CERVICAL EXAMS: WHO NEEDS THEM?

Internal cervical exams….a rant. Okay, so I know I’m about to get a whole slew of doctors upset at me – but you know what? I’m big…I can take it.

Lets start at the beginning…not the beginning of the pregnancy, but the beginning of the debate over internal exams which starts at around 36-38 weeks of pregnancy. Usually I will have a client of mine ask me sometime between 36 and 38 weeks if we’re going to check her cervix to see what it’s doing.

My response is always – WHY?

That’s a bigger question than youinternalexam probably think. I’m not just asking why she wants to check as in, “what do you want to find out”….but I’m also asking why she wants to check as in, “why do you feel the need to know?”

What do you want to find out? How far dilated you are? You’re 38 weeks…what does it matter? Oooohhhh… you hoping that someone (me) could tell you how much longer you will be pregnant? I BET YOU ARE!! That is the million dollar question, and one that I wish I could find out the answer to – because I would be one rich midwife if I could!! If I had been the Divine creator and designed our bodies, I would have put that belly button to use and make it glow bright green 24 hours before labor was going to begin! When will labor begin…yes, that’s an excellent question. How very unfortunate for all concerned that that is impossible to answer. I have seen women be not dilated or effaced at all and slip into labor and have their baby hours later. I have also seen women be 7cm dilated and not in labor!! That’s more of an extreme (in 15 years I’ve only seen 3 women do that), but it does go to show that where your cervix is TODAY has absolutely no bearing on what it’s going to do tomorrow.

Okay, so it won’t tell you when you will go into labor…but surely it will tell you how your labor will go! The further dilated you are now surely means that you will have a faster and easier birth? Again, how I wish that were the case…but, again, it sadly is not. Checking your cervix now does not tell us what it is going to do, it only tells us what it has done! You might get to 4cm with absolutely no extra pressure and feeling no vita mutari (if you don’t know what that means, please see my blog post titled “vita mutari”) – and then you might feel enormous vita mutari in order to birth your baby, and it might take many many hours!

Now lets address the reason you WON’T tell me when I ask you why you want an internal exam – but the reason that is almost always universally there….the need for reassurance that your body “works”. If you are dilated, then it’s proof positive that your body knows what to do and is functional. As you probably have gathered by now, that’s just not the case.

So checking your cervix does not tell us: when you will go into labor, how fast your labor will be, or how easy or challenging your labor will be.

Ah, but checking your cervix prenatally DOES do SOMETHING!! It ruins the end of your pregnancy.

If you are not dilated yet, then that means you will begin doubting your body, feeling broken, doubting that this baby will “ever be born”. Please be reassured, the longest human pregnancy ever recorded was not “forever”. These moms who find out that they aren’t dilated leave my office discouraged, often looking beaten down and sad. What a terrible thing to feel when you are right on the cusp of having your baby! (Sometimes you’re only hours away from labor!) Your body has known how to conceive this baby, it has (without our assistance) been able to grow from a teeny tiny egg mixed with an even teenier sperm into an entire person!! A full grown baby with toes and hair and the cutest butt cheeks you’ll ever see!! It’s done this miraculous thing…and now, based on a stupid cervical check, you will lose a huge amount of faith in its ability to finish the job it started so perfectly? SHAME ON YOU! Your body is amazing, incredible, creating life! It deserves our utmost adoration…now is not the time to start doubting it! What has it done to deserve your skepticism of its perfection? Nothing…absolutely nothing!

If she is dilating…then celebration and feelings of accomplishment and she will then often run home and tell everyone that the baby is going to come at any moment! She quickly puts all of her affairs in order making sure everything is ready for the baby…and then she waits….
…..
…..
And she waits…
And I see her at the office a week later…and she’s smiling….sort of. Why isn’t the baby here? And another week goes by (that’s a long time to hold your breath) and she’s still pregnant. It is only her estimated due date (which is a whole other blog post rant for me to tackle) and yet she FEELS 2 weeks late because she thought the baby was going to come 2 weeks ago when we did an internal exam on her. This is the mom that usually wants to start talking about inducing at home because her cervix is “favorable” and because she feels 2 weeks late.

So if we hadn’t checked these women’s cervix prenatally, the not dilated mother would have gone into labor and had her baby on her baby’s good time, and the dilated mother would have gone into labor and had her baby on her baby’s good time. What did we accomplish here?

So why do so many care providers do routine internal exams on every mother late in their pregnancy? I think that’s an excellent question for you to ask your care provider…and if there is an answer, I am very curious to hear it – because I can’t think of a good reason at all!

*************************************

What about in labor?
I get the call.,…vita mutari has begin and is growing, we’re ready for you to come. I head over to the family’s home and she wants her cervix checked. And again I wonder…why? Is it to prove to me that she’s in labor? I believe her…and I doubt that’s the main reason. The main reason women want their cervix checked in labor is to prove to THEM they are in labor! They can’t just let it be what it needs to be…and my question would be this – what does it matter? What you are feeling is valid and real, and what is going to be is what is going to be…

I don’t care where your cervix is when I arrive! I’m not going anywhere,…I’m here until this stops or we have a baby. The only time I can see the value in an internal exam is if labor doesn’t seem to be progressing in a way that we would expect, and I may want to check to see if there is an answer I can find (such as a baby’s head being crooked in there, for example). It is not to see how fast your progressing, really…as long as you are moving forward, I do NOT care how fast it is going! Take your time, have your baby in your own time…so long as everything is healthy. But for a normal labor, I don’t care how long it’s taking, I don’t care what your cervix is doing…I accept your labor is what it is and will take as long as it needs.

What about to see how much longer you will be in labor? I’ve seen women go from 4cm dilated to birth in an hour! I’ve also seen them take 12 hours to go from 8cm to birth. Okay, so that doesn’t help.

What about when you feel the need to push? Here is where I’m going to get the biggest chair-squirming from nurses and OB’s (and even a bunch of midwives). When you begin pushing your baby out, do I need to check your cervix to make sure it’s “okay” to push because we’ve made sure you’re fully dilated? (you know, to make sure you don’t ‘swell your cervix’) No, I don’t. Usually women don’t start pushing by all of a sudden full-on full body pushing…usually you hear a catch in their voice during the contraction, a grunt, a tightening. Rarely does this happen when she is fully dilated, it’s almost always in transition…and I’ve never seen little grunty pushes swell a cervix. What about when she does those full-body pushes? For the first 15 minutes or so my response is “YOU GO GIRL!” After that I look (externally…but LOOKING at the mother) for signs that the baby has moved down and therefore she’s fully dilated. Yes…you can actually see signs on the outside without touching mom! If she’s pushed for a while with no external signs, then and ONLY THEN will I ask if I may slip ONE finger in and see where the head is and if there is cervix I can find.

This past year I did 8 births in a row…with a total of 1 internal exam (because the mother said that with her previous babies she was “stuck at 8cm” for hours until her water was broken artificially and she felt for the last couple of hours that she was again “stuck”. This being her forth baby, I believed her…checked her cervix, she was, indeed, 8cm and we broken her water and she had her baby 15 minutes later. Did I mention that I have a HUGE amount of respect for the wisdom of mothers?? I’m always humbled by it..) I actually feel sorry for my apprentices – because cervical checks is going to be the LAST skill they master with me…because I just don’t do them very often.

Sometimes I will see a woman that loses all confidence in her body and the process for no reason other than societal anxieties and fears that everyone has given her that birth is scary and doesn’t work 32% of the time (our current cesarean rate).  Sometimes that mother needs to regain her confidence and that can sometimes be accomplished with an internal exam that shows that her cervix is blossoming open.  It’s wonderful to be able to help a woman regain the trust in her body!  (also runs the risk of finding out she’s not as open as she hoped and having her completely give up…even though her cervix could blossom open quickly and at any moment!)

So let me summarize my position on this subject:

REASONS NOT TO DO AN INTERNAL WHILE PREGNANT: it won’t tell you when you will go into labor, or how your labor will be.

REASONS TO DO AN INTERNAL WHILE PREGNANT: because you want to become frustrated with your body or want to wait with baited breath at the end. (note: the one GOOD reason to do an internal is if you are looking to induce labor – that is the only medically indicated reason to do an internal exam)

REASONS NOT TO DO AN INTERNAL WHILE IN LABOR: to make sure you’re really in labor, to see how much longer it will be before the baby is born, to make sure it’s “okay” for your to push.

REASONS TO DO AN INTERNAL WHILE IN LABOR: to make sure (after given ample time) that things are progressing (no matter how slowly) and that there aren’t issues that need to be addressed.

And my question to you is: Why do you need external validation that your body is perfect? And why is it that I respect the phenomenal perfection that is your body more than you do?

95 Comments

  1. Kolleen wrote:

    I have to say that until we looked into having a home birth and met you I never knew that so many medically endorsed things were optional and/or unneccesary. This whole birth process with Lena (4 kids later…) has been very eye opening and wonderful!!

    Tuesday, February 2, 2010 at 1:51 pm | Permalink
  2. Katie wrote:

    Love this! I forwarded the link to my pregnant sister in law.

    I also added you to my blog list.

    Tuesday, February 2, 2010 at 2:13 pm | Permalink
  3. Zsuzsanna wrote:

    Great post!!! Thank you!

    Tuesday, February 2, 2010 at 3:19 pm | Permalink
  4. Amy Drorbaugh wrote:

    I think part of the reason women want them done is the inherent competition between pregnant women. You hear from your mom, sister, best friend, perfect stranger, that they were dilated to a 4 at 38 weeks. And now they feel like they have something to prove.

    This birth was the first time I had no internal checks during labor and it was by far my quickest and easiest. I even slept for 3 hours at the end of labor. Would I have done that if I had been checked and “known” that I was in labor? Probably not.

    Tuesday, February 2, 2010 at 4:00 pm | Permalink
  5. Tiffany wrote:

    Fantastic post! I agree with every sentiment except the checking prior to full-blown pushing. I did squirm a little at that :p

    Been there done this got the t-shirt :)

    Tuesday, February 2, 2010 at 4:02 pm | Permalink
  6. Karen McCann wrote:

    Excellent article. However in the Hospital setting this is a required bit of information!

    Tuesday, February 2, 2010 at 4:59 pm | Permalink
  7. Thank you, my darling friend, for you perfect and complete confidence in the women you care for. And thank you for these words, to them and to the members of The Washington Birth Network (I posted a link!) that remind us that that confidence is well placed. We are amazing. Let us never doubt it.

    Tuesday, February 2, 2010 at 8:13 pm | Permalink
  8. Rebecca wrote:

    Hmmm…so does this apply to possible pre-term labor? It sounds like your cervix doesn’t tell you much usually, huh

    Tuesday, February 2, 2010 at 8:20 pm | Permalink
  9. Jodi wrote:

    I was one of those women who thought something was wrong with me because I never felt the urge to push and that I needed a doctor or midwife to tell me when I could. Imagine my surprise when I had my 4th baby (after one hospital birth with an OB, one with a midwife and a homebirth with a midwife) when I actually felt like pushing on my own without being told to by the midwife!! I’ve had 2 babies without anyone telling me how my cervix was doing and it just happened! I’ve got about a month or so before I have my 6th and am looking forward to just going with the flow, once again. :)

    Tuesday, February 2, 2010 at 8:49 pm | Permalink
  10. elfanie wrote:

    Rebecca:
    No no no….this absolutely does NOT apply to someone who is preterm!! Before doing any test – ANY test – I always ask the question, “What are we going to do with the information?” If you are worried about preterm labor, there is LOADS we could do with that information!! I see total value in checking the cervix if a woman is preterm with threatened labor….that is something we need to know before it’s too late!! This post was only in reference to those women who are full term.

    Tuesday, February 2, 2010 at 8:51 pm | Permalink
  11. Connie wrote:

    Great post, I agree wholeheartedly. We need to bring back the trust in our bodies and we do that by allowing our bodies to do what they are designed to do without messing with it.

    Tuesday, February 2, 2010 at 10:26 pm | Permalink
  12. Erika Obert wrote:

    I’m right there with you, Stephanie. Cervical exams of full term moms are by and large unnecessary, invasive, and dare I say for many women downright humiliating. Unless something isn’t right with the labor, I do not do cervical exams.

    Tuesday, February 2, 2010 at 10:42 pm | Permalink
  13. Anna wrote:

    Yep- been the one who goes from 4cm straight into transition and then pushing 15 minutes later. I had one cervical check, and all it did was piss me off! ;)

    Wednesday, February 3, 2010 at 5:58 am | Permalink
  14. Laura wrote:

    Loved the butt reference! Great info! My dd managed to only have 1 cervical check and only because her water had broken10 hrs ago!

    Wednesday, February 3, 2010 at 9:08 am | Permalink
  15. Noel wrote:

    I never understood this either. My most recent child, born at home, unassisted, and I didn’t have one single check my entire pregnancy.

    You should have seen the look on the Medwife’s face at the clinic I was going to for prenatal care when she asked to do a cervical check at 30ish weeks. I looked at her and said ‘we just met, and I don’t feel comfortable with your hands inside my vagina. But thanks.’

    Wednesday, February 3, 2010 at 11:21 am | Permalink
  16. Kristi wrote:

    Great post! I’ve been thinking a lot lately about these routines that are a part of mother and infant “wellness” care. Seemingly benign at first glance, but I think they insidiously contribute to building in women a mistrust of their bodies and a feeling of being unqualified as an authority about themselves and their babies.

    Another example of this is baby weigh-ins and plotting on the growth charts. I’ve seen women doubt their milk production and/or their ability to know their baby is growing and developing well based on nothing else but this static data point. These little things really do mean a lot!

    Wednesday, February 3, 2010 at 4:07 pm | Permalink
  17. Bethany wrote:

    I agree with most everything you said. I am a L&D nurse and feel that we do way to many exams in the hospital. But I was wondering how you check to make sure the baby is vertex. I see a lot of people do Leopold’s maneuver but some have been wrong. Do you have another way to tell the position of the head?

    Wednesday, February 3, 2010 at 4:54 pm | Permalink
  18. elfanie wrote:

    Bethany:
    Since I am a midwife (as opposed to an L&D nurse), I have the ability to be seeing these moms throughout their pregnancy (as opposed to seeing them for the first time in labor, which is what you have to do)…so I’ve been palpating (doing Leopolds) for MONTHS, checking position of the baby…seeing the stability of the position, engagement of the head can be felt externally…is it possible for me to be wrong? Sure. But the odds of the baby being breech is small, the odds of me not being able to tell is even smaller…so the risk of not checking internally, IMO, is worth it to avoid the risks…

    Wednesday, February 3, 2010 at 5:22 pm | Permalink
  19. Danielle Daniel wrote:

    This is great, Stephanie! Aww…I just love u! I was not checked prenatally, BUT I was checked during labor. When u checked me I was fully effaced and 4 cm dilated. I had worked sooooo hard up until that point and I was crushed to learn I was only 4 cm. I will not be checked next time! It’s just a mind game and I’m not playing!

    Thursday, February 4, 2010 at 12:05 am | Permalink
  20. Genet wrote:

    Thanks for this post. I’m both a word junkie and a birth junkie, so between this and “vita mutari,” you have a new fan!

    I was at 38 weeks a week before Christmas (2008), and I asked my midwife to check my cervix because I had family coming into town and apparently I thought my cervix was a crystal ball. ;) Not really, but I was anxious for some idea whether I should shuttle my family off to a hotel room! Well, my cervix “admitted a fingertip,” which of course resulted in about a day of bleeding. Every time I went to the bathroom and saw blood, I cried, thinking things like “I asked for that check, and now I’ve probably lost my mucous plug, and what if I have this baby before it’s ready because I wasn’t patient…”

    Thankfully, my baby waited another two weeks to be born on his own schedule, and needless to say, I am not going to stress myself out with pre-labor checks in the future!

    During labor, I only twice sat still long enough to let my midwife check me. Both times the result was reassuring and gave me renewed strength, but “less positive” results could easily have had the opposite effect! Having gone over my records and talked with friends who are apprenticing, I realize now that the paperwork required by the state is a huge part of why otherwise non-interventive midwives do regular cervical checks. Thanks, nanny state, for yet another interference in what should be a private and personal relationship! (Oops, I forgot to mention that I’m also a liberty junkie. ;) )

    Thursday, February 4, 2010 at 12:45 am | Permalink
  21. Kati wrote:

    Great article!

    With my first I was 4 cm dilated for 3 weeks before my 16 hour labour.

    With my second I was not dilated at all until I hit labour. That labour was 3 hours.

    :)

    Thursday, February 4, 2010 at 1:12 am | Permalink
  22. Thanks for sharing from the HCP point of view! I blogged about this last year, from the doula and CBE point of view, (and coincidentally used the same picture!) Thought I would share the link here, to read how an exam at 33 weeks almost turned out bad!
    http://www.newmoonbirth.com/2009/06/keep-your-pants-on/

    Thursday, February 4, 2010 at 3:27 am | Permalink
  23. I LOVE this post. When I “grow up” and get to be a midwife…I plan tio have this attitude.

    Thursday, February 4, 2010 at 1:09 pm | Permalink
  24. STEPHANIE wrote:

    I totally agree. My OB hospital birth w- my 1st was completely different than my midwife homebirth w- my 2nd. I was strongly encouraged to be induced w- the 1sst b/c at me EDD I was barely 1cm and -3, so I was induced at 40wk5d and it was horriblew, the back to back forced contractions and 12 hours of labor. I wanted to go natural but kept being urged to get an epi. when I was checked after 9 hours and crying b/c of the pain, i was at 40 on my epi, I was told i was 8cm and it could be at least 2 more hours. I didn’t know I was going to handle 2 more hours so I agreed to the epi, but over an hour later when the anest got there he placed the epi wrong so it was pulled and i didn’t allow them to replace it. by this time I was beginning to have the urge to push but wasn’t allowed to until my doc got there which was over an hour later, but funally my daughter was born. i got pg again a little over a yr later and chose a different ob, only to feel everything that could go wrong did and I m/c at 8wks. thet did an internal and pap w/out asking me if i wanted one or if it was ok, then when i started spotting a few days later I went back in and internal was done, everything “felt” fine, I was sent to the hossi for an u/s adn the external showed a good h/b but then the tech wanted to do an internal b/c my ob said, which it was a newbie and she was very rough, i was her 1st internal(wasn’t told til she had started doing it), after that I lost my mucous plus and started bleeding and cramping, 2 miserable days later i m/c so when i got pg again i was determined not to use a dr and sought a CPM. i had a great pg, was only checked at 37wk b/c i was going out of town, had been having lots of BHC but i was only 1 cm and -3. well, i had 2 false alarms, the 2nd i was checked and was still 1cm -3. when labor did start i was checked and i was 3cm -1, and 4 hours later gave birth to my 2nd daughter. I’m thankful for my midwife and willnever use an ob again

    Thursday, February 4, 2010 at 1:30 pm | Permalink
  25. Tara wrote:

    Great timely article! I’m 41 weeks and have declined checks knowing that they won’t tell me anything. But I was at the point where I needed some information, even useless information, and considered a check at my next visit. Now, I will sit and be patient. Thanks!

    Thursday, February 4, 2010 at 1:51 pm | Permalink
  26. Mara wrote:

    Great article (sadly 9 years too late for me). With my first, I was induced with Pitocin at a very high level at 41 wks, and cervical checks told the nurses/doc that “I wasn’t progressing”. I was not given the freedom to move around much with the Pitocin drip… duh! 8 hours into the induction, I was checked and was going to decide from there whether to accept a half-dose of pain med. Though I’d desperately wanted a natural birth, so much was being taken out of my hands & the Pitocin level was giving me unbelievable pain that no natural methods were helping me with. Again, “little progression”, so I accepted a half-dose of oral pain med. Unfortunately, the cervical check introduced bacteria into my amniotic fluid and I developed an infection in the fluid. My temperature rocketed up to 103, and I was told that my daughter was in fetal distress. Terrified and devastated, we agreed to the emergency cesarean. I was in the hospital for 15 days with fever before I was medically okayed for discharge (I’m allergic to most antibiotics)…& developed a wound infection too. I was in counseling for months, diagnosed with PTSD for the trauma of that experience. After 2 years, I felt healed enough emotionally that I was ready to give my daughter a sibling. Much better educated the second time around, we hired a doula to help us at our hospital birth. Unfortunately I was strep B positive and not in labor at 42 weeks, so again they induced, but thankfully at a more manageable level of Pitocin. We walked for miles around the maternity ward, but each time they did a cervical check (& of course I hadn’t progressed), my confidence would be shot. The impatient OB suggested a cesarean late that evening due to my lack of progression, but we told him we were not in a hurry and were committed to a VBAC. The next morning, I ecstatically delivered my son (26.5 hrs of labor), as happy about the VBAC as I was for his birth, I’ll admit! I felt such a sense of victory! But I’ll never forget how those cervical checks made me feel during both birth experiences, not only physically, but eroded my confidence in my body, my confidence as a woman. I so wish I had seen your post 10 years ago… thank you so much for sharing with those who are pregnant today!

    Thursday, February 4, 2010 at 2:48 pm | Permalink
  27. Kelli wrote:

    After laboring all day on no sleep, being told was 5cm at the hopital was devastating. I cried, I considered drugs, cried again believing I’d surely beg for drugs I did not truely want before I finished dialating, and worked myself into a panic calculating the hours it had taken to dialate halfway to predict when my work would be done. All that mental/emotional drama and I birthed my son less than 30min after that cervical check. Yeah, its funny now…

    Thursday, February 4, 2010 at 9:23 pm | Permalink
  28. Christi L wrote:

    I have 8 dc, 6 born at home. I believed I was broken for the longest time. It wasn’t till I read Power Birth that I realized what my body was doing was absolutely RIGHT. Great article. thank you for sharing it so articulately.

    Friday, February 5, 2010 at 11:52 am | Permalink
  29. Diana J. wrote:

    I think I’ve already commented on this article, but I LOVE IT and have cross-posted it with my own comments. Thanks for talking on this subject!

    http://birthingathome.blogspot.com/2010/02/sacred-cow-of-modern-pregnancy-care.html

    Monday, February 8, 2010 at 8:30 pm | Permalink
  30. Sara wrote:

    I loved this post because I really believe it. My ob’s office routinely started doing internal exams at 36 weeks, which I declined, much to my mother’s dismay. I had a great pregnancy- never felt any contractions until I went into labor on my due date, much to my surprise. She was born 5 hours later- the only cervical check I had was upon my arrival at the hospital which really was just a glance confirming that I was pushing her out! The surprise was so much better than trying to guess how much longer I would be pregnant :)

    Thursday, April 1, 2010 at 1:51 pm | Permalink
  31. Maggie wrote:

    You rock! This is one of the most awesome things I have ever read! I’ll be sure to come back and read it again once I get antsy about baby getting here and doubt my decision to refuse internal exams (I’m 30 weeks right now).

    Tuesday, April 6, 2010 at 2:43 pm | Permalink
  32. Lorie wrote:

    Thank you for posting this phenomenal article! In my case, EVERY single unwanted intervention that ultimately led to one very unwanted, unnecessary cesarean, was precipitated by cervical checks for dilation. I have written a blog about it and plan on editing it to include a link to yours. http://www.mybestbirth.com/profiles/blogs/avoid-the-cascade-of

    Monday, May 3, 2010 at 3:49 am | Permalink
  33. Mama&Ellie wrote:

    My midwife checked me twice during my labor and never prenatally. The first time it was because I felt “stuck” for a couple hours, and apparently I was as I had gone from 6 cm back to 4 cm. Then later when I was involuntarily pushing, I didn’t believe it could be time for the baby to come so I asked her to check. The baby’s head was in the birth canal.
    When those two checks were done, I was not ashamed or uncomfortable as I have been in the past during OB checks at the doctor’s office. I had transferred to my midwife’s care at 20 weeks and fully anticipated internal exams, until she told me they weren’t necessary and I researched them better.
    It’s amazing what women think is necessary for them to have a baby!

    Thursday, May 20, 2010 at 2:35 pm | Permalink
  34. Susan Peterson wrote:

    I thought nobody would ever say this.

    The first time they told us in Lamaze class that you must never push before the doctor checks you and tells you you are 10 cms, I wondered, how did babies get born when women just had them at home? Wouldn’t the woman know when to push them out? I also wondered how everyone could dilate to exactly ten when people and babies and babies heads were different sizes.

    I wound up having my fourth through my eighth with nary a cervical check in labor…and my ninth with one just because I felt something when I went to the bathroom and wanted to know what it was so I asked the nurse midwife (yes I finally got a CNM, but she had been a direct entry midwife before that)
    to check me and I was at 7 and it was the bag of water bulging. I was relieved chiefly because I was afraid until then that she didn’t believe I was in labor.

    What a crazy tyranny of numbers!
    I think that much more must be going on than a circle opening getting larger in a mechanical way.
    Tissues are softening. Babies are moving down and wiggling their heads into better position. Probably a midwife could think of a slew of others. The cervical dilation numbers involve imposing a very simplified mechanical model of birth on a much more complex natural process. The doctors even have charts and rules; you have to dilate so many cms per hour, or else!

    Your baby will be born. You need never, EVER, know how many centimeters your cervix is dilated!
    Hooray! Thank you again.
    Susan Peterson

    Tuesday, May 25, 2010 at 11:59 pm | Permalink
  35. Tangie wrote:

    So glad i read this one…thanks for being so empowering!

    Wednesday, July 14, 2010 at 12:13 am | Permalink
  36. Linda Honey wrote:

    I am a midwife for the past 33 1/2 years & I rarely do vaginal exams anymore. I can tell by the way she moves & the sounds she makes where she is in labor. I occasionally have to hold up a cervical lip, but women don’t complain about that. The thing is my students are not learning how to do vaginal exams either, but they learn how to read women too. How exciting is that ladies!

    Tuesday, July 20, 2010 at 9:10 pm | Permalink
  37. Melanie wrote:

    Great article! It is so refreshing to see a health professional advocating that women should trust their bodies. Childbirth is such a natural and wonderful experience and I feel it is diminished by unnecessary medical interventions. Thank you, I now feel so much more confident with the choices I have made.

    Tuesday, August 10, 2010 at 8:48 pm | Permalink
  38. Leigh wrote:

    “I’ve never seen little grunty pushes swell a cervix.”

    I *have* seen this happen, where a woman is pushing gently, gruntlingly, and then I check her and she is swollen up like a donut where before she was paper thin. It has always (so far) ended in c-section. I do wonder, though, when it happens, if the swelling is not a result of the little pushes, but of the underlying problem that is preventing birth.

    Thursday, August 12, 2010 at 10:00 pm | Permalink
  39. Alexander wrote:

    Thanks for your information. This article is very useful for my wife because she is pregnant. But if you ask me, women do not need to do a cervical exam unless there is something wrong in her body.

    Friday, August 13, 2010 at 12:04 am | Permalink
  40. Sandra wrote:

    I’m so glad I surfed and found your site. Thanks for the inspiration, you’ve helped me out a lot.

    Friday, August 20, 2010 at 9:36 am | Permalink
  41. Thanks for taking a stand. My wife and I had both of our children with the help of midwives and by passed much of the crazy things that the doctors would try to force on my wife. Both of our babies were fine and my wife came through with flying colors. Thanks for the post.

    Saturday, September 4, 2010 at 4:24 pm | Permalink
  42. beloved wrote:

    Thank you for writing this! I was offered cervical exams by my midwife, but didn’t take her up on them until today (41 weeks) because I felt they’d just put me on an emotional rollercoaster. Curiosity finally got the best of me today, though. I was told that the baby is not engaged and my cervix is not ripe. Yeah so, now I feel SO much better (yes, I’m being completely sarcastic). The baby will get here when he gets here. I’m pretty sure he could not care less about the state of my cervix. :)

    Tuesday, September 7, 2010 at 9:44 pm | Permalink
  43. Marissa O'Dell wrote:

    I’m just wondering how you feel about checking when women are experiencing pre-term labor?
    I’m not trying to argue your point with you, because I believe you have the experience to back it up, I’m just wondering because I am a woman who experiences pre-term labor. The first time, everyone had me so convinced that I would just “know” it was labor, that I could have lost my daughter, had my OB not checked my cervix to find that at 30 weeks I was 4cm 80%…. so I’m just wondering…

    Monday, October 18, 2010 at 9:56 am | Permalink
  44. elfanie wrote:

    Preterm labor is a different story….
    I always ask before testing or checking something, “What are we going to do with the results?” Preterm labor with notable cervical change, we would DO something with those results! If at any time in the pregnancy there is a suspicion that something is wrong, you want to check it out by whatever means you have.
    Even in labor…I’m not opposed to a cervical exam in labor if we are going to alter our actions and the course of action based on what we find…I just don’t see an advantage to doing it routinely ever!

    Monday, October 18, 2010 at 10:49 am | Permalink
  45. Heather wrote:

    I can’t tell you how much I hate vaginal exams. They hurt and make me feel violated. I tried to refuse them and was bullied into them in both of my labors.

    My first, I was at a 3 by 40 weeks, 100% effaced and stayed there until I went into labor at 41 weeks, 6 days. Prodromal labor started at 38 weeks, btw, so it was a very frustrating 4 weeks.

    When I was in the hospital, I felt like anyone who walked into the room seemed to feel they had the right to just stick their hand inside me, though we’d never met before.

    (I’d refused my OB giving me a cervical exam at my first appointment–she got mad and I should have stopped seeing her after that appointment, which I left, crying, after… like I would after most appointments with her)

    With my second, I refused all prenatal checks and was respected. After 9 hours of active labor (and 7 hours of labor the day before–60 seconds every 2 minutes and I still knew it wasn’t time yet), I went into transition and felt the desperate need to go to the hospital. Where I learned I was a 2 from the exam that they told me they wouldn’t care for me if I didn’t have.

    I burst into tears.

    They asked what was wrong.

    My husband had to tell them the obvious–I’d been in labor for 9 hours, I didn’t want to hear that I was only a 2 and they were going to send me home. I started to sit up and my water exploded. I had another 14 hours of labor ahead and if I wasn’t in premature transition, I’d have never gone in that early. It was a nightmare labor and the checks just made it worse. I didn’t progress and I didn’t progress (this was a VBAC) and finally, 7 hours later, I was given Nubain so that I’d stop crying (and because the baby had been in distress off and on the whole time) and an hour later, finally an epidural, at a 4. 6 hours later, I started pushing. I didn’t bother waiting for a check–I knew the urge I never got to feel the first time (because I was a 10 at least an hour and a half before I was ready to push and I was directed to push, without having a real urge, for all that time, then they gave up on me when I shouldn’t have been pushing yet at all–but they coerced me into it because I was a ’10′) and let them know that I was pushing and to get the doctor there.

    20 minutes later, I pulled my second little girl onto my stomach.

    Sadly, the one time I ASKED them to check me, they refused and threatened me with a cesarean! They were going to start pitocin (because my contractions stopped for an hour–middle of the freaking night!–and my toddler was asleep and couldn’t get them going again) and I wanted them to confirm that I hadn’t progressed before doing it. I also wanted to refuse it, since it nearly killed me in my first labor, but I was so shocked by the threat that I just consented.

    So much for checks having a place. They ruined my first birth and sent me into hysterics in my second, then weren’t used when they should have been :(

    Tuesday, October 26, 2010 at 7:59 pm | Permalink
  46. Nirvana (Doula) wrote:

    The first 2 paragraphs alone I TOTALLY AGREE!!! THAT HAS BEEN MY ISSUE AS WELL!! Go with the rant girl.. GO!

    Tuesday, October 26, 2010 at 8:13 pm | Permalink
  47. Linda Honey wrote:

    I don’t do vaginal exams anymore for pregnancy or birth. Only if labor is long & need to chcek for baby head position.

    Tuesday, October 26, 2010 at 8:23 pm | Permalink
  48. There is one really valid reason to do a cervical check… that is if you suspect scar tissue. I’m very lucky that I had a midwife who was very skilled at massaging out scar tissue.

    Tuesday, October 26, 2010 at 10:25 pm | Permalink
  49. Adel wrote:

    So nice to have someone spell it out! My HB MW didn’t do them, but I did end up in the hospital with PPROM for 3 weeks, during which time they were smart enough to keep their grimy fingers OUT of me. When I did go into active labor, they checked me a few times for ONE reason: the doctor wanted to know if she could go home or if she had to wait around for me. ugh.
    Actually, the first MW I went to worked with a hospital, and she was incensed that I refused the initial exam (to “establish pregnancy”). She said to me, “How are we going to deliver this baby if we don’t do an exam?” I said, very respectfully, that the baby would come whether or not she did the exam. When I left, they said they didn’t think they were going to see me anymore. I didn’t give them the chance!

    Wednesday, October 27, 2010 at 5:10 pm | Permalink
  50. Sharalyn wrote:

    Do you want to come be my midwife? (WA State) Please?

    Wednesday, October 27, 2010 at 7:18 pm | Permalink
  51. Vanessa wrote:

    Thank you for this.
    With my second (my last obgyn pregnancy before i moved on to midwives) i always felt horrible having the cervical exams. I’d leave feeling defeated. I “still” wasn’t dilated at 38,39,40 & 41 wks. Clearly my body was failing at pregnancy and motherhood.

    I never had those feelings with my last two (midwife assisted) pregnancies. She never did a cervical check, she informed me i could have one if i wanted but explained they weren’t necessary (basically explaining what you did here)
    I didn’t have the defeated, guilty feelings every time i left her office like i had with the previous two.

    Saturday, November 13, 2010 at 6:15 pm | Permalink
  52. Christy wrote:

    I am one of those women who walked around very dilated for weeks before my first came a week “late.” That was a birth center birth. I had a great hands-off midwife next who only does VEs upon request. I made the mistake of requesting a couple during my 2nd labor (homebirth) and was discouraged to not be as far along as I would have liked. She had tried to tell me previously that dilation doesn’t tell when the baby will be born, but I guess I had to learn that lesson the hard way. Baby #3 came before the same midwife arrived, and it was my best yet, and of course, no VEs.

    Saturday, November 13, 2010 at 6:21 pm | Permalink
  53. Alison Velasco wrote:

    Another reason not to do internal exams: UTI and kidney infection after 30 hours in the hospital and who knows how many internal exams, “just to check how I was progressing :( The positive side was that I did get my VBAC!

    Saturday, November 13, 2010 at 6:28 pm | Permalink
  54. Nikki Lee wrote:

    It is possible to know where a woman is in labor by her behavior: her noises and movements are clues.

    How many women hold back, at least energetically, because strangers are invading that most private place?

    warmly,
    Nikki

    Sunday, November 14, 2010 at 12:12 pm | Permalink
  55. elfanie wrote:

    Nikki:
    It’s USUALLY possible to tell where a woman is in her labor…..but I have been fooled!! Many times!

    But I think the bigger question is…what difference does it make? Why do we feel a huge need to “track” her labor to begin with??

    Sunday, November 14, 2010 at 1:56 pm | Permalink
  56. This is great….

    Sunday, November 14, 2010 at 9:57 pm | Permalink
  57. Lisa wrote:

    I was “stuck” at 6cm with my first (an “augmented” natural birth… don’t get me started on that one), which prompted my Dr to want to do a c-section. By the time he got back from scrubbing, I had no choice but to push, I couldn’t stop it. Luckily, by the time they checked me, I was “fully” dilated, so I was able to proceed naturally, but it was one of the many things about that labour that really got me thinking. I later came across this article that I found rather interesting, especially considering my own experience…
    http://www.midwiferytoday.com/articles/ruleof10.asp
    If they hadn’t been in such a hurry to check constantly, it would have just progressed as needed, and everything would have been fine. I wouldn’t have had that threat of surgery over my head.
    My second was a much more pleasant MW assisted birth.

    Monday, November 15, 2010 at 12:04 pm | Permalink
  58. Thinks for great information.It is well for woman health .So thanks for post.

    Friday, November 19, 2010 at 3:25 am | Permalink
  59. Dottie wrote:

    Speaking of internal exams, I am wondering—-I’ve had three babies. When I go to my OB for my first prenatal visit they always insist on a internal exam and Pap Smear. Is this necessary in your opinion or can you request to not have that done?

    Friday, January 28, 2011 at 5:43 pm | Permalink
  60. elfanie wrote:

    It is ALWAYS your right to consent or refuse to ANYTHING….absolutely. is it necessary? No…but whether it’s a good idea in your particular case I can’t comment. Each person should decide for themselves what they believe is best for them in their individual circumstance…

    Friday, January 28, 2011 at 5:47 pm | Permalink
  61. Thank you for writing this informative blog post. I look forward to a pregnancy and labour that is free from cervical exams unless truly warranted.

    Tuesday, February 1, 2011 at 4:17 pm | Permalink
  62. Suzanne wrote:

    With my first two I dilated to 5cm without being in labor, but I’m VERY glad my OB checked me. Their heads were not low and were not engaged. I’ve since learned that if my water had broken on its own I could have been in a situation with a prolapsed cord and a baby whose life was in danger. So, sometimes there IS a good reason to do an internal check.

    Wednesday, February 2, 2011 at 8:55 am | Permalink
  63. elfanie wrote:

    But….knowing that when we check your cervix it can accidently rupture your membranes…or put you at an increased risk of them rupturing later because we weakened them….and knowing that neither of the babies heads were low (as we can tell that from palpating the abdomen on the outside)…I would think that would be a good time NOT to mess around in there….
    how did them doing your internal exam in any way prevent a cord prolapse?

    Wednesday, February 2, 2011 at 12:24 pm | Permalink
  64. Good article but I must say that the picture of the hand and glove up close is scary.

    Thursday, February 3, 2011 at 12:58 pm | Permalink
  65. Suzanne wrote:

    The exam obviously didn’t prevent the prolapse of the cord, but once I was 5 cm dilated I was sent immediately to the hospital to be induced so I could have the babies in a controlled environment where we could be rushed to the operating room or wherever necessary if that happened. I wasn’t left having a prolapsed cord in my living room.

    Thursday, February 3, 2011 at 2:18 pm | Permalink
  66. Kelley wrote:

    It is actually very normal for the baby not to engage in the pelvis until labor begins, especially if it is not your first. I have 5 and only my first dropped before labor began. The chances of a cord prolapse may be greater if baby isn’t engaged when your water breaks, but it is still rare (and my mother lost a child to cord prolapse, in the hospital, so I don’t take the seriousness of it lightly).
    Unless your dr knew for a fact that the cord was presenting first, then him inducing for ‘potential prolapse’ just because you were a 5 and baby was floating was IMO absolutely not needed. According to his logic a large percentage of multips would need to be induced for every labor (because we are often dilated early with floating babies) because of an increased risk of prolapse, and this is just not true.

    Also, as was mentioned you can tell whether or not baby is engaged by palpating, a VE isn’t needed. And just because you are 5cm already doesn’t mean your water will break before labor or before baby engages (though more VE’s will increase the chance of it breaking earlier than it would otherwise).

    As for VE’s. I vent about them often and have been meaning to blog about it for a while. What on earth did women do before the almighty hand reaching up inside them to tell them how dilated they were? Oh wait, I know, they let their BODIES work unhindered, as they were designed to. When God created us to give birth He didn’t also give us an instructional manual on how to check for dilation, LOL!! We were given a working body, and instincts, and that is all that is needed. I can think of a few reasons why a VE may be helpful but they would be the exception. Out of 5 kids I have had them only during my first (once during pg, a few times during labor, and they were not helpful). I had zero VE’s during my last 4 pregnancies and births, and despite long labors and pushing, my body worked perfectly on it’s own, like it is supposed to.

    Monday, February 7, 2011 at 12:51 pm | Permalink
  67. Morgan wrote:

    Amen! I have had four children and only ONCE did I “need” an internal. My fourth baby was being putzy and I was starting to freak out. I needed the reassurance from my beloved MW that all was well. It turned out fine, but after a long time of “pushing” with nothing to show for it, I wanted to make sure. Turns out he had a tight true knot in his cord. (We didn’t know until after his birth of course!) Had I had a million internals at some hospital, I would have felt like my body had failed me. Instead, all was well, and he was born lovingly at home. Once I realized I could do it. ;)

    Thursday, February 10, 2011 at 9:53 pm | Permalink
  68. JOllina wrote:

    This is more of a request. May I use a slightly edited version of this to present. It reads like a “speech” and I think it would be great heard aloud.

    Saturday, February 19, 2011 at 10:18 am | Permalink
  69. elfanie wrote:

    Jollina: Sure!

    Saturday, February 19, 2011 at 10:45 am | Permalink
  70. sivaprasad wrote:

    Good article but I must say that the picture of the hand and glove up close is scary.

    Monday, February 28, 2011 at 11:52 am | Permalink
  71. Kali wrote:

    Thank you! I shared this on my facebook for my doula page. Love it!

    Tuesday, March 8, 2011 at 11:09 pm | Permalink
  72. Ilona wrote:

    Wow, you’re attitude towards mothers and giving birth is fantastic. I live in Italy and here everything seems to be under doctors control.
    I wish you could be my midwife.
    Thanks,
    Ilona

    Wednesday, March 9, 2011 at 4:53 pm | Permalink
  73. Kacie wrote:

    With my first child, my midwife wanted to do an internal when I was 38w or so and not in labor. I asked why, and she said to confirm his position so we could encourage him to spin if he wasn’t already. I told her not to tell me the status of my cervix beyond his position!

    With my second, i opted out of all internals entirely. While I was in labor, the midwife kept telling me my dilation even though in my birth plan I said I didn’t want to hear the number. Good thing the numbers were always good in my laboring mind, or I would have been annoyed!

    Plus, I needed a transfer from the birth center to the hospital (pre-eclampsia) and knowing that I was transfering at 6-7cm was good for me to know.

    Friday, March 11, 2011 at 10:45 am | Permalink
  74. Tamara wrote:

    I refer people to this post *all.the.time*. LOVE IT.

    Friday, March 11, 2011 at 7:22 pm | Permalink
  75. Maria wrote:

    Great article! I feel there is much truth in what you’re saying. I’ve always wondered why women/physicians feel it is so necessary to do cervical exams because surely the first women never received them and managed to know when to push their babies out. I’ve had two unassisted births (due to the lack of midwives in my area) and started pushing when I felt the urge to. With my first, that urge lasted half an hour, with my second, twenty minutes. I only started when I found myself instinctively doing it, when it made the contractions feel better, not because of any conscious thought (my conscious thought told me not to push because my water hadn’t broke yet) and I truly believe that is how it was intended to be.

    Monday, July 4, 2011 at 2:57 pm | Permalink
  76. Liz wrote:

    I’m 34 weeks and am scheduled for a cervix exam in 2 weeks. The reason I want to get it checked is because I’ve heard doctors tell some patients that they can’t have a normal birth because their cervix is too small and therefore they have to have a c section :s…so I have no idea what that means. I mean if your body is made for this..then how can my cervix be too small and how can the doc tell me weeks in advance that my baby will be a c section!? confused!!

    Monday, August 15, 2011 at 5:03 am | Permalink
  77. Laura wrote:

    Can I come to you? I’m due in a little over a month, and I just left my doctor’s practice because they basically said “you do this our way, or we won’t treat you anymore.” When I’ve had a perfectly normal and healthy pregnancy. They want me to deliver flat on my back with my feet in the air, IV, epi, and as many vag checks as THEY want. And that’s just the start.

    I told them “fine, I’ve got better places to put that money anyway.”

    Friday, October 14, 2011 at 10:46 pm | Permalink
  78. Lalla wrote:

    god, i wish the midwives in aus knew what you did, every labour i have been given multiple exams, the first was quite painful setting me up for later fear no less. given, the last labour was breech and stuck, but the other 2 they did it because THEY didnt believe i was in labour! even when i was dilating! well, bub was with us only an hr later, lmao! still, it has done little for my faith in the midwives here. they didnt even believe my waters had broken, when i had started crowning, til they did an internal, and were telling me to stop pushing when i was fighting my bodys own bearing down! now that i have needed an emergency caesar, i doubt the dr’s etc here would condone a homebirth, but thats where im having to look for my next, to avoid being told to not trust my body, and avoid being forced onto my back like a piece of meat :(

    Monday, November 7, 2011 at 7:26 pm | Permalink
  79. Adrianna wrote:

    I am currently completely deprived of confidence and hope that I can make it through labor and delivery. I had been checked for dilation ( I am 37 weeks along), and although I am a little dilated and effaced I don’t see how this was really so necessary. The exam was horribly painful, I am still bleeding/sore and feeling violated. My OB said that I need to get an epidural as soon as my labor starts…and that tells me she thinks I am no good for drug free labor & delivery. She left the office leaving me cry not answering my other questions I had for that appointment. I am definitely NOT getting another manual exam by her or at the hospital.

    Friday, December 16, 2011 at 10:31 am | Permalink
  80. alex wrote:

    Thanks for this wonderful post.. really very informative..

    Saturday, February 4, 2012 at 1:19 pm | Permalink
  81. Lisa wrote:

    Love this post! I will add, though, that having switched to a home birth midwife at 20 weeks into my first pregnancy (and therefore never having experienced any checks for dilation by an OB), I think you can have a totally different emotional approach to cervical checks when you’re seeing a midwife. My midwife prefers not to check, and she’s happy to never check ever (she usually checks when you feel the urge to push, but she’s happy to forego that if you don’t want it), but I asked her to check and was glad I did. In my first labor I kept begging for internal exams because I wanted to gauge how far I’d come. Every time, my midwife would remind me that it wasn’t going to tell me anything about the future progress of labor, but I wanted them anyway. They made me feel better. It was a pretty long labor (36 hours), and getting the checks (I probably had 2 or 3 total, because that was all I could talk her into!) were like seeing mileposts in a long-distance race. They helped me pace myself.

    In my second labor, which was much faster, I didn’t feel the need for internal exams. I knew a lot more then about the emotional stages of labor, and I was able to gauge my own progress by how I was feeling (for example, when I absolutely HAD to strip naked, I knew I was in active labor and getting close to transition). :)

    But my second labor also had several weeks of prodromal labor, and I had one internal exam during pregnancy because of that (I think it was around 36 or 37 weeks). I asked for that exam, too, because I was worried that the prodromal labor was actually labor starting. I knew that an exam wouldn’t tell me anything about how much longer I had to go, but I really wanted to know whether anything had happened already. When she checked me and found I wasn’t dilated at all, it was actually a huge relief. I had been worrying that I was already IN labor but couldn’t tell, and knowing I wasn’t made it easier for me to relax and wait. Because there wasn’t any pressure or concern of “are you dilated yet” or “you should be starting to dilate,” it wasn’t at all upsetting–and was actually a huge relief–to learn that I wasn’t dilated at all.

    Of course, since labor didn’t start for another five weeks or so, I might have gotten frustrated if I HAD already been dilated at that point!

    All that to say, I think there’s a place for internal exams when the woman really wants them, as long as she understands what they can and cannot do and how little they really mean. They can be reassuring sometimes, especially if the care provider doesn’t put any pressure or significance on them.

    Wednesday, February 15, 2012 at 9:08 pm | Permalink
  82. Loraine wrote:

    Love this article and soooo true!!! With both of my sons I was 3-4 cm and 80% effaced for a week and a half.

    When I gave birth in December my labor was fast and furious (only an hour), I was having the urge to push but “couldn’t” because I was only 6 cm even though his head was RIGHT there.

    I was also completely violated and it HURT like hell when the nurse shoved her hand in me with NO warning during a ctx. She was panicking because my body was pushing on its own.

    It was an awful experience!!

    Monday, April 9, 2012 at 10:44 pm | Permalink
  83. merrissa wrote:

    I WISH i had this yesterday. drs reason was so we can PLAN what to do next. i didnt want to.be examined and yet as always felt PUSHED to do it. i seriouly dislike drs for their pushiness. wish you could come.to my area and be my midwife.

    Tuesday, February 19, 2013 at 5:10 am | Permalink
  84. Brittany wrote:

    Im a First time mom to be due around the 18 of march 2013. & 20 years old, i think what you have written makes so much sense that I cant wait to share this, the theory behind it just explains alot , and im very thankful you wrote this, I cant disagree with one thing.

    Friday, March 1, 2013 at 12:10 am | Permalink
  85. Crissie wrote:

    Actually, cervical exams have a purpose. For one, how many surprise breeches occur with births? Leopoldo’s abdominal exam is only so good, especially on women with larger BMI. Pelvic abdominal exam is much better at determining the presenting part. Second, pelvimitry still has a purpose with experienced midwives. The four types of bony pelvis can be determined by a pelvic exam. Gynecoid, android, platypelloid, and anthropoid shapes may help determine if transfer is needed if you have a protracted active phase. Some pelvic shapes may hinder successful vaginal birth or more likely lead to posterior babies. Third, of course women who are closed may go into labor tonight and other women already 3 cm may stay that way for weeks but come on, odds are going to favor the usual text book progress. If I had 100 women closed and 100 women 3 cm, most of the women who are 3 cm will deliver first. Add to that if this is her fourth child and she lives an hour away from the birth center, you would advise her to have a lower threshold to leave for the birth center than a woman who is having her first child and is closed. I can go on, but we like to be prepared in many aspects of life. An ounce of prevention is worth a pound of cure. Stories of unplanned OOH births, surprise breech presentations, prolonged active or second stages of labor can be lessened (not completely prevented) by cervical exams weekly at term. Or you can stick your head in the sand and be surprised. No ones crystal ball can predict labor, but good clinical exams can lessen potential dangers.

    Saturday, March 23, 2013 at 4:41 pm | Permalink
  86. Crissie wrote:

    Lorraine # 82. Precipitous birth, nearly an OOH birth. Some midwives will assess your situation, have you had babies before, how far dilated are you, how far do you live from the birth center, etc. some hospital midwives will arrange an induction for you after 39-40 weeks so that you can already be in the hospital and walk around, use the birthing ball or tub without all the chaos of finding someone to come get your other kids, race to the hospital, and tell you not to push until the midwife shows up. Can make it more sane for a family to deliver this way. Of course you have to be on board for agreeing to an induction, but in instances like this, it should be offered as one option for informed consent.

    Saturday, March 23, 2013 at 4:49 pm | Permalink
  87. Crissie wrote:

    Women arrive in birth centers all the time vocalizing that they have to push, and a cervical exam often enough finds them only 1-2 cm dilated. Some women deliver OOH stating they barely had an urge to push for less than an hour or so, or arrive at the birth center with mild pains and are already complete. External signs can work often but not everyone follows test book rules. You already said you cannot trust the cervical exam to predict when you are going into labor or how long it will last. Our experience is similar, and in addition external signs are even less telling. Everyone has a different discomfort tolerance. If you start pishing before you are complete, cervical swelling is only one problem. But cervical swelling will usually pass. We have seen some women get cervical tearing and post partum tearing when they pushing against a non complete cervix. And then you have to clamp and pack the vagina and transfer the women to the hospital for surgery after delivery. Now we do hundreds of deliveries and this only happens rarely, but it can be lessened by following progress with cervical exams.

    Saturday, March 23, 2013 at 5:01 pm | Permalink
  88. Crissie wrote:

    Our current total CS rate is 32%, which includes planned elective CS and repeat CS. The primary CS rate for planned trials of labor is actually closer to 16-22%. Still high but not as high as you are scaring pregnant moms.

    Saturday, March 23, 2013 at 5:11 pm | Permalink
  89. Sarah wrote:

    I was really looking forward to reading the info in this article. Afterwards, I was extremely disappointed that I am having trouble taking someones professional opinion seriously when there are so many grammatical and vocabulary errors in their writting.

    Tuesday, May 7, 2013 at 10:21 pm | Permalink
  90. Fifi wrote:

    thanks for this post – Im 41 weeks, with baby number 2, just come back from the docs and been told nothing is happening – its very disappointing indeed, but your post cheered me up immensely!

    Thursday, May 16, 2013 at 9:14 pm | Permalink
  91. FTMOMMY wrote:

    My Dr said he wanted to do cervix checks starting at 35 weeks because if I was dialating, it would mean I need to stay off my feet, whereas if I wasn’t dialating I would need to walk around more. Doesn’t make sense to me though…baby is gonna come when baby is good and ready. Why would he tell me that?

    Wednesday, June 19, 2013 at 1:11 am | Permalink
  92. Crissie wrote:

    You say you have had women devastated after hearing the results of pelvic exams? Don’t you discuss ahead of time that primiparous women will usually be closed longer and multiparous women may dilate sooner? Preparing the woman for the correct expectation of what happens commonly helps her accept the lack of dilation or the early dilation that usually is found on exam. Most HCPs will explain to primiparous women not to expect much, and when examined and found to be closed or 1 cm, no one is devastated. So have you not prepared women for appropriate expectations that you blog how women you have cared for in the past? It is an easy fix. Just talk to your clients ahead of your exam and the won’t be let down. And you won’t miss any breeches either. Too many patients arrive in labor at hospitals after laboring with no exams done and are found to be breech. Oops.

    Wednesday, July 10, 2013 at 11:43 pm | Permalink
  93. Janel wrote:

    Thank you! I was checked today and I didn’t feel right about it for some reason. I really do feel violated, I bled and had cramps after and the Dr. said I’m 1 cm and he touched the top of my babies head. I hope it doesn’t affect my baby! I’m only 35 weeks and I won’t have it done again thanks to you!
    Sincerely,
    Irritated

    Friday, August 9, 2013 at 1:54 am | Permalink
  94. Tamara wrote:

    I agree with Chrissie. I feel like there is generally some need for cervical exams(preterm labor patients, incase baby turns breech at the end, determine pelvic bone structure) Also, people really do have different pain thresholds and it would seem almost impossible to determine what each individuals actually is. I know that I didn’t know that I would be able to handle contractions as well as I did. Mine were not bad. I didn’t have the jerk reactions and facial grimaces and grunting that lots of women have(that mid-wives may look for). I agree that many times it works, but not always. Isn’t it smarter to err on the side of caution when there is relatively little risk involved in the exams? Unless the patient personally feels uncomfortable, then that is another story all together. Educating the patient beforehand about how dilation and effacement may or may not play into the onset of labor is key. That is what I think the main issue with this situation is, not the exams themselves. I know I preferred to know with the kind of profession I had (standing/walking ALL day) if it was affecting my cervix too early. For some women active jobs like that can put stress on the body and pull them into pre-term labor category. I wanted to know if I was subject to that as to avoid pre-term labor, thus avoiding a higher chance of CS. In my case, having the exam made me feel safe to know I could still continue working at the level that I was used to working. Listening to your body is important, yes, but sometimes the mind has a way of tricking us into thinking we can do anything we did pre-pregnancy. I think that there is something to be said about trusting your physician or mid-wife. If you trust them, then let them do what they feel is best for you and baby…whether than be cervical exam or no exam. I think the same fear you are placing on the exam you are now placing on women who still want the exam. There is no scientific evidence that points to the exam being dangerous for mom and baby. It’s truly a personal choice. I feel like making a negative connection between the two is not necessary. It’s good that you feel so strongly about something that is very important to pregnant women everywhere, but women who come across this site are going to doubt physicians they entirely trusted beforehand. This will make their visits more stressful for both doctor and patient. It’s better to have an open mind about this particular matter. I think a much better way to approach this sensitive subject is to tell your patients why you don’t personally do them, but keep that information between you and your patient. Let them decide based on your history and education if you’re the right fit for them instead of blasting all physicians who still deem the exams very useful. I feel like if they caused more harm than good that the majority of physicians would no longer implement them. This is just my opinion.

    Monday, August 19, 2013 at 11:00 pm | Permalink
  95. Joan wrote:

    My midwives arrived after I started pushing. I wish I had put in my birth plan not to be internally checked because it was very obvious the baby was coming and it was very painful to lie down and have her check me. It took 8 cycles of pushing to lie down and get back up when I could have been in the pool. That is my only regret from my birth.

    Friday, October 18, 2013 at 11:02 pm | Permalink

13 Trackbacks/Pingbacks

  1. Cervical Checks « Team Willms on Friday, February 26, 2010 at 9:33 pm

    [...] midwife’s blog post Cervical Exams: Who Needs Them? rants in more detail on the [...]

  2. NHBS › Birth of Baby J! on Tuesday, April 6, 2010 at 6:25 pm

    [...] and barely 50% effaced.  She was disappointed, I know…but (and this makes me laugh) had read my blog post on internal examinations and knew that she shouldn’t put too much stock into [...]

  3. Sondra’s story, Part 2 « intensely trivial on Wednesday, June 23, 2010 at 10:40 am

    [...] appointment with Carina, her midwife. Carina checked her cervix. (Oh, I am getting mighty tired of unnecessary prelabor cervical checks.) She was still 0 cm dilated, but had effaced a lot, and her cervix was farther down — which [...]

  4. Born Doula Services – Calgary, Alberta on Tuesday, September 28, 2010 at 8:18 am

    [...] Cervical Checks: Who Needs Them? [...]

  5. My 10 Tips for a Natural Birth « Euphoric Birth Services on Friday, October 22, 2010 at 10:47 am

    [...] more than an hour. It is a risk! If it ain’t broke don’t break it ) Read the article Cervical Exams – Who Needs Them?! 5.) Do not go to the hospital until you are in ACTIVE labor. Labor out in the parking lot or a [...]

  6. Cervical Exams: Who Needs Them?! « Euphoric Birth Services on Tuesday, October 26, 2010 at 7:35 pm

    [...] This was written by elfanie. Posted on Tuesday, February 2, 2010, at 12:18 pm. Filed under Midwifery, Pregnancy. Bookmark the permalink. Follow comments here with the RSS feed. Post a comment or leave a trackback. [...]

  7. Cervical Exams « [full of it] on Wednesday, October 27, 2010 at 1:17 pm

    [...] Cervical Exams: Who Needs Them? [...]

  8. [...] This post was mentioned on Twitter by Crystal Di Domizio, Pregnancy Awareness. Pregnancy Awareness said: Pregnant? Do you, will you need an exam? Read and tell us your thoughts! http://fb.me/Uuil4wz1 [...]

  9. Should you have a cervical exam? « misskalypso on Wednesday, March 9, 2011 at 6:00 am

    [...] http://www.nurturingheartsbirthservices.com/blog/?p=50 [...]

  10. NHBS › Prenatal Perineal Massage on Monday, July 18, 2011 at 11:22 am

    [...] labor. I get asked to check a woman’s cervix in my office at the end of her pregnancy (I wrote a blog post about that, too!) and I find that fitting two fingers inside is a little snug. I try to be as [...]

  11. [...] more than an hour. It is a risk! If it ain’t broke don’t break it ) Read the article Cervical Exams – Who Needs Them?! 5.) Do not go to the hospital until you are in ACTIVE labor. Labor out in the parking lot or a [...]

  12. [...] out the Nurturing Hearts blog for a more in depth article from midwife’s perspective. The comments  also make for good [...]

  13. 33 weeks and no thinning at all? advice? - BabyandBump on Tuesday, August 20, 2013 at 4:13 pm

    [...] crystal ball. Dilation/effacement is really not all that great at predicting the onset of labor. This article does a good job breaking it [...]

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