CERVICAL EXAMS

Are they really needed?

What can your cervix tell you?

Do They Harm or Help?

Cervical exams are rarely truly needed. They provide data for the care provider and hospital, but they may inhibit and create pain for the laboring mother. The mother is often asked to lie on her back for the exam and during labor this can be next to impossible and incredibly uncomfortable. Her cervix is changing and this makes it more tender. It is possible to monitor outward signs of labor instead in most cases. Does the mother have 60 second long contractions that demand all of her focus? Is she showing emotional signs of labor by turning inward? These are great alternatives to invading a mother's vagina, especially with a stranger's hands, and during a process that makes her cervix extremely sensitive. 

The Purple Line

An interesting option is to look for a purple line on the mother. A longitudinal study showed that,

"The purple line was seen at some point in labour for 109 women (76%)."

When Would One Make Sense?

Even though most exams cause pain from the invasive nature of the procedure and may begin the cascade of interventions for some mothers, they do sometimes provide helpful information. For example, a care provider might suspect a positioning problem and may have the skill to feel the baby's fontanelle (soft spot) and this will give them potentially valuable information about the position in the pelvis. They could then recommend specific positioning movements and techniques to help. An alternative would be to go through the desired positioning techniques based on external observation of the labor pattern and the mother's movements. Also, in some cases, when a mother begins to push, she may desire her care provider to check her cervix. Other moms prefer to opt out. There is a small possibility that a tiny part of the cervix is left and when the mom gets the urge to push a little bit too early, she may push on this cervical lip which may swell and impede the 2nd stage. If it does swell, she would need to be in the child's pose to take the pressure off of her cervix and to help the swelling go down. If the care provider checks her cervix when she feels an urge to push, they can determine if dilation is indeed complete. This occurrence is also a reason why many mothers prefer to breathe deeply for as long as they are able, so that they are not putting too much pressure on their cervix by pushing before it is completely gone.

When would one not make sense

Checking yourself

Bishop Score

Skipping Triage/asking for your provider

Dilation

The cervix opens to roughly 10cm. You can measure items in your home, such as canned goods and jars. Anything with a circle. This will tell you exactly where you are at this moment in labor. It will unfortunately tell you nothing about where you are going. Once the cervix reaches 10cm the baby should move through to come down and out of the mother. Some care providers track dilation, expecting to see 1cm every hour and intervening if they don't. The variability of the process is another reason to decline cervical exams and to find a care provider who practices expectant management.

It is very common for a cervical exam to last through a contraction in active labor, which might surprise and upset a laboring mom. She might be on her back and that may create excessive discomfort for her. The care provider often only shares the number with the laboring mom and her support team, but that is often the least telling piece of information.

EFFACEMENt

The effacement may be more important and more significant to track than dilation, because once the cervix is short or completely thinned, there is no resistance and with no resistance it can quickly pop open. If a mother is 80% effaced, like in the Dublin study she may be able to open faster than a mom who is 50% or less. If a mom were told that her cervix did not change over the course of a few hours, ask for the effacement. It is possible that the mother's body was working on this first and she may rapidly go from 6/7 or even 5 cm to 10.

The Cervix Changes Direction

The cervix not only thins, softens and dilates, it moves from an upward position to a downward one. This is another piece of information that tells you that change is happening, but it does not tell you anything about what comes next. When the cervix moves into a downward direction it is primed for delivery. 

The Cervix Gets Softer

This is another good indication that the cervix has made some significant changes. If the cervix is soft, then there is very little resistance and the dilation may catch up rapidly, even if it was not changing before. The texture of the cervix begins by feeling hard like our nose and then softens. It may feel like your cheek. It eventually feels as soft and squishy as your ear lobe.

TEL: 202-441-6771 chava@birthingwithjoy.com