Cervical checks during pregnancy and birth and their challenges
Cervical checks during pregnancy and birth have long been a routine practice in obstetrics. They usually start at the end of pregnancy and continuing frequently during the birth. However, recent research has called the necessity and potential harm of cervical checks into question:
First, cervical checks introduce bacteria and can create unnecessary infections. Even when done with sterile gloves or instruments, inserting anything into the birth canal will introduce outside bacteria. This becomes especially problematic when the membrane (bag of water) has already ruptured. It increases the risk of infection which can affect both, mom and baby. Routine checks prior to the onset of labor can also introduce bacteria that cause premature rupture of the membranes.
Second, cervical checks can disrupt the natural progress of labor. Introducing stress and discomfort through this procedure can slow down labor and even have the cervix close again. This may lead to unnecessary intervention, such as induction or augmentation of labor. They can also lead to physical trauma, which is particularly problematic for trauma survivors.
Third, cervical checks may provide inaccurate information about the progress of labor. The cervix can change rapidly. It isaffected by factors such as hydration, position, and the mother’s emotional state, making it difficult to accurately assess dilation and effacement. In fact, a study found that cervical checks were accurate only 50% of the time.
Fourth, checking your cervix will not predict when labor starts or how it will progress. A woman’s cervix may be dilated for weeks before labor begins. Or it may be closed and show no change until the onset of contractions.
So, in what cases cervical checks may be valuable?
They may be valuable when there are indications of fetal distress or other medical concerns. In these cases, cervical checks may provide information to make decisions about immediate next steps for mom and baby.
If you are planning on getting an epidural, a cervical check may be needed for the hospital to administer it. Some hospitals have policies in place how far your cervix must be dilated before they’ll offer you anesthesia.
When you have an epidural, you may need cervical checks to confirm when dilation is complete and you can begin pushing as you may not feel the urge to bear down.
Having said all this, in most cases, cervical checks are not necessary and may be harmful. Instead, a mother’s own perception of her labor can be used as an informative indicator. Other non-invasive monitoring techniques such as fetal heart rate monitoring, also provide important information about the progress of labor.
It is important that pregnant women are informed about the potential risks and benefits of cervical checks. It allows have open and honest communication with the healthcare provider about their preferences before and during their labor and birth. Some women may choose to opt out of cervical checks altogether, while others may choose to have them done only in specific situations.
In conclusion…
Based on most recent studies, cervical checks should not be routine prior to the onset of labor and are only in certain circumstances valuable during the birth. You do have the choice to opt out of these exams and/or ask for further information. If you are uncertain how to – just keep your clothes on during your next prenatal check in and when your provider asks, let them know you prefer to not have a routine cervical check. The same is true for your birth – if you don’t want on-going cervical checks, tell the nurses and doctors, and ask your doula to help support you should you encounter pushback. If you feel pressure to have your cervix checked, ask your healthcare team why and how this information will inform your care in that moment. Informed consent (covered here) means that you have the right to choose the care that is right for you and your baby. If you are unsure how to proceed and it’s not an emergency situation, read more here about the BRAIN method here to help you navigate making the right decision for you and your baby.
*Disclaimer: Any content provided by doulasmilwaukee.com is intended for informational and educational purposes only and should not be used as a substitute for personalized medical advice by your doctor, midwife, or other healthcare professional. Click return to homepage.
References and studies:
1. A systematic review published in the Journal of Obstetrics and Gynecology Canada in 2014. Found that routine cervical checks do not predict when labor will start and can cause unnecessary intervention
2. A study published in the American Journal of Obstetrics and Gynecology in 2011. Found cervical checks are not associated with a lower risk of cesarean delivery.
3. A study published in the Journal of Midwifery and Women’s Health in 2012. Found that routine cervical checks can be uncomfortable or even painful for some women.
4. A study published in the Journal of Obstetrics and Gynaecology Canada in 2018. Found that cervical checks can be unreliable and inconsistent, with different healthcare providers providing different results.
5. The World Health Organization (WHO) recommends to avoid vaginal exams during the first stage of labor (that’s all the way up until pushing), unless there is a specific indication.
Perinatal mood and anxiety disorders (PMADs) thrive in darkness. You can’t always see them, you won’t always talk about how it feels. You may start to struggle and not feel like yourself. For me, even the most obvious symptoms happened weeks before I finally reached out to a therapist for help.