Trigger Warning: Some language in this blog post may be upsetting for those who have experienced sexual assault and/or medical assault in the past. Please proceed with caution.

You’re nearing the end of your pregnancy… maybe you are coming close to your estimated due date or you have long passed it and you are DONE. I’ve been there. The end of pregnancy is effing hard. Physically, you are in pain and tired. Mentally, you are ready to meet your baby and the birth anxieties may be at an all time high. Some mama’s choose to have cervical checks by their provider towards the end of pregnancy and some don’t. When an OB or Midwife assesses the cervix, they can usually determine the current dilation and effacement of the cervix and station of the baby. What makes an expecting mom choose to have cervical exams vs. forgo them and what do all of these terms mean?

Depending on your provider, you may be offered cervical checks at your routine appointments during the last month of your pregnancy. Some providers don’t perform cervical checks at all and others only provide checks once your estimated due date rolls around. All providers have different opinions and routine practices when it comes to cervical checks so first and foremost, you’ll want to have an understanding on what your OB or Midwifes’ routine care towards the end of pregnancy looks like. Then it’s up to you to make an informed decision on what is right for you and your pregnancy.

How Is A Cervical Exam Performed?

To perform a cervical check, your provider will insert two fingers inside of the vagina and feel for the cervix as well as babies head. They can then determine how open (dilation), thin and soft (effacement) the cervix is (or isn’t) and how low (or high) your baby’s head is in the pelvis (station). Dilation is measured in centimeters (cm) and goes from 0-10 cm. Effacement is measured in a percentage and goes from 0% (hard and thick cervix) to 100% (completely thinned out or non-existent). Stations are measured from -3 to +3. Check out the diagrams below to get a visual…

Should You Opt-In For Cervical Exams?

It is important to understand the benefits and the risk factors when determining whether you will opt in or forgo cervical checks at the end of your pregnancy. It may be beneficial for a mom experiencing preterm labor symptoms in order to determine whether medical intervention is necessary to help keep baby in longer or to help baby’s lungs mature faster in the anticipation of an early delivery. The biggest risk factor of these checks is introducing bacteria into the uterus causing an infection, especially if the amniotic sac has ruptured.

The other thing to consider is how a cervical check might impact you mentally. Some moms like to have the information so they can feel how close or far away labor may be but the reality is that no amount of dilation or effacement can give you an accurate telling on when labor will occur. Some moms get checked, find out they are not dilated at all but then go into labor spontaneously later that day. On the other hand, some moms walk around at 4 cm dilated and 70% effaced for weeks before active labor begins. For some, this may not mentally impact you at all. For others, it can become a big mental game that affects your emotions negatively.

Cervical checks are also sometimes routinely done during labor to determine your progression of active labor. You can absolutely decline cervical checks in labor as well if it is against your wishes. Make sure your provider, hospital staff and/or birth team are all aware of these wishes prior to labor and upon admission (if birthing in hospital or birthing center). You can do this via birth plan and/or vocally, but I usually recommend doing both. This can help prevent any possible uncomfortable conversations while you are in the midst of active labor feeling vulnerable. You want to avoid disruption to your labor zone!

Where In The Pelvis Is Your Baby?

For me, as a birth doula, it can be beneficial to understand baby’s location in the pelvis. This is especially true when a mom is experiencing prodromal labor, start and stop contractions, or a stalled labor. A cervical exam (done by your provider) is one way to determine baby’s location in the pelvis. If your provider determines your baby to be a -3 or -2, baby is in the inlet (top of the pelvis). A -1 thru +1 station would mean the baby is in the mid-pelvis and +2 or +3 would mean baby is in the outlet (bottom of pelvis). However, for those who do not want cervical checks prior to or in active labor or simply do not have access to a provider check at the time, there are other ways to get a pretty accurate understanding of where in the pelvis your baby is. Your provider or doula may be able to get an idea of baby’s location based on a combination of where you are feeling the most discomfort with contractions, what kind of labor noises you are making, how you are instinctively moving your body during labor, as well as looking for some visual indicators in your lower back/butt and/or hips.

The Importance Behind Baby’s Location

The location of your baby is important because it gives us indication of what “tools” may be necessary to physiologically help your labor progress. This can include different types of massage and stretching to create balance in your pelvis, as well as different laboring positions to create space in your pelvis. It’s your baby’s job during active labor to rotate and move down but they can only work with the space and conditions they have. Sometimes laboring moms will instinctively move and change positions creating the space baby needs. She may not know at the time why she is doing what she is… other than it’s what felt good at the time! Sometimes moms can benefit from suggestions and assistance on different laboring positions to try, especially those with epidurals that may not have all of the feelings in their lower body to follow.

Whether or not you decide to have or decline cervical checks in pregnancy and labor, just remember that body autonomy is your RIGHT and it’s up to you to explore the risks, the benefits and decide what is right for you. As a doula, it is my job and an honor to educate, support and never judge your choices.

Lots of labor love to all!!

XOXO,

Katie

Birth Doula

Mom of 5