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?

45 Comments

  1. 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
  2. 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
  3. 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
  4. 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
  5. 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
  6. Sharalyn wrote:

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

    Wednesday, October 27, 2010 at 7:18 pm | Permalink
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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
  12. This is great….

    Sunday, November 14, 2010 at 9:57 pm | Permalink
  13. 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
  14. Thinks for great information.It is well for woman health .So thanks for post.

    Friday, November 19, 2010 at 3:25 am | Permalink
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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
  22. 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
  23. 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
  24. 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
  25. elfanie wrote:

    Jollina: Sure!

    Saturday, February 19, 2011 at 10:45 am | Permalink
  26. 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
  27. 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
  28. 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
  29. 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
  30. Tamara wrote:

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

    Friday, March 11, 2011 at 7:22 pm | Permalink
  31. 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
  32. 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
  33. 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
  34. 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
  35. 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
  36. alex wrote:

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

    Saturday, February 4, 2012 at 1:19 pm | Permalink
  37. 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
  38. 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
  39. 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
  40. 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
  41. 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
  42. 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
  43. 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
  44. 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
  45. 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

5 Trackbacks/Pingbacks

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

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

  2. […] 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 […]

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

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

  4. 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 […]

  5. […] 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 […]

Post a Comment

Your email is never published nor shared. Required fields are marked *
*
*