and fetal head station (how low your baby’s head has dropped!) through a cervical exam.
And just for your reference, dilation is always measured in centimeters, with 10 cm being considered fully or completely dilated.
How long does a cervical check take?
While it should be brief, there are things that might impact how long a cervical check takes and how uncomfortable it might be:
- Provider experience: A cervical exam may take longer if the provider doesn’t have much experience doing it
- The position of your cervix: It’s normal for your cervix to be high and posterior prior to labor beginning, making a cervical exam more difficult
- Discomfort: If you are unable to remain still and relaxed during the exam, it may make the check more difficult
Note: Your provider should always explain what they are doing prior to performing a cervical exam, including answering any questions you might have. They should also get your verbal consent before completing the exam, and stop the exam promptly if you are not tolerating it and/or at your request!
What is your provider assessing when they do a cervical check?
Your cervix, which connects your uterus and vagina, is located about 3-6 inches inside your vagina. When performing a cervical check, your provider is assessing:
- How dilated (aka open) your cervix is
- How thin (aka effaced) your cervix is
- Where baby’s head is (aka station)
As I previously mentioned, this is done by inserting one or two gloved fingers into your cervix and seeing how far apart they can spread their fingers.
Cervical dilation is measured in centimeters. When we evaluate you with a cervical check you can be anywhere from closed (we are not able to get any part of our finger into your cervix) to 10 cm dilated (your cervix is completely dilated and your provider can’t feel any cervix around baby’s head).
Normally, but not always, once you hit 10 cm it’s time to push!
How are cervical checks done?
As previously discussed, a cervical check is done by inserting two fingers through the vagina, into the cervix and seeing how far your provider can spread their fingers.
Depending on where you are in the labor process and whether or not you are actually in labor, it might be more difficult for your provider to reach your cervix.
When not in labor, your cervix is normally closed, thick, high, and posterior. Posterior simply means that the cervix tilts backward, making it more difficult to get to and perform a cervical check.
Not to worry though – this is very normal, and your cervix will begin to come forward, thin, dilate, and tilt forward once in labor. One centimeter is less than half an inch and 10 cm is almost 4 inches, just to give you a little perspective.
Are cervical checks painful?
That might depend on who you ask and what your definition of painful is. I would venture to say that nobody loves cervical checks, but some women tolerate them better than others.
I know that some of you might (strongly) disagree with me on this, but I would say uncomfortable, rather than painful, is probably a more appropriate word to describe a cervical check.
It’s also good to keep perspective on what your body will be going through over the next few hours, days, and weeks (aka labor and birthing a baby) – just trying to keep it real with you guys!
How to make cervical checks less painful
Okay, so we’ve established that cervical checks just plain suck, right?! And of course, you always have the right to refuse them. But, if find yourself really struggling with cervical exams, you might want to give this little trick a try.
Sometimes wiggling your toes during a cervical check distracts you just enough to help you relax. Staying relaxed and allowing your butt to stay flat on the bed can make the exam faster and less painful, so it’s a win for everyone.
Other things that might help:
- Taking slow deep breaths during the exam
- Reminding yourself that it will be over soon
- Keeping your bottom flat on the bed
- Keeping the lower half of your body relaxed and staying in “position”
- Your provider will likely have you bring the soles of your feet together and let your knees fall open like butterfly wings
Before we move on to cervical checks in pregnancy, I want to address the Bishop score because it often goes hand in hand with cervical checks!
In short, your Bishop score is your cervix’s readiness for labor. It is a system used by medical providers to determine things like:
- How close you are to labor beginning
- The likelihood of a successful vaginal delivery
- Whether or not an induction is a good choice for you
Generally speaking, the higher the score, the more likely you will deliver vaginally. As with anything though, there are exceptions to the rule. I have seen women that score high and end up with C-sections and vice versa.
The system takes into consideration 5 components and assigns a number, (0-3) to each category based on a cervical check.
Bishop score categories
- Cervical dilation
- Not dilated at all (closed) = 0
- 1-2 cm = 1
- 3-4 cm = 2
- 5 cm + = 3
- Cervical position
- Posterior = 0
- Middle = 1
- Anterior = 2
- Cervical consistency
- Firm = 0
- Medium = 1
- Soft = 2
- Cervical effacement
- 0-30% = 0
- 40-50% = 1
- 60-70% = 2
- 80% + = 3
- Fetal station
- -3 = 0
- -2 = 1
- -1/0 = 2
- +1/+2 = 3
Cervical checks during pregnancy
Are cervical checks necessary during pregnancy? The short answer is no!
You don’t actually need routine cervical checks at the end of your pregnancy. Routine means that it’s being performed with the sole purpose of seeing if you are dilated or effaced.
Now, if you are like me and just a curious person, then you might say, “Why not, let’s go for it!”. But, if the thought of a cervical check makes you anxious and uncomfortable, then feel free to say, “Thanks, but no thanks!”
Ok, now let’s dive further into this.
There are many reasons why routine cervical checks can make women anxious. Aside from the discomfort, they can also be discouraging. It’s actually pretty common for a woman to not be dilated at all until 40-41 weeks, especially if it’s her first baby.
Hearing this might stir up discouraging thoughts in your head and make you feel as if your body is a failure and that it will never go into labor.
On the flip side, maybe you learn that you are already dilated 2-3 cm and you are only 37 weeks? This could create unnecessary anxiety leading you to believe that your labor will start any minute or any day, when in reality, you can actually remain dilated for days or weeks.
Yes, your cervix is an indicator of how prepped your body is for labor, but guess what? Your cervix can change from 0-10 cm within hours. Trust me – I see it all the time. So should you decide to have a routine cervical exam during your pregnancy, try not to get hung up on the number.
When do cervical checks start?
Now that we’ve covered whether or not cervical checks are necessary, let’s get into when they might be necessary and when you can expect to receive one.
A lot of providers will offer a routine cervical check around 36 or 37 weeks. In addition, a cervical check might be necessary if it’s going to change your plan of care. What do I mean by this? Here are some examples:
- You are being induced
- You present to the hospital and think you are in labor
- You are having contractions and you aren’t full-term
- Baby’s heart rate is unstable during labor
This is not an exhaustive list, but instead, is my way of showing you how valuable cervical checks can be when used appropriately.
And remember, if you are like me and your curiosity has the best of you, there’s nothing wrong with having a routine cervical check done during pregnancy.
Can I ask for a cervical check?
You can definitely ask your provider for a cervical check. Now, I will mention that they are probably going to ask you why, so unless you have a good reason, they may or may not be willing.
What do I mean by a good reason? Usually, that means any signs of labor including:
- Cramps or back pain
- Bloody show
As I mentioned above, most providers will offer a routine cervical exam around 36-37 weeks. If your provider does not offer this, you can certainly ask for one. I am not guaranteeing they will do one, but it’s certainly worth an ask.
What about asking for a cervical check in labor?
If you are in labor and wanting a cervical check, it’s a bit of a different story. Your birth team will likely be more forthcoming with cervical checks during labor because it’s how we measure your progression
But also, we really try to not over-do them as it can lead to infection. This is not common and sterile gloves should be worn every time one is performed to decrease your risk of infection. Generally speaking, most providers like to stick to the same “only perform them if it’s going to change the plan of care” rule.
For example, frequently I have patients request a cervical check during labor because they are trying to decide their next steps for pain management.
If it’s only been 10 or 15 minutes, I might encourage them to wait a bit longer, but otherwise, I’m all about supporting my patient and doing everything I can to help them have the birth experience they desire.
So bottom line – Yes, you can ask for a cervical check at any point during pregnancy or labor but it’s a good idea to at least have a good reason behind your request, especially if you are preterm.
Pros and cons of cervical checks during pregnancy
Many of these I touched on previously but let’s review the pros and cons of cervical checks prior to labor so you have them all in one place.
Pros of cervical checks during pregnancy
- They will fill your curiosity bug. For me, knowing how dilated I was eased my mind, and I think that definitely counts for something!
- They can determine your Bishop score and give you an idea of when labor may begin
- They can help determine the appropriate course of action for your induction and whether or not you want to proceed with an induction
Cons of cervical checks during pregnancy
- They can be uncomfortable
- They might induce unnecessary anxiety or make you feel discouraged
- While highly unlikely, there is a small chance that your provider might accidentally break your water during a cervical check
Can cervical checks induce labor?
It’s darn near impossible that your labor could be induced from a cervical check alone. A cervical check is not a method that is routinely used to induce labor, but rather an assessment method used to determine cervical dilation, effacement, and station.
There is a very small chance that the person performing the cervical check may accidentally break your water during a cervical check, but again, it’s very rare.
Related Reading: Natural Ways to Induce Labor: I Have The Answers!
Cervical check vs. membrane sweep
Now that you know what a cervical check is and when they are generally used, let’s discuss membrane sweeps and how the two differ.
A membrane sweep involves your provider sweeping their gloved finger between the thin membrane of the amniotic sac and your cervix.
The sweeping motion helps separate the amniotic sac from your cervix and in turn can release prostaglandins, which can trigger your uterus to begin contracting.
The biggest benefit of a membrane sweep is that it might put you into labor – hopefully within 48 hours at that! A membrane sweep, however, does not come without risks.
Let’s take a look:
- Can be pretty uncomfortable for some (usually even more than just a cervical check)
- Potential for vaginal bleeding or spotting
- Accidental rupture of membranes (aka breaking your water)
- Must be dilated at least ½ – 1 cm to have it performed
- Can cause painful contractions, but not actually put you in labor
Related Reading: What is a membrane sweep?
Pros and cons of cervical checks during labor
Pros of cervical checks during labor
When performed during labor, a cervical check can be a very valuable tool that provides both the patient and the birth team with a lot of information.
A cervical check can help guide the plan of care and provides us with information that might help the patient and team adjust the plan of care to better suit the needs of the patient.
What exactly do I mean by this? Here’s a common scenario I see when caring for patients:
- A mama has been laboring for a looong time and is starting to get exhausted, frustrated, and losing hope of achieving her goal of an unmedicated birth
- Either her provider or I (her L&D nurse) offer a cervical check to see where she is and reassure her of her progress
- We check her and she learns that she’s 9 cm dilated and that it’s almost time to start pushing. This provides her with the encouragement she needs to push through those final contractions and help her achieve her goal
This is just one of many situations where knowing your cervical dilation in labor can be encouraging and just what the patient needs!
Other pros to cervical checks during labor:
- Helps us, as your birth team, determine if you are in labor and whether or not you should be admitted
- Can be used to determine baby’s presentation to ensure it’s safe to attempt a vaginal birth
- Helps us determine if your labor is progressing and lets us know if we need to alter the plan of care
4 cons of cervical checks during labor
1. They can be subjective
This isn’t a con specific to cervical checks during labor, but rather just a con of cervical checks in general. And its that they can be very subjective depending on who is performing them.
Yes, you heard me right.
Someone might check your cervix and call you 4 cm and someone else might call you 3 cm.
Does that mean that your cervix started closing instead of opening? Not at all!
Before you start panicking, know that this is fairly common when you have different providers performing the cervical checks and is just based on their interpretation of dilation.
What is not normal is for one person to call you 9 cm and then an hour later a different provider say you are 3 cm – in that scenario, it’s safe to assume that one of the providers was inaccurate.
2. They can be discouraging
They can be discouraging. Similar to the scenario above about the mama the learned she was 9 cm and able to keep pushing through to get her unmedicated birth, cervical exam results can also be discouraging.
I have also seen a situation where a mama has been laboring for a looong time, has her cervix re-examined only to find out she’s still 4 cm, and becomes very discouraged.
3. They can be uncomfortable
Even when your cervix starts to move forward and starts dilating during labor, cervical checks can still be uncomfortable.
4. They can increase your risk of infection
If performed too frequently and not appropriately, there’s a potential risk for infection.
Are cervical checks necessary?
That’s a loaded question. Necessary? Definitely not the majority of the time. But when used appropriately, they can be a very beneficial assessment tool to guide the course of action for labor and help adjust the plan of care to better suit the needs of the patient.
Refusing cervical checks during labor
As the patient, you can technically refuse anything. Let me repeat that, you can technically refuse anything! And yes, that includes a cervical check during pregnancy and labor too!
I am all about mamas having the tools to be able to advocate for themselves. Remember – you are a key member of your care team! Only YOU know exactly how you are feeling, so I encourage you to take an active role in your care and advocate for yourself every step of the way.
But before you refuse, I do recommend doing your own research, listening to both the pros and cons of what your provider is recommending, and going with your gut – because sometimes, our gut is all we need to steer us in the right direction.
Related Reading: How to Advocate for Yourself During Labor
Cervical checks can be a controversial topic for both medical professionals and patients, and sometimes do more harm than good. With that being said, cervical checks certainly have a time and a place.
I hope it has given you the tools and information you need to make the most informed decisions about your labor, especially in regard to cervical checks.
Happy laboring, mama!