What Your OB Won't Tell You About Cervical Exams
READER NOTE: This post may not be for you if you are experiencing PTSD from birth and/or sexual assault, or if you are pregnant or freshly postpartum and wanting to protect your energetic space. Xx
Cervical Exams are a subjective measurement of your cervical dilation (openness) at any given moment. This means that two nurses and a doctor might all get slightly different readings even if your cervix has not changed. Effacement is the term used to describe the thinning of your cervix as your uterus contracts and pulls the cervix open and upward toward the fundus (top) of the uterus. This process builds the fundus, increasing the power of contractions as the birth process progresses - and ultimately aids the fetal ejection reflex at the climax of your birth story. Medical staff declare women "complete," meaning "ready to push" when the cervix is 10 centimeters dilated and maximally effaced. This diagnosis does not consider that women do not need instructions to birth their babies.
Anybody who has witnessed, or given birth with regulated birth attendants knows that cervical exams - also known as cervical checks, dilation checks, and simply "checks" - are assumed to be just part of the deal. Here's the thing though - done without full, enthusiastic consent - cervical exams are sexual assault.
The delivery room is the #1 place where variations of rape are considered appropriate care. This includes unauthorized episiotomies, the insertion of internal fetal monitoring and contraction monitoring technology, the insertion of medical instruments or drugs such as vacuums, forceps, foley catheters, cervadil and cytotec, and forced removal of the placenta- but most frequent is the performance of cervical exams during labor.
If we zoom out of this picture a little, we can take note that most women will receive their first cervical exam while they are still pregnant! This is usually communicated as a way to determine if you will go into labor soon, based on the dilation and effacement of your cervix at the time of your appointment. Prior to this, most women receive regular pelvic exams as part of standard obstetric care, with pap smears (cervical biopsies). In other words, the human cervix is no stranger to manipulation.
The cervix is, however, a wise portal that deserves love, respect, and trust. It is a source of power in the female body - a connection to the soul land. The cervix knows how to open, in it's own time for birth - and will do this when it feels safe, and in correspondance with your baby.
Here's what you need to know about cervical exams:
Cervical Exams Do Not Tell You How Your Labor Will Progress.
Your cervix may change at any speed. You could be open 1-2 centimeters for weeks before labor begins, or until your baby is fully ready to emerge when you open very quickly thereafter. You could also be comfortably open 4 centimeters before you feel any sense of contractions, and you may or may not birth your baby within 24 hours after this! Conclusion: the numerical measure of your body's openness does not really matter.
Birth, while it is the same in many aspects for women everywhere, comes in infinate variations in regards to cervical change, time, intensity, and perceptions of sensation.
In an industrial setting, like a hospital or in the presence of midwives practicing under the obstetric care model - cervical exams are a way to place women and birth on a timeline. If your body's process does not adhere to this man-made model, there is an increased liklihood for unneccesary intervention to occur, such as administration of uterotonic drugs like pitocin or syntocinon, membrane sweeps, artificial rupture of membranes, and cesarean section surgery.
Cervical Exams Increase the Risk of Infection & More.
The standard practice for cervical exams is to receive one upon arrival to the hospital. This is to determine if you are indeed in labor (*insert eyeroll*), then to confirm that you are indeed far enough in the birth process to be accepted into the labor and delivery unit, and to document your baseline presentation for comparison later should any concerns arise. This is already at least two cervical exams.
THEN, because a man named Friedman (circa 1955) decided that first time moms should only labor for up to 14 hours, and women who have birthed before should only labor for 8 hours, the standard for care is also to perform cervical exams every hour to assess that the cervix is indeed opening and effacing at a consistent speed to meet these time parameters (like cervixes have speedometers. *more eyeroll*). Assuming that one particular birth lasts 8 hours - that is a total of 10 cervical exams within that time, granted that nobody decided to get a second opinion.
That is a LOT of vaginal entry - each one possibily introducing bacteria to the cervix and therefore the baby and uterus. Standard practice is to use sterile gloves, for this reason - and while this definately helps, it is not guaranteed to prevent infection.
With every exam (or entry of other foreign objects into the vaginal space during birth), comes the additional risk of artificial membrane rupture. The amniotic membrane is protective to the baby en utero. Artificial rupture (intentional or not) increases the risk of infection to the amniotic space your baby is living in, increases the risk of cord prolapse and can prematurely increase the intensity of uterine contractions because the cushion of the amniotic fluid is now gone. This can subsequently contribute to fetal distress and increase your risk of additional interventions.
Cervical Exams Can Strengthen Contractions and Prolong Labor.
This piece right here is what inspired me to write this blog post today - because so, so many women when faced with memories of cervical exams wince and talk about the pain and discomfort.
The cervix is a sphincter. It is the opening to the uterus. It's primary jobs are to hold uterine contents in, let uterine contents out, and protect the uterus from external invasions.
Cervical exams are performed with two fingers, pressed against or into the cervical opening. If the space is larger than 3-ish centimeters, the person performing the exam spreads their fingers to either side of the cervical opening. This in and of itself is a violation to the cervix's purpose #3 as stated above.
In the oh-so-popular birth education book "Ina May's Guide to Childbirth," Ina May Gaskin writes about the Sphincter Law, which in summary states that sphincters function best in privacy. This is reflected in a human's nature to seek privacy to release stool and urine. This Sphincter Law states that when this process of relaxing and opening is disturbed (such as with touch), the sphincter can and likely will close. This is a protective mechanism that is very often pathologized under the umbrella term "Failure to Progress," much to the detriment of women, babies, and the cultural norms around birth.
The stimulation of the cervix, especially in mid-late phases of the birth process, can irritate the uterus, causing strong contractions that would not otherwise be part of your birth process. These contractions can feel much more painful than your body's natural rhythm, and may be accompanied by light bleeding. Fear and bodily tension inform your brain and birthing hormones that it is not safe to birth here and now - and the wise body responds accordingly by slowing or stalling it's contraction frequency and duration.
To the unattentive eye, this might appear as Failure to Progress, and again, lead to more intense intervention.
Cervical Exams Are Not Necessary
While obstetric interventions have their place, they simply are not appropriate for standardized "prophylactic" care of birthing women.
The female body is exquisitely wise. Birth amplifies one's awareness of a human woman's primal intuitive driving force. This level of consciousness - of superawareness - of power and rebirth - is not supported, or arguably possible when birthing women are endlessly infantilized, pathologized, oppressed, and abused. In fact, some would argue that it is for this reason such arbitrary obstetric practices exist is in the first place.
It is quite eye-opening to realize that despite the wealth, wisdom, and resources available in the United States, that our country has one of the worst statistics for infant mortality. I dare say that this is due to the mistreatment of women - especially of BIPOC women - the systematic abandoment of new mothers, and the disbandedment of women-centered communities.
To revive and rise, women must return to the wisdom within them - and create spaces for the reconnection to their primal, intuitive knowing - their natural rhythms - their protective instincts. With these vital qualities intact - one could compare a birthing woman to a fierce, regal lioness - and would not dare step into her space uninvited.
Please note that many common obstetric habits used today are not evidence based guidelines. Your informed or uninformed consent is imperative to quality care. Trust your heart and your gut feelings. Coersion into cervical exams and all other screenings, tests, and interventions is unethical and abusive. Please ensure your provider and planned birth environment feel appropriate for you, your body, & your values.