C is for Cervical Checks

One of the most uncomfortable parts of pregnancy, cervical checks, sadly continues during labor.  When you first arrive at the hospital to be admitted, you will be taken to a triage room where a cervical check will be performed to check your labor progress.  This allows the nurses to determine whether or not to admit you and also tells them if you are in early labor, active labor, or nearly ready to push. 

For you lucky ones who haven’t experienced a cervical check yet, they are similar to a pap smear.  You will be asked to lay on your back on the triage table just like for a pap smear, however instead of using the speculum and swab they will insert two fingers and search for your cervix.  This can be quite painful as your cervix may still be posterior, or at the back of your pelvis, and require the fingers to be inserted rather deeply to feel for any cervical changes.  Cervical checks can also cause cramping, spotting, and overall discomfort for a few hours or days. 

Cervical checks are not necessarily a good indicator as to whether or not you will go into labor soon.  Even if you are dilated to 3cm, it may still be weeks before labor begins.  But stay positive, that’s three fewer centimeters you need to dilate during labor!

Are cervical checks needed?  These checks can satisfy your curiosity of how you are progressing during labor, and when you are dilating it can be very motivating to know you are almost fully dilated.  These are also for the convenience of your doctor/midwife and the nurses so they know where in labor you are and whether it is safe to begin pushing. 

What do cervical checks tell you?  Cervical checks tell you and the staff your Bishop score, in other words - how dilated you are, how effaced you are, what station the baby is at, and your cervix position and consistency.  Most hospitals these days will only admit you if you are dilated to at least 5cm – some have even higher requirements.  At the end of labor, these checks will tell you and the staff if you are completely dilated; this determines if it is safe for you to begin pushing without risking a cervical tear.

Can you refuse cervical checks?   You have every right to refuse a cervical check during labor.  However, you will find greater resistance if you refuse getting checked when you first arrive at the hospital so they know whether or not to admit you and again when you think it is time to push so they know you are complete and it is safe to push.  You also have the right to refuse cervical checks during your pregnancy, if you do not want a cervical check, do not give them your consent – they CANNOT force you to have a cervical check during pregnancy or labor.

During labor, if you are at the hospital for a long time, they may want to check you frequently (around every 4 hours), especially if your water hasn’t broken.  This is simply for information of where you are at the time, as it is not a good indicator of how much longer your labor will take.  Pausing to lay on your back during labor for a cervical check is quite painful and can completely disrupt your labor rhythm.  Finding out you haven’t made any progress or have only dilated 1cm over an extended number of hours can also be very discouraging.  This puts extras stress on you as well, which can cause labor to slow down.

Also, each time you have a cervical check, it increases your chance of infection due to bacteria introduced during the check, and the risk increases if your waters have already broken.  Even with clean hands and gloves, there is still a risk of bacteria being introduced.

Another thing to keep in mind regarding cervical checks: the stimulation of your cervix by the doctor or nurse’s fingers can cause you to dilate faster.  This could be a good thing if you are full term, however, if you are in preterm labor, consider limiting your cervical checks.  Frequent checks at the end of labor or during pushing can also aggravate the cervix and cause cervical swelling, which is the opposite of what you want and will likely cause your labor and/or pushing to take longer.  There is also the risk that your waters will rupture during a cervical check while in labor. If you are wanting them to break naturally on their own you may want to consider limiting the number of cervical checks you have.

Cervical checks during labor can be very uncomfortable especially if they continue the check during a contraction.  If you feel a contraction coming on, you can ask them to stop the check until the contraction finishes.  Sometimes the doctor or nurse may want to check during the pushing stage while you are pushing to see how effectively you are pushing – again, if you do not want this, make sure you speak up!

Cervical checks can also be misleading if done by different nurses or doctors over the length of your labor.  Dilation is measured by finger span, and everyone’s finger size is different and so every person measures dilation slightly differently.  So, one nurse may check you and say you are 6cm, just to have a different nurse check you a few hours later and say you are only 5cm, how disappointing!

If you are familiar with your own cervix and your bag of waters is still intact, you can also always perform your own cervical exams to satisfy your curiosity.  Added bonus is you are much gentler on yourself - although it may be difficult to get into an ideal position for checking with your belly in the way.

The choice of if you want cervical checks is completely yours.  Did you have cervical checks during labor?  Personally, I wanted cervical checks every few hours to satisfy my own curiosity.

Next week I will be blogging on the letter D… D is for Dilation.