What You Should Know about Cervical Exams during Pregnancy
Cervical exams to check progress during labor are one thing, but let’s talk about cervical exams BEFORE labor.
Many of our clients are surprised that their providers want to perform cervical exams each week during the last part of pregnancy, often starting at around 36 weeks (although some providers may initiate these routine exams earlier or later).
Let’s dig into what these exams can really tell us, what your options are, and some tried and true tips for communicating with your care provider about cervical exams during an appointment.
So what’s the deal with cervical exams during pregnancy?
Note: We are talking here about full-term pregnancies where there are no additional symptoms like bleeding or signs of premature labor.
Also called pelvic exams or vaginal exams, cervical exams during pregnancy are offered as a routine part of care for many OBs and hospital-based midwives (some home birth and birth center midwives too). That often looks like one exam each week beginning around 36 weeks gestation until labor begins.
Even though there are no studies demonstrating clinical benefits to routine cervical exams before labor, many providers still consider them a normal part of prenatal care.
What’s involved with a cervical exam?
During a prenatal office visit, a provider may ask you to undress from the waist down so they can check your cervix. You will be asked to lie back on the exam table with your feet in the stirrups and knees wide. This exam is performed manually with a gloved hand using lubricating gel. The provider inserts two gloved fingers into the vagina (no speculum is used) and reaches up toward the cervix. They cannot visually see the cervix and are relying on touch alone. Prenatal cervical exams usually last between 30 seconds to a few minutes.
A cervical exam late in pregnancy usually involves evaluating:
the position of the cervix (whether it is still in the pregnancy position facing your lower back, or has moved to face in a more forward direction toward your pubic bone)
the consistency of the cervix. The cervix changes from firm during pregnancy to very soft during labor. Sometimes that change begins to happen prior to labor beginning. (This is not a measurement, but an adjective describing the consistency of the cervix as your provider perceives it with their fingers.)
whether the cervix is dilated (open), and if so how much. During pregnancy it’s normal and healthy for the cervix to be tightly closed, keeping your baby protected from things on the outside. During labor, the body uses contractions to open the cervix. Sometimes, the cervix starts to dilate a centimeter or two (or sometimes more) late in pregnancy, before contractions begin.
whether the cervix has started to efface (thin), and if so how much. Late in pregnancy, the cervix can start to thin out in preparation for labor. Labor contractions are really helpful in creating this change, but sometimes the body can start moving in this direction beforehand.
the baby’s station (one aspect of their position in the pelvis). Some babies begin to move lower into the pelvis late in pregnancy (you may have heard this referred to as the baby “dropping”). Labor contractions are the primary way that babies move down through the pelvis, so this measurement doesn’t mean very much prior to labor.
Remember - the answers to all these questions just tell us what is happening right now. Based on this information, clinicians CANNOT predict with any accuracy:
when you will go into labor
if you will go into labor spontaneously by a certain point in pregnancy (i.e. before your due date, before 41 weeks, etc.)
whether you are a good candidate for a VBAC (vaginal birth after cesarean)
If your provider tells you that a cervical exam CAN predict any of those things, I would consider that a red flag.
All a cervical exam tells us is the perceived state of the cervix during the time of the exam (remember - these exams are subjective and results can vary from provider to provider). Your cervix could experience huge change within the next 3 hours, 3 days, or 3 weeks. As birth professionals often say, “your cervix is not a crystal ball.” It can’t help us make any predictions about the future.
A cervical exam CAN be very helpful if you are going to be induced in the next day or two.
If you have agreed to a medical induction of labor, having a cervical check to measure your Bishop score close to the time of your induction can be helpful. This information can help determine the process of your induction, influencing what medical options may be available or recommended by your provider. In some cases, your Bishop score determined by a cervical exam might even help you decide IF you want to move ahead with an induction. (If you want to learn more about labor inductions and your options, our Decision-Making Skills for Labor class might be just what you’re looking for!)
Having a cervical exam done the day or two before an induction can give you a better idea of what to expect during your induction process, and give you more context for questions you may want to ask ahead of time. If you have a doula, they can be a very helpful resource in this situation!
For the record, a cervical exam more than a couple of days before an induction date will not give much actionable information since things can change quickly.
And just to be clear: having a cervical check done before an induction is still completely your choice! It is not a requirement.
Agreeing to a cervical exam at any point during pregnancy or labor is an extremely personal decision. No one can force you to have a cervical check.
Besides preparing for an upcoming induction, what are the pros and cons of a routine prenatal cervical exam?
Pros:
Possibly satisfy your own curiosity about whether your cervix is changing prior to labor (keeping in mind that your cervix doesn’t NEED to change at all before labor, and the state of your cervix currently has no bearing on the future)
Satisfy your provider’s request for routine weekly cervical exams in late pregnancy, even though they are not evidence-based and do not provide any health benefit to you or your baby
Cons:
Cervical exams (and the pressure to agree to them) can be triggering for some people, and unfortunately many medical providers are not adequately prepared to provide trauma-informed care. It’s possible that if you agree to a cervical exam but change your mind at any point, your provider may not be prepared to stop the exam.
Cervical exams can be painful or uncomfortable, especially for people who have a history of trauma or pelvic floor pain or dysfunction. Many people find that their genital areas are more sensitive late in pregnancy.
It’s possible for a provider to accidentally break the bag of waters during a cervical exam (one study showed that people who had weekly cervical exams before labor had a three times higher risk of their water breaking early compared with people who did not have cervical exams before labor)
Some providers perform a membrane sweep at the same time as they do a cervical check, often without their patients’ knowledge or consent. Membrane sweeps are a topic for another day, but it’s important to know that they are a form of induction, are not without risk, and are separate procedures from cervical exams. Consenting to a cervical exam does NOT mean you are also consenting to a membrane sweep, unless you explicitly give consent for that procedure too - but not all providers acknowledge this.
Your provider may use the results of a cervical exam to encourage you to schedule an induction (or a repeat cesarean if you were hoping for a VBAC). Remember - this is not based on actual science! But unfortunately it happens all the time. This can not only lead to unwanted and unnecessary inductions and cesarean births, but it can also lead to a lot of stress to “induce labor naturally” prior to the deadline a provider gives. As it turns out, stress is one thing that can actually PREVENT you from going into labor on your own! So this can definitely be a recipe for a fraught and challenging last few weeks of pregnancy. (We see this frequently for people giving birth for the first time, people who have not experienced spontaneous labor before, and people who are planning a VBAC.)
The results of a cervical exam before labor may lead to you feeling disappointed, discouraged, or stressed. As one of our clients said, “I really wish I hadn’t had those exams in my last few OB appointments. They totally messed with my head.” You may have hoped for a different result, feel guilty, depressed, as though you’ve somehow failed, or just feel frustrated that labor doesn’t seem to be coming anytime soon. Your care provider may communicate the results to you in a way that feels discouraging.
OR, your doctor or midwife might tell you excitedly that your cervix is definitely moving toward labor and it could happen any day… and then the days might start going by without labor, leading to stress and disappointment and maybe a little bit of worrying that you’ll be pregnant forever (trust us - you won’t!) Don’t discount the emotional roller coaster that can come alongside prenatal cervical checks - as a doula who has talked to many clients in tears after a 39 week OB appointment, the emotional side of this is very real.
A word of warning: sometimes people are aware of the possible emotional “side effects” of a cervical check during pregnancy, and tell themselves that they will be open to whatever the results are without judgment. Because pregnancy hormones are what they are, especially late in pregnancy, it’s often very difficult to stick to that level of non-attachment about a cervical exam.
Based on the pros and cons, YOU get to decide if you want any cervical exams during pregnancy. And if you decide yes, YOU get to decide how many and when. Saying yes to a cervical exam in an office visit one week doesn’t mean automatic consent for the same thing next week.
Tips for communicating with your provider if you decide YES on a cervical exam during pregnancy:
We highly recommend bringing a supportive person with you to your appointment. Ideally someone who is comfortable helping you to ask questions and advocate with and for you if needed! You may even consider sending them this post to read ahead of time so you’re on the same page.
Make a plan for coping with uncomfortable emotions that may arise after the exam. In case the results of the exam aren’t what you’d hoped, it’s easy to feel overwhelmed, disappointed, frustrated, and even scared. Think about how you’d like to handle these emotional challenges ahead of time, so you can treat yourself to the #SelfCare you need just in case.
Have a conversation with your provider prior to the cervical exam:
Let your provider know whether you are consenting to a cervical exam AND membrane sweep, or if you only consent to a basic cervical exam. (Remember - they are separate procedures and a membrane sweep is a form of induction.)
Ask your provider what they will do if at any point you want to stop the exam. Setting this up ahead of time (especially if you are worried that an exam may feel triggering and/or very painful for you) will help you feel more comfortable asking for what you need during the exam itself. This is an invasive exam and you are free to withdraw your consent and stop at any time.
If you have a trauma history, you are not obligated to share that information with your care provider. That decision that is completely up to you.
If you need a minute to collect yourself before your exam, you can always step out to the restroom first to take a couple deep breaths. Eye contact and any physical touch that is comfortable with your support person can also be helpful if you feel nervous before the exam.
Communicate during the exam:
You can ask your provider to slow down or stop at any time, for any reason.
You can play relaxing music on your phone, or even listen to a guided meditation during the exam.
If you have a support person with you, you may want some physical contact (like holding their hand) or to hear some comforting words during the exam. Or you may prefer quiet and not to be touched.
After the exam:
Remember that the results of the exam do not predict the future. They just give you and your care provider a little bit of information about the current state of things.
If you have a doula and want to debrief after an office visit that included a cervical exam, they will likely be very glad to talk with you about it!
Tips for communicating with your provider if you decide NO on a cervical exam during pregnancy:
We highly recommend bringing a supportive person with you to your appointment. Ideally someone who is comfortable helping you to ask questions and advocate with and for you if needed! You can even consider bringing someone with you virtually on the phone or by video chat if possible. You may even consider sending them this post to read ahead of time so you’re on the same page.
If you’re able to have someone present to support you, we recommend letting them know that you plan to decline a cervical exam if one is offered/recommended. You can talk together about how you would like to be supported if your care provider or their assistant is surprised or even upset that you are declining an exam.
Before the appointment:
It may be helpful to decide on a phrase you’d like to use if/when you are asked if you want a cervical exam (or, more likely, asked to undress for a cervical exam). You might even want to write it down in a notebook that you take with you to your appointment. Phrases like this could be helpful:
“No, thank you.”
“No, I don’t want a cervical exam today.”
“No thank you, I don’t feel like it today.”
“Thanks, but actually I’m good without an exam today.”
“I know this is a routine practice for you with most of your patients, but it’s just not the right decision for me today.”
“I’m not feeling up for it today, I’d rather skip this one.”
Think about how you’d like to respond if your care provider inquires about the reason for your choice. Some people prefer not to give a reason (since this is extremely personal and you don’t technically have to have any reason to say no). But other people feel that it would be more helpful to have a frank conversation with their care provider about why they are declining a cervical check.
In our experience, most of this comes down to your provider’s personality and mood during the appointment, and what you feel up for in the moment. Some providers are more collaborative and are curious and interested to hear why someone is declining a routine recommendation. Other providers may feel a bit defensive and ask patients to argue their case for declining a cervical exam. We recommend feeling out the situation and deciding what you feel up for emotionally and socially. You can go as far as you want to down the road of defending your decision in the moment. You could also just use the “no” phrase that you chose, and not get into any details about why you’re saying no. Or, you could ask to talk about this later and communicate with your doctor via email or messaging if you’re more comfortable addressing the question in writing outside of the pressure of an in-the-moment discussion.
If you want to read more about communicating with your care providers during more tense situations that can arise when declining a recommended/routine procedure, check out this blog post.
During the appointment:
Remain dressed. This is a great way to indicate visually and physically that you don’t want to have a cervical exam. (There is no other reason why you would need to remove clothing from your lower body during a regular OB/midwife appointment late in pregnancy, unless you specifically wanted your provider to take a look at something.)
Expect that when it is time to decline the exam, your care provider (and/or their PA, nurse, or other medical assistant) may be surprised, and it may be an uncomfortable conversation. If your “fight, flight, freeze, or fawn” response kicks in, that’s totally normal and ok.
When it’s time to let your care provider know that you are declining an exam, take a breath and connect with your support person if you have someone with you in person or virtually
Calmly state your “no” in whatever way feels most comfortable in the moment. You can read the phrase you wrote down to bring with you, or improvise.
Be on the lookout for coercive language. If your care provider and/or their assistant tries to convince you to change your mind by suggesting that you are putting yourself or your baby in danger in any way, or that they really really recommend this exam and there is no risk, or that it will only take a few seconds, remind yourself that this is YOUR decision and that no one has the right to try to manipulate you.
If at any time you need a minute to regroup, you can always step out to the restroom to take a couple deep breaths.
If there is push-back, whether it is gentle or more aggressive, you can continue to calmly repeat your “no.” Many providers aren’t used to their patients declining something that they recommend routinely, so it may surprise them. That’s ok! You aren’t doing anything wrong, this is 100% a decision YOU get to make about YOUR body, and it’s completely ok to keep repeating your “no” as needed. (This is a great time to lean on your support person, if you were able to bring someone with you! They can help to amplify your voice and diffuse the tension if needed.)
After the appointment:
If your provider was not respectful about your decision to decline the exam during your appointment, you may want to make a game plan with anyone who will be with you during your birth about what to do in case declining a cervical exam (or any other communication challenge or conflict with your care provider) becomes an issue during labor. Thinking it through and making a plan ahead of time can go a long way toward helping you feel more comfortable as you prepare for birth.
If you had a support person with you who may also support you in a future visit or during your birth, discuss how their support was helpful for you during the visit. If there is anything you wish they had/hadn’t said or done, you might also want to talk about that as well so you’re on the same page when labor comes along.
If you have a doula and want to debrief after this experience, they will likely be very glad to talk with you about it!
We hope this is helpful! If you try out these strategies, we’d love to hear how it went.
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