The Cervical Exam: A History Report, Not a Crystal Ball for Labor Progress
As birth doulas, we often hear from clients in their last few weeks of pregnancy who excitedly report on their prenatal visits with their providers. Often these reports include some measurement of cervical dilation that occurred in those visits.
Cervical dilation is measured from 0 centimeters to 10 centimeters (with 10 centimeters being a “fully dilated” or “complete” cervix) and is assessed through a vaginal exam by your midwife or OB.
But, did you know that your dilation isn’t the only indication of labor progress?
In fact, prenatal cervical exams do little to tell us about what will happen in the coming days or even hours; only what’s happened up until that point.
Very often, pregnant people who consent to cervical exams in late pregnancy are left with one of two feelings:
Initial excitement that their cervix has started dilation, and then disappointment that active labor and birth may not follow “soon” after.
Initial disappointment that their cervix hasn’t begun yet to dilate, only to be surprised that they are greeting their baby Earthside or are in active labor in the immediate days or even hours after the exam.
Unfortunately, your cervical dilation alone isn’t a crystal ball for when your labor will begin, or how fast or slow it might be. Instead, think of cervical exams as a history report; one which tell us what’s been happening up until the moment of the exam.
Now, that’s not to say that cervical dilation isn’t useful at all.
That history report can be valuable when needed. For example, if you are considering an induction, and need to know which method of induction you might choose. Or, if you are in labor and are requesting pain medication, a cervical exam can reveal whether you have time to benefit from that medication or if your baby is very close to being born instead.
But, it’s not the be all, end all for a complete picture of your labor pattern.
There are also a few other ways to measure labor progress. These include additional evaluations which give us a more complete picture of how your labor is progressing or which tell us that your baby and your body have begun the earliest stages of birth.
What might they be?
Your cervix shifts from back (posterior) to front (anterior), in preparation for birth.
Your cervix begins to soften, often called “ripening”.
Your cervix begins to thin or efface (and is measured in a percentage of 0% to 100%).
Your baby begins to engage in your pelvis (measured using as assessment of “station” from -3, or not engaged to +4/5, or crowning).
Why is this important?
It’s important because you, your baby, and your body will do such hard, beautiful work together in labor and birth.
A single assessment of dilation doesn’t fully honor or reflect that effort.
So, if you are presented with the option of a “quick check of your cervix”, consider asking for all of the findings of that exam. Ask your provider to also inform you of your cervical position, your effacement, and your baby’s station.
Finally, if you’re unsure of your baby’s position, ask for your provider’s opinion, or try Belly Mapping. Consider registering for an upcoming Spinning Babies Parents Class to learn more about how a baby’s position can impact your birth.
Want more information about prenatal vaginal exams and cervical checks? Check out this video by Dr. Rebecca Dekker of Evidence Based Birth for the evidence for and against them.