Cervical Exams may just be the most common intervention in birth. This exam, also called "cervical checks" is performed by inserting two gloved fingers into the vagina and assessing the unseen cervix only by feel. The standard protocol for cervical exams during labor is upon triage when presenting to the hospital or birth center, upon admission to the L&D unit, then every 2-4 hours until the completion of your birth.
Cervical exams are standard practice for most providers, and birth settings, even though they do not generally improve birth outcomes, nor do they predict the timeline of your birth. When you are reflecting on your birth philosophies, or constructing a birth plan, consider the value that cervical exams have in your own eyes. Is this information something you want continuous access to or that you want your medical team to have continuous access to - or is this circumstantial - or do you feel it's not something that you warrant of value so will choose to bypass altogether?
It's important to note that you can choose to deny consent for cervical exams at any time, or for the entire duration of your birth. If you plan to, or even think you might want to, decline any cervical exams, it is crucial that you know you can fully trust your provider (and any of their back-up providers) to fully respect your autonomy, meaning that they back off if you say no and that they will ask for explicit permission to do any cervical exams if they feel one would provide important information to your birth in any given moment. Be aware that many providers assume consent by you simply existing in the birth room, and push for routine exams for their own documentation.
In any case, cervical exams can provide some insight to the perceived state of your birth process in any given moment. This post shines some light on the information that can be obtained from a cervical exam from the perspective of a medical provider operating under an obstetric model of care. It also serves to break down communication barriers by introducing you to medical lingo you may hear, even though your providers should always talk to you directly, honestly, and in terms you understand.
Remember that you get to decide the value of this information in your own birth.
1. Your Dilation
How open your cervix is perceived to be.
Measurements range from 0 to 10 cm on a standard obstetric scale, with 0 being that the cervix is closed, 1- 4 cm categorized as early labor, 5-10 cm categorized as active labor, and 10 cm initiating the second stage of labor: birthing your baby.
Cervical dilation is a subjective measurement, meaning that each provider that performs an exam may have a different measurement, and that their measurements do not promise that your cervix is really open at that measurement. Cervical exams can only give an idea of where your cervix is at ain any , does not predict progress. Exam may regress dilation.
How is this information used? Used to document that the cervix is indeed opening over time, and to leave a paper trail of your birth progression. May be used to triage which stage of labor you are in, which can be relevent to hospital admission, and is used to signal providers to get ready for your "pushing stage" or if they will tell you not to push yet to prevent cervical swelling or injury. May also be used to diagnose "failure to progress" if dilation change does not occur at a speed preferred by providers.
2. Your Effacement
How thin your cervix is.
Measured in percentages ranging from 0, being no effacement and full cervical length of about 2 cm can be felt, to 100%, being complete efffacement where the cervix can no longer be felt.
How is this information used?
Used to document that the cervix is indeed thinning over time, determine if the cervix is thinning symmetrically or to help guide it to thin more symmetrically through maternal position changes. This is sometimes known as a cervical "lip" which is simply a cervix that is not finished dilating. May be used to anticipate how close you are to your "pushing stage" and if providers will tell you not to push in attempt to prevent cervical injury. May also be used to diagnose "failure to progress" if effacement does not happen at a rate providers prefer. Intervention may include application of a prostoglandin cervical suppository like Cervidil.
3. Your Baby's Engagement
How far down in the pelvis is your baby?
Measurements range from -4 to +4 with 0 being your baby's presenting part at the level of your ischial spines. Negative numbers mean that your baby is still above the level of your ischial spines, with - 4 being the highest position. Positive numbers mean that your baby has decended past the level of your ischial spines, with +4 meaning that your baby's is at the lowest position in your pelvis, about to be born. In order for your baby to manuever through your pelvis into the lower stations, they will need to flex, extend, and rotate their bodies - something they are intricately designed to do independently.
How is this information used?
Used to document the progression of labor and that your baby is able to continue descending through your pelvis. May be used to diagnose cephalopelvic disproportion (CPD), shoulder dystocia, and justify intervention. Interventions may include encouraging you to move around or change positions, pitocin to strengthen contractions and encourage baby to descend, used of suprapubic pressure if shoulder dystocia is assumed, and possibly cesarean section.
4. Your Baby's Presentation
Which part of your baby's body is coming out first and what position is it in?
Includes variations of breech (feet first or butt first), vertex or cephalic (head first, with your baby's head being in any certain position), transverse (hand only because baby is sideways), and complex (any two body parts are presenting together, like a hand up by your baby's head). The position of your baby's body can be felt externally by palpating your abdomen, and an internal exam would give additional detail about that position.
How is this information used?
Used to determine possible complications before or after birth, and determine if/what type of intervention may be helpful or needed to aide the baby's birth. Interventions may include encouraging you to change position to better accomodate your baby's presentation, potential cesarean section if the provider is uneducated in attending breech birth, and definate cesarean if your baby is transverse while emerging through the cervix. Your provider may also decide that use of a vacuum, forceps, or an episiotomy is appropriate.
5. State of the Umbilical Cord
Where is the cord in relation to the baby?
A prolapsed cord will be felt during a cervical exam, and is an abnormal occurance that increases risk of insufficient blood and oxygen to the baby. This hypoxia may lead to permanant brain damage or neonatal demise. If no cord is felt during an exam, it is assumed that the cord will follow your baby out. Cervical exams do not guarantee that a prolapsed cord will be detected, and a prolapse may suspected if you simply feel the presence of the cord in your vagina without a cervical exam.
How is this information used?
Used to determine if intervention is necessary. Intervention may include instructing you to assume a knee-chin position with your pelvis higher than your head to prevent pressure on the cord followed by a cesarean section. In cases where vaginal birth is imminent, your baby may need to be oxygenated or resuscitated.
Cervical exams can provide information that is beneficial to medical providers, and that helps a birthing woman and her partner feel reassured, but the routine use of cervical exams can and does contribute to the overuse of medical intervention such as vacuum, forceps, episiotomy, and cesarean sections. This fear-based practice, rooted in fear-based maternity, also leads to increased risk of infection while continuously disturbing the physiologic birth process. Submitting birth to routine cervical exams is not proven to improve birth outcomes, yet remains a popular part of routine obstetric care.
What would it feel like to trust your body, to surrender to birth without numerically measuring your body and your baby's progess, and instead - reserving cervical exams for when they become medically relevent to your unique birth journey?
You are the sole authority of your body and your birth.
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