Cervical Exams in Labor

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It is said that “Cervical exams are for you and your provider to know the progress of labor.” The idea that doctors can give moms an idea of when the baby will deliver. But is this really true? Are cervical exams necessary, and do they give us good data?

What is a cervical exam?
Also called vaginal exams or pelvic exams. This exam is the examining of the cervix, which is part of the uterus.
Your cervix should be closed and thick (5 cm in length) during your pregnancy.
This means that your cervix is competent and can hold your baby inside of your uterus until the time of birth, around 40 weeks gestation.

When is a cervical exam routinely done?
-First OB visit.
-If problems arise in pregnancy (preterm labor, preeclampsia, gestational diabetes, etc.).
-It is common in physicians' offices to start cervical exams at 37 weeks gestation, and perform the exam weekly until labor starts.
-Arrive at the hospital (should you be admitted to the L&D unit or go home?)
-When labor seems to have changed.
-When mom feels like she needs to push (“I feel a lot of pressure!”)

How is the exam performed?
This exam should not hurt. Notify your healthcare provider if she or he is hurting you.
Also, make sure you are relaxed (relax the muscles around your vagina), make sure you have given your healthcare provider permission, and you are ready.
The exam might hurt if your doctor tries to dilate your cervix and strip the membranes (separate the membranes from the cervical wall). This is common for healthcare providers to do at the end of a pregnancy, without your permission. So, make sure you tell the healthcare provider if you consent to this or not.

The exam is done the same way at the office or at the hospital.
The nurse or doctor will place two fingers into your vagina and feel for your cervix. They are checking for three things:
Effacement (shortening, thinning, ripening, ability to stretch) - 0% to 100%.
Dilation (how big is the hole?) - 0 cm to 10 cm.
Station (how high or low baby is inside of mom) - the examiner is feeling for the ischial spines in relation to the top of the baby's head. 0 station is top of baby’s head at ischial spines, + station is when the baby’s head passes the ischial spines and comes down into the vagina.


“Why does a doctor need to check your cervix late in pregnancy?”
The exam is very useful for moms with preeclampsia, gestational diabetes, baby is not growing adequately, etc.
An assessment is done using a tool called the Bishop’s score. This is used to determine the likelihood of successful vaginal birth with induction of labor (or if mom will need a C-Section for delivery).

Why does a nurse need to check your cervix in labor?
To notify the doctor or midwife of the progress of labor and when to come.

Is it necessary?
Late in pregnancy?
Why do we need to check the thinning and opening of the cervix if mom does not have a medical condition and the baby is healthy?
In my opinion, cervical exams are not necessary late in pregnancy unless there is a medical indication (preeclampsia, gestational diabetes with the need for induction).
But the exams are not needed routinely if mom and baby are healthy because these cervical exams do not tell us how close you are to labor or the birth of your baby.

In labor?
It is said that these exams are used to determine the progress of labor. The question is..."Is this really encouraging mom or discouraging mom in her labor process?"

Is it dangerous?
Research shows that there really is no harm and no benefit to cervical checks at the end of pregnancy.
If the cervical check leads mom to be discouraged about her labor progress, this could lead to negative effects.
Also, if the doctor strips the membranes, there is possibly a risk for PROM (premature rupture of membranes) with the cervical checks. If Mom's water breaks, there is increased risk for infection with each cervical exam thereafter. Also if PROM occurs and labor does not start, Mom might find herself going down a road of interventions that she did not desire.

Bottom line:
Cervical checks cause a lot of anxiety, yet they don’t give us a lot of information about the progress of labor.
If you do decide to get cervical exams routinely and throughout labor, then make sure you get “all” of the information (dilation, effacement, and station), and take it with a grain of salt.

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