The “C” Word: What’s up with cervical exams during birth?

I don’t mean the “C” word you’re probably thinking of.

For me, the dreaded “C” stands for the first word in “Cervical Exam”. I’m going to be completely honest and opinionated about this. I really dislike cervical exams during birth.

Watching a birthing woman get out of her rhythm and onto her back so her health practitioner can put gloved fingers inside of her to poke around at her cervix is on the very bottom of the list of things that make me happy.

And it’s not just because cervical exams are “kind of awkward”. They can cause a serious amount of discomfort in a birthing woman. Not only that, in my opinion, they seem unhelpful and counterproductive, giving little information for a birthing woman to work with and doing a lot of potential damage to her process.

I don’t know about you, but I’m  pretty picky about who I allow to put their fingers inside my vagina. I generally don’t let complete strangers do it, and I’ve NEVER let more than one person do it in one day.

If you’re birthing with a doctor, by the time you finish your stay in the hospital, you will potentially have had at least 3 people’s fingers up there at various stages: two or three nurses as shifts and breaks rotate through, and your doctor . If you’re at a teaching hospital such as BC Women’s, you can probably tack on a resident to the list as well. If you’re lucky, it will be your own doctor performing the exam at least one time. But only if he or she happens to be on call. The rest of the people putting their fingers in you will be people you have only just met, and they certainly won’t take you out to dinner first. Note: One advantage to choosing a registered midwife as your primary practitioner means she will be the only one examining you (unless she ends up consulting with an OB about your birth at some point) and you will have at least had a conversation with the woman beforehand. But even in that circumstance, I’m still not not happy.

So why do these complete strangers want to put their fingers all up in your goods in the first place?

Worrying that mom will push against a cervix that is not fully open:

Let’s explain what is going on with your brilliant cervix during birth. The cervix is the bottom portion of your uterus, which opens into the vagina.  The baby moves through the cervix, into the vagina and out into the big wide world.  Before your birthing time, your cervix is hard, long and closed. It feels like the tip of your nose. This is so the baby doesn’t just fall out before he or she is ready to live and breathe outside of mom’s body. During birth, the cervix softens, opens and shortens. It becomes as soft as your lips, and opens up from closed (0 cm diameter) to what we call “fully dilated” which is 10cm in diameter. The female body is pretty amazing.

The fear is that mom will start pushing before her cervix is fully dilated and nice and soft. Pushing against a hard cervix can cause the cervix to swell, and then one would be hooped because there would not be room for baby to come out. Or you may tear your cervix, which obviously we all are inclined to avoid. That just doesn’t sound awesome.

If we don’t do a cervical exam, how does a birth attendant know when mom is ready to push? Well, they don’t necessarily (although there a certainly some signs of dilation other than cervical exams). But mom does. Her body is pretty cool. At some point, she will slowly start to get what is called the urge to push. As her pressure waves continue to get longer, stronger and closer together, she’ll usually start to sound “pushy”, making deep throaty sounds with her waves.  The surges will start to take over her whole body as her uterus makes motions to push the baby further and further down. Eventually, mom will usually bear down a bit with each wave. She’ll do this naturally and gently, only as much as feels good to her with each wave. Ultimately, her body’s sensations will be so wonderfully intense that she will work with them. It will feel good to push, and she may not even realize she’s doing it! Baby’s head will be able to move around the pubic bone and out the vagina. Amazing.

Of course, if mom has had an epidural, she won’t be tuned in to her sensations, and she won’t get that urge to push. In this case, cervical exams are necessary to assess dilation, so that when the cervix hits 10cm a whole crew of cheerleaders: dad, nurse, midwife, doula can gather round the bed and scream “push, come on, keep it coming, you can do it, don’t stop, breathe in push again, you got it, push push push, hurry HARD” like some kind of curling team gone mad.

So, what about that fear that mom will push before her cervix is open fully? My personal belief is that mom, if left alone, will NOT push until her body is ready. Just like we don’t go sit on the toilet for 8 hours and push before our bodies tell us we will soon be having a bowel movement, and no one has to tell us to push when the time comes. Our bodies are made for this, and they know what they are doing. But if mom’s not confident in her body and wants some reassurance once she starts finding herself bearing down with her pressure waves, she certainly has the right to gently ease her own fingers inside herself and feel how open and soft she is. In the end, you’ll know she became fully dilated because a baby will come out.

But at the very, very least, if mom WANTS a medical professional to asses her dilation, why not wait until she starts to feel pushy? If mom is worried about pushing too soon, I can’t understand why you would want to start assessing her dilation hours before she even begins having the urge to push.

Why do they start doing cervical exams so early in the birth process?

Because hospitals are all about efficiency and management. They want a birth to progress at a certain rate. Once a woman is in the active phase of birthing (5cm of dilation and onward), they want to see her dilate at a rate of 1cm per hour. They perform vaginal exams so they can diagnose if birth is progressing too slowly for their standards, and if it is, they will recommend augmenting progress through an induction method such as rupturing her membranes or administering artificial oxytocin with an I.V.

It’s important to note that women are not baby factories, and giving birth is not simply about being efficient. Every woman’s body is different, and every birth will progress at a different rate. In fact, generally speaking, a slow birth can be a much more gentle experience on mom’s body.

The risks of cervical exams:

They interfere with mom’s rhythm

Women kind of go away during birth. They go into an altered state, becoming very inwardly focused, and this altered state allows the normal progression of birth to take place. Interrupting her, asking her to get onto her back (the most uncomfortable position to be in while birthing) and allow you to perform a vaginal exam while she is having pressure waves every 30 seconds interrupts this altered state, and it is difficult to get back into it.

They are uncomfortable and stressful

Vaginal exams are uncomfortable at the best of times, even when a non-pregnant woman simply has one done in her annual medical physical. During birth, women are very sensitive, and extremely uncomfortable being on their backs. The often extreme discomfort of a cervical exam can cause stress, and as I always say, stress is the enemy of birth. Stress hormones get released, and they actually physiologically inhibit the progression of birth. This has an evolutionary explanation: if a mammal in the wild was suddenly in danger, she would need to stop birthing so she could run away to safety.

They can throw off mom’s confidence somethin’ awful

This again relates to the huge role stress plays in inhibiting and slowing down birth. For example, one of my first hospital births turned quickly into a medical procedure when mom was given artificial oxytocin to bring on pressure waves after hers stopped completely. Why did they stop? Because after a cervical exam, the midwife sighed and said “It’s been two hours, and you’ve only progressed another half centimeter”.  Mom became scared she was going to be given artificial oxytocin, and through her prenatal education had learned how much more intense pressure waves are with that intervention. Her pressure waves stopped instantly because she became stressed, discouraged and disappointed to hear her body wasn’t performing up to par. It was amazing. Nothing highlights the truth about mind-body one-ness like birth. I really liked a recent article that explores this, called How Cervical Dilation Checks Undermine the Imaginal Power of Birthing Women.

Ultimately, what we are doing with vaginal exams is trying to make sure birth is progressing “fast enough”, while the very act of the vaginal exam has huge potential for slowing down birth! Not only that, it has the added risk of introducing bacteria with the potential of causing an infection with every single exam. It seems ridiculous to me.

Your rights when it comes to cervical exams

As with anything in our medical system, you always have the right to decline diagnostic techniques or medical treatments. It is very important that you give consent to a vaginal exam before it is performed. It is also important to know that if you make an informed choice to decline an exam or being examined by any particular person, it is absolutely your right to do so. That being said, care providers have their own philosophy and reasons for wanting to do cervical exams.  If you feel more comfortable and confident having your medical professional assess your cervical dilation regularly, that’s fine too.

But just know it’s your choice.  This should go with out saying, but it is always up to you to decide who you let put what in your vagina, whether they are wearing scrubs and a white lab coat or not.

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  15 comments for “The “C” Word: What’s up with cervical exams during birth?

  1. Carla
    September 23, 2015 at 10:00 pm

    I just had my first baby a week ago. I went to the hospital soon after my water broke at home because I was Bstrep positive and chose to take the antibiotics during labor. I had two cervical checks right away and both midwives/doctors said they couldn’t find my cervix since it was so far back behind baby’s head and probably just 1 cm open. The checks were excrutiating. The midwife even said she is very rough with hers. I then labored for 10 hours with no intervention. I felt the contractions becoming almost unbearable, 60-90 sec. long but not very regular and about 2-4 min. apart. I refused any more checks and the midwife said that was totally fine. But she did eventually suggest a little pitocin because the monitor was showing that the contractions weren’t that strong and they needed to become much stronger and closer. I decided I wouldn’t take the pitocin without an epi because I was scared. All was well in the end, but now I’m left wondering how close I was, and whether the midwife could have known for sure I had a long way to go as she said.. When they checked 4 hours after the pitocin started I was fully dilated and +3 station.
    My question is: can a very experienced, awesome midwife know how dilated you are by looking at you and the contractions on the monitor? Was it a mistake to refuse the checks and accept other interventions having no idea how dilated I was? Thanks for any input.

  2. Lisa
    June 8, 2015 at 12:20 pm

    I’m sorry you had a bad experience but I think you are very mistaken. You are making it sound like medical professionals treat birthing mothers like “baby factories” as you put it. Medical professionals are there to help you and your baby succeed. I am a registered nurse and can tell you that good doctors and nurses would never push you unnecessarily. There is a reason why we want the birthing process to progress at a certain rate and it has to do with complications that can develop from prolonged or precipitate births/labours, such as postpartum hemorrhage, exhaustion, perineal lacerations, fetal anoxia, fetal intracranial hemorrhage, infection, fetal distress, etc. Everything we do has a rationale. Those nurses and doctors on the unit are extremely busy and have better things to do than conduct vaginal exams if they are not totally necessary; they do it to keep you and your baby safe and though I understand that it may be very uncomfortable and probably the last thing you want while you are in labor, it is necessary and is part of an ongoing assessment to ensure you and your baby remain safe.

    • Jessica
      June 19, 2015 at 3:43 pm

      Hi Lisa. Thanks for your comment.

      Here’s what the Cochrane Collection has to say about routine cervical checks during birth:

      ‘If labours that are slow, but not abnormal, are mis-diagnosed as being abnormal, this can lead to unnecessary interventions such as drugs to try to speed labour on or caesarean section or forceps for giving birth. There are also concerns about introducing infection to the uterus and to the baby.”

      “In addition, some women find the process of vaginal examinations uncomfortable or distressing, and so it is important that there is good evidence for its use. We looked for studies to see how effective routine vaginal examinations in labour are at reducing problems for mothers and babies.”

      “We identified no convincing evidence to support, or reject, the use of routine vaginal examinations in labour, yet this is common practice throughout the world. More research is needed to find out if vaginal examinations are a useful measure of both normal and abnormal labour progress.”

      You can read the full review here:

      I like this quote from a study on the effectiveness of routine vaginal exams:

      “It is surprising that there is such a widespread use of this intervention without good evidence of effectiveness, particularly considering the sensitivity of the procedure for the women receiving it, and the potential for adverse consequences in some settings.” (Downe et al, 2013)

    • Jessica
      June 19, 2015 at 3:48 pm

      Also, just to avoid confusion, I’m not sure what you mean when you say “I’m sorry you had a bad experience.” I have not personally had a bad experience with vaginal exams, but I have witnessed and heard countless mothers complain about them and the impact they had on their birth. I’ve also witnessed countless births with no exams whatsoever. I understand that there are always rare circumstances where interventions and examinations are helpful, but I urge you to explore your belief that *routine* vaginal exams are as necessary and helpful as you currently think they are :)

  3. Elle Graham
    November 29, 2014 at 3:16 pm

    WHERE???? Where are you ppl having these babies where you can say NO to a cervical exam??? I sought care with a midwife and told her at my meet and greet that I will not consent to having anything shoved up my lady bits in labor. I went through my entire pregnancy without being “poked”. Then my contractions started and it was like the mask dropped. All of a sudden it was, “you will do it or you can have your baby here.” I found this traumatic and coercive. Obviously, it all ended in an unnecessarian 48 hours later (after countless exams by ppl I didn’t know, and interventions, etc. because I was too scared to relax and dilate). So…who are these doctors/midwives who take NO for an answer? Where are they? I really want another baby or two but I CAN’T live through the psychological trauma of being threatened and coerced again.

    • December 12, 2014 at 12:10 am

      Hi Elle! Where do you live? It is so upsetting to hear these kinds of stories from women who had these kinds of experiences. Start connecting with your local birth community and ask around, interview midwives and find out who the choice supportive pros are in your area!

  4. Chelsie
    October 12, 2012 at 6:34 pm

    I am ALL for this (refusal of cervical exams)! Of my 3 homebirths, I’ve only been examined once (as I felt the urge to push with my first child). It was the most painful part of labor for me and since then have refused all exams since I now know what it feels like when I’m ready to push. :) It bums me out that women are coerced into routine c-exams. Ick.

  5. June 14, 2012 at 12:06 pm

    This post is something I’d wish I’d read three years ago!  But does anyone know how to explain the involuntary desire to push with a posterior baby where most of the labor feels like it’s along the woman’s back?  This is the big question I have to try to help me understand the birth I went through, and what I could have done differently.  So if you or anyone else has any ideas on this, I would love to learn more!  Thanks so much for writing this blog, Jessica, and for your work.  It is so incredibly vital.

    • June 14, 2012 at 10:03 pm

      Thanks for your comments! 

      I’m curious… when you felt the desire to push, do you mean this was long before you were fully dilated? And where were you feeling the pushy sensations? In your front / back / bum? (curious, if you don’t mind sharing!)

  6. Liesl
    June 5, 2012 at 9:20 am

    Unfortunately, with my (attempted homebirth) labour, I did feel a strong and undeniable urge to push at 6cms. The midwives tried everything to get me to stop and I could not. My cervix did swell and I ended up with a c-section.

    • June 7, 2012 at 2:10 pm

      Thanks for your comment! Although your birth took a course that differed from your vision of a homebirth, I hope you felt like you were informed and involved in the decision making processes along the way! 

  7. Robyn
    June 4, 2012 at 4:18 pm

    Don’t forget about rough exams causing a premature rupture of the membranes.  YIKES!

  8. Midwife International
    June 4, 2012 at 12:55 pm

    I agree with this 90% of the births do not need vaginal exams.
    However — I have discovered asyncitic baby and babies ( twins) that needed a little reclining up
    Vag exam dd this and has successful home deliveries
    Yes, very limited vaginal exams are the best and should be the same person
    But great good can save lives ,when vaginal exam shows prolapsed cord, or foot etc

    Gail Jonson CPM

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