Cervical Exams: The Good, the Bad, and the Ugly

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Beautiful Pregnant Woman“Is this something I have to do?” my childbirth students frequently ask me about cervical exams. The short answer is no. Especially in teaching hospitals, women are often examined in labor frequently, without even knowing why. The most important question to ask when considering an exam, like any other test, is “What will we do with this information?” Discuss your preferences regarding cervical exams with your provider prenatally, and include it in your birth plan.

The good news about exams is they can be helpful when a laboring woman is deciding whether to stay in the hospital and be admitted, or go home, or if this is a good time for her to get pain medication. They can provide encouraging news to women if they show increased dilation in labor. In the absence of increased dilation, they can still be encouraging, if she is able to get positive news about increased effacement (thinning) of the cervix or station of the baby.

The bad news about exams is they increase the risk of infection, especially when they are done after the release or artificial rupture of membranes (water breaking). In a hospital setting, they are usually done in bed, which is often an uncomfortable place to be during labor. Sometimes a woman is laboring successfully in out of bed positions, but after getting in bed for an exam she stays in bed, which can slow labor and increase pain. If an exam does not yield information about increased progress, it can be discouraging. VBAC women especially may wish to avoid exams during their labors until they are quite confident they have progressed past the farthest dilation of their last labors.

We all come from a long line of women stretching back to the beginning of time who have successfully birthed babies. When students ask me if exams are something they have to do, I like to think of those grandmothers laboring without exams, pushing when they had the urge to do so. The energy of birth is down and out, and having an exam in labor can often feel like energy flowing in the wrong direction

What the laboring mom wants to know is how much longer will it be until she is holding her baby in her arms; exams don't give this information. Imagine driving on the highway and seeing a sign that tells you what town you have entered. Without knowing how quickly you're driving, knowing where you are doesn't tell you when you'll arrive at your destination. Likewise, cervical dilation in labor is only a mile marker, not an indication of when your baby will be born.

For women with a history of sexual abuse, probably about one third of laboring women, exams can be triggers. It’s also important to remember that exams are subjective, what feels like six centimeters to one provider, might be seven to another. In precipitous labors, women will often have transition like contractions before their cervixes catch up to that dilation, and being in transition with a cervix that seems to have only begun to dilate can be quite discouraging.

And what about prenatal cervical exams? While these can be encouraging or discouraging, depending on the information they yield, they don’t necessarily indicate how close a women is to starting labor. Again as with all tests, a great question when considering a prenatal cervical exam is “What will we do with this information?”

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