Myth Monday: Cervical Exams
Welcome back to my new blog series: Myth Monday, where we discuss a common pregnancy, labor, or birth myth and why it may or may not be supported by evidence. Today's topic: Cervical Exams!
What is a cervical exam, and do I need one?
A cervical exam involves inserting two fingers into the vagina to assess the cervix for dilation, effacement (thinning), position of the cervix, firmness of the cervix, and baby's station (how low/high baby's head is in the pelvis).
Depending on your provider, they may start recommending cervical checks around 38 weeks gestation. While you may be curious to know if your cervix is changing, dilation is only relevant if you are in labor. It's common to start dilating and effacing before labor begins, especially if you have had a previous vaginal delivery. Your cervix can't tell you when labor will begin!
"Your cervix is not a crystal ball!"
Routine cervical checks during labor are common in a hospital setting. These exams aim to reassure the birthing person (and staff) that the labor is progressing "normally," and to provide early warning if this is not the case. If labors that are slow, but normal, are misdiagnosed as being abnormal, this can lead to unnecessary interventions such as drugs to try to speed labor, or a cesarean section.
Your progress in labor is about more than just cervical dilation. And your rate of dilation is not a straight smooth line from start to finish. There are many factors that can affect how slowly or rapidly your cervix thins and dilates. A cervical check can't tell you how long it will take to get to the finish line, only how far you've already come! When providers perform checks during labor, they often only use cervical dilation to measure progress, when we know there are many other ways our bodies are changing during that first stage of labor.
Routine cervical checks during labor (and pregnancy) also introduce bacteria that can lead to infections in the uterus and the baby, especially if the amniotic sac is already broken. During pregnancy, these infections can increase the chances of your water breaking before baby is ready to be born, and research has found that prenatal cervical checks provide no benefit. Additionally, the process of getting a cervical check can be uncomfortable, distressing, and/or disruptive, especially for survivors of abuse or sexual assault.
Why is my provider recommending a cervical exam?
This is an important question to think about before consenting to any intervention. In the case of cervical exams, it may be as simple as this is how they were taught to practice. Or that this is "hospital policy" or "standard procedure." But let's dig a little deeper into the WHY.
The history of American medicine and women's bodies is problematic. Dr. Marion Sims, who is considered to be the "Father of Gynecology," developed his procedures and instruments by experimenting on enslaved black women. These procedures were performed without anesthesia, even though anesthesia existed at the time. These women endured great pain and suffering. These practices, and many others that removed the sexual and bodily autonomy of women, formed the basis for modern obstetrical and gynecological care. To this day, many healthcare providers are not taught how to perform cervical exams in physically comfortable or empowering ways.
Medical providers are often viewed as official "authorities of the body," and they often take that control over the body, bypassing a patient's individual right to consent to what happens to them in the name of medicine. This results in a power balance that prioritizes compliance and silence during care. I've witnessed this first hand as a doula. When a provider wants to perform a cervical exam during labor they might say: "I'm going to check you now." This doesn't allow any room for the patient to ask questions or decline the procedure; it's assumed that the patient will comply.
There are instances when cervical exams are necessary, but when making that decision, it's important to understand what information your provider is looking to gain from the procedure, and why that information is necessary for your care. For example, a cervical exam prior to an induction can assist in predicting whether the induction of labor will be successful, and what medications will work best based on the results of the exam. Ultimately, this is your body and you get to decide what goes into it.
Bottom line: your cervix is not a crystal ball! Cervical checks during pregnancy and labor are NOT mandatory and you have the right to informed consent or refusal.
To learn more about informed consent and refusal, sign-up for a Childbirth Class today!
Information in this blog should not be taken as medical advice. Any questions regarding your care during pregnancy, birth, or postpartum should be discussed with your provider.