It’s a familiar experience: A pregnant woman in labor gets to the hospital, and is examined in the Labor and Delivery (L&D) triage to see whether she’s in active labor, or if she still has some time (and cervical dilation) to go. If it’s the former, she’ll be admitted to a hospital room, and if it’s the latter, she’ll be sent home and told to come back once she’s further along in the labor process.
It can also be a frustrating experience, both for moms who are convinced they are in active labor, no matter the results of the exam, or for mothers in the thick of hard contractions who want nothing more than to get out of the public space of L&D triage, and into the more private space of a hospital room. But for the women who opt for a hospital birth, the “gateway” cervix check is a typical part of the process of giving birth.
Recently, I wrote about cervical checks during pregnancy—what doctors look for during a check, and what a check can and can’t tell you. I noted that during labor, the information gained in a cervical check is often more meaningful than the information gained in a cervical check before labor has begun. In this article, we’ll explore that idea further: When and why do medical providers do cervical checks during labor? What does checking a laboring woman’s cervix tell them? What are the risks to having one’s cervix checked, and what (if any) are the alternatives?
The purpose of the cervical check
A cervical check looks primarily at effacement and dilation of the cervix. Effacement is the thinning and softening of the cervix before and during labor, and is described as a percentage (e.g., “30% effaced”). Dilation is the opening of the cervix, and is measured in centimeters (e.g., “5 centimeters dilated”). The contractions a woman feels during labor suggest that her cervix is effacing and dilating. You can picture the process of dilation and effacement kind of like pulling a turtleneck over your head, but in this case, it’s like your cervix is being pulled back from in front of your baby’s head to behind it. The cervix (turtleneck) opens wide and thins as it goes over the baby’s head and recedes behind it. When a woman’s cervix is fully effaced at 100% and dilated approximately 10 centimeters, she is ready to start pushing.
Cervical checks can also show the cervix’s position (whether it’s anterior or front-facing, like it should be during labor, or posterior, meaning towards mom’s back), and the baby’s station (where the baby’s head is in relation to mom’s pelvis) and sometimes the baby’s position as well.
In addition to performing a cervical check when a woman arrives at the hospital, providers may also do cervical checks at other times during labor, particularly to assess whether labor is progressing, and/or if the woman may be ready to start pushing.
The limitations of cervical checks during labor
Not a predictor of how much time til baby’s here
Abby Jorgensen, a birth and bereavement doula, told me that “cervical checks cannot predict the future and tell you how much longer you’ll be in labor; they can only tell you how much some parts of your body have changed in response to labor. I like to quote Mater from ‘Cars’ regarding cervical checks: ‘Ain’t no need to watch where I’m goin’; just need to know where I’ve been.’” In other words, you may be dilated six centimeters, say, for hours, and then progress rapidly from to ten centimeters. Every woman’s body is different and even every labor is different.
Checks may be done for provider convenience, and effacement estimates may be inconsistent
With uncomplicated labor and planned C-sections, Jorgensen says, cervical checks aren’t usually necessary, but many providers do them routinely because they don’t stay with the woman throughout her labor and therefore can’t see for themselves how labor is progressing.
Unfortunately, cervical checks aren’t very precise. There isn’t a common definition of “60% effaced” versus “70% effaced” (as an example), and while experienced providers can correctly estimate dilation within a centimeter most of the time, there can be a great deal of inconsistency in estimations of effacement.
Possible complications of cervical checks in labor
Infection risk
Cervical checks can also introduce bacteria and cause an infection in the uterus. As a result, says Jorgensen, many providers try to limit the number of cervical checks they perform, especially after a woman’s water has broken. (The amniotic sac is a protective barrier between the baby and bacteria, so once it’s ruptured, the baby loses that closed, protective environment and is vulnerable to infection.) Providers may take the woman’s temperature occasionally to look for a fever, which can be an early sign of an infection, but fevers in labor are tricky because they can occur for infectious or noninfectious reasons.
Pain
Another drawback to cervical checks is that they can be uncomfortable and even painful. Jorgensen says that “providers who are gentle or trauma-informed will offer suggestions for how to manage the physical discomfort” and help the woman feel in control. They should also always ask for the woman’s consent before every cervical check. She recommended that women who want to have the information obtained from a cervical check but anticipate that it will be difficult for them should talk to their provider and support people to create a plan that will help them “feel confident and agentic.”
Alternatives to cervical checks during labor
Natal cleft
Unfortunately, Jorgensen says, alternatives to cervical checks can be even less precise, depending on the woman. For example, during labor, a line can appear in a woman’s natal cleft (between the two buttocks) that extends as the cervix dilates. When the line reaches from the anus to the top of the natal cleft, it means the baby’s presenting part has descended, and it’s time to start pushing. It’s a great alternative to cervical checks, because it doesn’t involve a risk of infection or the discomfort of a cervical check, but it’s not always visible, and not all providers are confident in their ability to identify it, because it isn’t the usual method of checking. Jorgensen notes that “since most medical resources focus on white bodies,” providers may need to actively look for resources on identifying it in women of color.
Vocalization, focus, movements
In her work as a birth doula, Jorgensen uses other signs to determine how labor is progressing, including vocalizations, focus, movements, and “even how complex their sentences are.” These signs are obviously not precise measures, but she’s found that they follow predictable patterns—and they are more comfortable and less invasive than a cervical check.
Women who use certain fertility awareness methods may be able to do a cervical check on their own, Jorgensen said. Methods such as Boston Cross-Check, SymptoPro, Sensiplan, Couple to Couple League, and NFPTA use cervical position as a biomarker to track fertility, and Jorgensen said that she has had clients who have done their own cervical checks. Still, she adds, their provider may want to do a check themselves if the patient and provider want information about the baby, not just the cervix or if the patient is about to start pushing.
Leg check
This article in Romper identifies another alternative: the “leg check.” It’s used by indigenous Mexican midwives and is based on the increase in blood flow to the uterus that occurs as the cervix dilates. This increase in blood flow to the uterus makes a woman’s legs become colder, and midwives can track that change “in two finger increments, from the ankle to the back of the kneecap, correlating it with centimeters of dilation,” according to the midwife interviewed for the article.
So, should you get your cervix checked while in labor?
Ultimately, whether or not you have a cervical check should be based on a conversation between you and your provider (and, possibly, your partner). With an understanding of the pros and cons, and a trusted doctor, nurse, or midwife, you can make the decision that is right for you and your baby.
Additional Reading:
Cervical checks during pregnancy: What they can- and can’t- tell you
Beyond the epidural: labor pain management options
Yes, perineal massage might sound weirdly “crunchy.” Here’s why you should consider it anyway
The 6 things every woman considering a natural childbirth needs to know
Vaginal seeding: the controversial postpartum trend for Cesarean moms
