During labor, one of the ways to access your labor progress is by having a cervical checks done by a provider or nurse. This is when they use their fingers to assess dilation & effacement of the cervix, station of the presenting part of the baby in the pelvis, and position of the baby in the pelvis.
While cervical exams are a routine part of many hospital births, they can be a source of confusion and anxiety for many expecting parents. That’s why it’s important to understand what cervical checks involve and why they are performed.
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What does a Cervical Checks measure??
Dilation is how open the cervix is from 0cm or closed to 10cm or fully dilated/complete.
Effacement is how thin the cervix is on a scale of 0-100%.
Station is where the baby is in the pelvis based on the ischial spines. Ischial spines are 0 station and anything above is a negative number; and anything below is a positive number. The baby is considered engaged in the pelvis at -1/-2 depending on the provider and pelvis.
How are Cervical Checks done?
Medical personal learn how to do cervical checks using two fingers in the cervix to see how wide the cervix is open and how much of the cervix is present based on the knuckles of their fingers. This is one reason why dilation and effacement can be slightly different depending on the provider that did the check. One person might call a cervix 3cm and 50% effaced while doing cervical checks, but another may say it’s more 2cm/25% effaced.
It is a subjective assessment and why they normally recommend that the same person check the cervix each time if possible. Station is again based on the ischial spines and how far above or below the ischial spines the presenting part, usually the head, of the baby is located. This is also provider based because one person may say you are +1 while another would call you 0 when you are doing cervical checks by different people.
The last thing they check when you are doing cervical checks, is the position of the baby in the pelvis. Since most babies born vaginally are head down, they determine position by assessing the sutures of the baby’s head. The cranial sutures are different in the front and back of babies head. So we feel for a certain shape to determine where the baby is facing and if the baby’s head is flexed or extended.
Considerations
Cervical Checks are not a comfortable thing to go through for most. Especially if you’re undergoing induction of labor and your cervix is closed and still behind the baby’s head. As labor progresses, cervical checks can get easier as that cervix moves forward! Some find it helpful to place their fists under their hips creating a posterior tilt of the pelvis, which brings the cervix closer and easier to reach. This makes it easier for the provider to not just be able to assess the cervix but can be more comfortable for you.
You always have the right to decline cervical checks or tell your medical provider to stop so you can take a break from the check.
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When could it be a good time to get a Cervical Checks during your labor timeline?
At admission/start of induction so you know where you are starting in the induction timeline
When a decision for your plan of care needs to be made, such as you have been on LND for a few hours with no change in your contraction pattern, pain level, and temperament. Maybe an intervention needs to be utilized to help progress your labor such as break your water (AROM), start Pitocin, or maybe you are progressing just fine on your own.
Maybe you are just curious what your cervix is, and that is a perfectly good reason.
When could be a good time to decline a Cervical Checks if you are wanting to limit them?
If the provider says it’s been 2/4 hours and they just want to make sure your making progress. Cervical dilation does not predict when labor will begin, nor how it will progress. You can be 2cm, and be complete and pushing in an hour. Or you can be 8cm, and still have 10 hours of labor to go. Your cervix is not a crystal ball at any point during pregnancy or labor.
If your contraction pattern has changed drastically and your temperament and intuitive movement patterns are changing, as well. We have external signs of labor progress so maybe giving it more time before doing an invasive assessment like a cervical check.
Your water is ruptured. The more cervical checks you have, the higher the risk of infection.
Understanding different aspects of your care during pregnancy and birth can make it much less intimidating. We are here to help you feel more informed on your birth, so you can make decisions that work best fo you and your family. If you feel unsure or uneasy about cervical checks, have the conversation with your provider and staff members that trust. Your provider should never push a check on you, nor should they continue to do one when you ask them to stop.