5 reasons to skip the routine cervical checks
There are definitely a few reasons why you might want a cervical exam at some point. Maybe there has been a stall in labor descent and your provider wants to determine baby’s station. Or maybe they need to get up there to insert an intrauterine pressure catheter, an internal monitor, or an amniohook. Some providers like to push the ‘last lip’ of the cervix away near the end of dilation, though it seems the jury is still out on that one.
Generally though, cervical checks are kind of pointless. Really the main reason they are done are because the provider hasn’t been trained in other ways to assess labor progress, or just purely out of a need to follow a protocol, or fill in a note on the schedule. Sometimes, especially in pregnancy, they are done to put pressure on a pregnant woman to go into labor ‘on time.’ So, here are a few reasons to avoid the routine:
Cervical Status prior to labor is NOT an indication of when labor will start or how long it will be: This can’t be stressed enough. Many women can walk around for weeks with a cervix 3 or 4 cm dilated, with or without experiencing prodromal labor, and still not see a baby for weeks. I have heard many women, especially VBAC women, told things like, ‘your cervix is hard and high, so it could be a while,’ or ‘if you aren’t more dilated by your next appointment,’ or ‘if you don’t go into labor by xyz time, then we will need to do a cesarean.’ This is not a medical reason for abdominal surgery, folks. It’s more likely that it’s a ‘bait and switch.’
Increased risk of infection: The vagina has a self-cleaning system. You might have noticed that your vagina makes a sort of ‘discharge,’ or, a word I like better for it that doesn’t sound like trash: ‘cervical fluid.’ Sidenote: this cervical fluid is actually an awesome tool for tracking your fertility. Cervical fluid flows down and out of your vagina, bringing bacteria with it, down and away from the baby. So when a hand, sterilized and gloved as it may be, gets shoved up there, it drags along some of that bacteria-filled fluid with it. The vagina is naturally cultured with bacteria that can be harmful, if it’s not in the right balance, or the right place at the right time. Introducing this bacteria to the cervix again can still increase the risk of infection to the amniotic sac, the cord, or the placenta.
Increased risk of accidental or unconsented membrane stripping, sweeping, or premature rupture of membranes: Even with lots of skill, a provider can still disturb the amniotic sac. Sadly, this is how most unconsented cervical procedures are done - during a routine cervical check. You might not even realize they are being done. Yet each of these procedures comes with its own set of risks.
Increased risk of preterm labor: This is mainly due to the risks that come along with the procedures mentioned above. If the amniotic sac is disturbed, a baby could become stressed, triggering a process to cause early labor.
May cause unnecessary distress or disappointment based on where your body is right NOW: The important thing to consider with cervical checks, especially in labor, is that it doesn’t actually tell you much. What it tells you is what progress your cervix has made so far (including effacement, dilation, and station), but that information CANNOT predict the future. Knowing this information might be useful for making decisions in the moment, like whether or not you need to change positions to help balance your body and help a baby navigate the pelvis, but it won’t tell you how many hours until pushing time. Your vagina is not a crystal ball. It can’t tell you the future.
Maybe you’re exhausted and you just want to know that you’ve made some kind of progress. That is so understandable, and I have even done that myself. But beware, this is risky: many women I work with do this only to find out that after hours of labor, they’ve only made it to 3 or 4cm dilation, or only made it a bit further in effacement than the last time they were checked. A small number can seem disheartening. But many people do most of their cervical dilation very quickly only near the end of labor.
It’s important to note also, that cervical checks are a very subjective measurement. Its accuracy can only really be measured up against another care provider’s subjective measurement. The reason your nurse wants to ‘get a baseline,’ is because once a new nurse comes in, she might be measuring your cervix completely differently. There have been studies to show that even an ultrasound is more accurate at telling whether a baby is persistently posterior in labor than fingers at the cervix.
Tbh, providers pushing their fingers up there (and pushing against the vagina's natural cleaning system of bacteria flowing downward) for no reason other than routine, to 'get a baseline,' or to 'check if you're complete' seems just creepy to me lately. #skipthechecks #unlessyoureallyneedit