The Sacred Cow of Modern Pregnancy Care: Routine Cervical Exams

I've been meaning to write on this topic for so long that, as usual, someone else got there before me! Thankfully she did a top-notch job, so check it out!

Cervical Exams: Who Needs Them?

(If you haven't subscribed to her blog yet, do! It's been great so far, and Stephanie is a superb midwife and wonderful thinker. She has great stuff to say.)

Anyhow, back to the topic - routine cervical exams.

Cervical exams are so much a part of routine pregnancy management nowadays that women don't really think to question them. I know that I didn't. When we were on our way to our first visit with our midwife, I remember telling my husband that I was sure our midwife would do a vaginal exam along with the visit. Why? Because "that's just what you do."

(Not that I have anything against needed vaginal exams. I remember telling my mother when I was a young teen that I would gladly die of cancer rather than submit to a vaginal exam, but when that time rolled around I didn't find it that big of a deal - when needed, that is.)

After that first visit (no vaginal exam), my pregnancy progressed (to my utmost surprise) without any vaginal exams whatsoever. When I finally broached the subject with my midwife, she gave the surprising response: "It doesn't serve any purpose or tell me anything worth knowing, so I don't do them unless there is a reason to do so." Wow! What a world-changing statement! Talk about shooting down sacred cows!

During labor, it was the same thing - my midwife told me that she would do vaginal exams only if something appeared to be amiss or if I particularly requested it. When I was in active labor, I repeatedly asked "Are we almost done yet?" and she would reply "You'll be done soon, but if you want numbers then I'll have to check. Do you want me to check?" And I would think about it and decide that I would not be able to handle things emotionally if the news was "bad," so I refused the checks (thank goodness!). During that first labor, I had only one check. During my next labor with our last-born, I had no checks whatsoever, bringing my grand total of pregnancy/labor checks to one.

Cervical checks during the last weeks of pregnancy do not serve any good purpose (a ripe cervix does not necessarily portend either a fast labor or an impending labor), and I believe that routine cervical checks during labor can be actively harmful. Why?

(1) If the membranes have ruptured, cervical checks increase the likelihood of infection.

(2) They put the mother "on the clock" if she is birthing in-hospital.

(3) They are uncomfortable (read: excruciating, if done during a contraction), disturb a mother's concentration (which is vitally important), require (usually) a prone position, and can be embarrassing/humiliating when done by strangers or in front of strangers.

(4) They are unnecessary - a good care provider can tell if labor is progressing by using external signs. Here are some signs that labor is progressing: vomiting, confusion, loss of modesty, inability to talk, "I can't do this anymore" statements, the "birth smell", disorientation, change in vocalizations, etc.

(5) Most of all - they are a major source of discouragement, i.e. "What do you MEAN I've been laboring for X hours and I'm only at 3 cm?????" I can't count the number of times that I've read some variation of the following: "I wanted to know how far I had gotten, so I asked the nurse to check me and I couldn't believe I was only at X centimeters, so I got the epidural because I couldn't take it anymore." Listen - labor is HARD. Very hard. It is vital not to invite discouragement during this intense process. If I had been told "2 centimeters" or something like that when I was in that much pain, I don't know if I could have taken it. If I had been birthing in-hospital, I definitely couldn't have kept going. But being told repeatedly - "You are doing fine, your labor is going well, and you are doing a great job" - WITHOUT a number being attached to that - was incredibly heartening and was one of the only things that enabled me to make it through. In fact, it was so helpful NOT to know my dilation that I wrote it into my second birth plan - "If you need to check me, please do NOT tell me my dilation unless it is medically necessary that I should know." I really think that women would do better in labor if cervical checks were reserved for times when it became obvious that something was wrong, rather than just being a part of routine labor management.

Anyhow, I could keep writing for ages, but I will just say - read the article! Stephanie has said it all so beautifully, and I whole-heartedly agree with everything she wrote. Read it, love it, send it to every pregnant woman you know.

(As usual, this is really an issue of mother-preference. Some mamas love cervical checks and want to know every inch of progress, from pre-labor to birth - they find it energizing. If that's the case, great! But it shouldn't be forced upon women, and I definitely question its use as a routine part of pregnancy/birth care.)