I am consistently surprised when I meet with doula clients who don’t know that having a cervical exam is their choice! Although it’s become fairly standard, especially for those working with an OB, cervical exams at the end of pregnancy (or anytime throughout pregnancy and labor) are absolutely not required.
Because we believe so firmly that every mama deserves to know her options in pregnancy, labor and birth, today I’m going to dig into the details of cervical exams – why they are performed, what the research says and how to talk with your provider if you do or do not want one.
The Basics: when and how they are performed
Cervical exams (also referred to as vaginal or pelvic exams) are typically performed near the end of pregnancy, starting around 36 or 37 weeks and generally continue routinely at each prenatal appointment. Cervical exams are also usually performed upon arriving at the hospital and throughout your labor.
Your provider will insert two gloved fingers into your vaginal opening until they reach your cervix. They will evaluate your cervix briefly (usually taking less than one or two minutes) and share information on dilation (how many centimeters open your cervix is) and effacement (if your cervix is still long or thinned out, as a percentage). They may also assess the position of your cervix, the consistency (or softness) of your cervix and the baby’s station (if baby is high, middle or low in the pelvis).
Why are cervical exams performed?
All of these measurements gathered during a cervical exam (dilation, effacement, position, consistency and station) provide a snapshot of labor progression. During prenatal appointments, your provider is checking to find out if your body has started progressing toward labor. Upon arrival at the hospital, a nurse may perform an exam to determine if you are in active labor (usually defined as 6cm dilation). During labor, you may have cervical exams done to evaluate your progress over time.
However, the information gathered is just that… a snapshot of the very moment. A cervical exam does not give us a forecast for when labor will begin or how it will progress moving forward. Many like to say that “a cervical exam is not a crystal ball!”
We tend to agree with our friends at Evidence Based Birth – cervical exams satisfy curiosity. In some cases, a cervical exam is performed to determine the best method of necessary induction, but in most other cases, these exams simply give us a bit of information about where the pregnant person is in the present moment.
The Research
The body of research on the effectiveness of cervical exams is limited. An updated Cochrane review published in 2022 compared several methods of assessing labor, including cervical exams. The researchers concluded that no one method, including cervical exams, was more or less effective. They suggest that further research is needed and should include the evaluation of a woman’s experience to truly determine if a cervical exam (or any other assessment) is effective.
It’s also important to understand that cervical exams do potentially come with some risks. Some women find the exams to be triggering mentally or emotionally. Sometimes a provider may recommend an induction if you aren’t “progressed enough,” which can be particularly frustrating if you’re waiting for spontaneous labor like most VBAC mamas.
Another study performed in 2022 found an increase in infection for those who had at least eight cervical exams compared to those who had one to three exams. Furthermore, cervical exams are also linked to the potential for PROM (premature rupture of membranes, essentially your water breaking early) and/or having a membrane sweep either with or without your consent.
Essentially, researchers seem to agree that there is no actual benefit to doing cervical exams, and some suggest that unnecessary exams should be avoided altogether.
Things to Consider
As with all things in pregnancy and birth, we want to remind you that you have choices. Cervical exams are no exception. After reviewing the research, here are a few things to consider when deciding if you want to have a cervical exam…
- Does the idea of a cervical exam make you uncomfortable physically? Exams can cause discomfort, pain and some bleeding.
- Does the idea of a cervical exam make you uncomfortable emotionally?
- How might the outcome of the exam affect you mentally?
- Will the outcome of the exam change your mind about anything you are or aren’t doing to prepare for labor? During labor?
- Are you curious about how your body is progressing?
- Are you concerned about having a membrane sweep, PROM or risk for infection?
Advocating for Yourself
As explained above, cervical exams “generally” start around 36 or 37 weeks and “generally” continue routinely each week. Cervical exams are “generally” done when you get to the hospital and every few hours during labor, BUT… they are not a requirement. Just because something is “generally” done or a standard procedure for your provider or birthplace does not mean that you have to do it.
Here are some suggestions for communicating with your provider about cervical exams…
- Discuss your provider’s standard care and plan for cervical exams before you get to 36 weeks so that you don’t get caught off guard.
- Don’t undress. If you know you don’t want an exam, keep your clothes on for the whole appointment rather than undressing before the provider comes in.
- Bring a partner to help you communicate confidently.
- Remember, you don’t have to provide research or defend your choices. Simply saying, “No, thank you,” is more than enough.
And remember, YOU are in charge of your birth experience. If you change your mind about wanting or not wanting to have a cervical exam at any point, you have that right. Hopefully this has given you the information to make the choice that is right for you as you plan your VBAC.
As always, I’ll leave you with this affirmation and reminder…
We’re VBAC Moms