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Cervical Exams: The Good, the Bad, and the Ugly, by Julie Brill, CCCE, CLD, CAPPA Faculty

“Is this something I have to do?” is a question about vaginal exams frequently asked by my childbirth students. The short answer is no. Especially in teaching hospitals, women are often examined frequently, without even knowing why. The most important question to ask when considering an exam, like any other test, is “What will we do with this information?” A woman’s preferences regarding cervical exams can be discussed with her provider prenatally and included in her birth plan.
The good news about exams is they can be helpful if a laboring woman is deciding whether to stay in the hospital and be admitted or go home, or if this is a good time for her to get pain medication. They can provide encouraging news to women if they show increased dilation in labor. In the absence of increased dilation, they can still be encouraging, if the mom is able to get positive news about increased effacement (thinning) of the cervix or station of the baby.
The bad news about exams is that they increase the risk of infection, especially when they are done after the release or artificial rupture of membranes. In a hospital setting, they are usually done in bed, which is often uncomfortable during labor. Sometimes a woman is laboring successfully in out of bed positions, but after getting in bed for an exam she stays in bed, which can slow labor and increase pain. If an exam does not yield information about increased progress it can be discouraging. VBAC women especially may wish to avoid exams during their labor until they are quite confident they have progressed past the farthest dilation of their last labors.
We all come from a long line of women stretching back to the beginning of time who have successfully birthed babies. When students ask me if exams are something they have to do, I like to think of those grandmothers laboring without exams, pushing when they had the urge to do so. The energy of birth is down and out, and having an exam can often feel like energy flowing in the wrong direction in labor. For women with a history of sexual abuse, probably about one third of laboring women, exams can be triggers. It’s also important to remember that exams are subjective, what feels like six centimeters to one provider, might be seven to another. In precipitous labors, women will often have transition like contractions before their cervixes catch up to that dilation, and being in transition with a cervix that seems to have only begun to dilate can be quite discouraging.
And what about prenatal cervical exams? While these can be encouraging or discouraging, depending on the information they yield, they don’t necessarily indicate how close a women is to starting labor. I recently emailed with a woman considering a VBAC who was told by her provider after she had difficulty with a prenatal cervical exam that this was an indicator that she would have difficulty VBACing. Again as with all tests, a great question when considering a prenatal cervical exam is “what will we do with this information?”

Julie Brill, CCCE, CLD owns and manages WellPregnancy in Bedford, Massachusetts. She has been teaching childbirth classes and attending births since 1992, and mentoring new birth professionals as a member of the CAPPA Faculty since 2003. She is also certified to present Peggy Huddleston’s Prepare for Surgery, Heal Faster workshops. Her website is www.WellPregnancy.com.