Cervical Exams During Pregnancy?
Photo by Thandy Yung on Unsplash
Let’s talk about cervical exams. To have… or not to have, prenatally?
Well, besides the fact that a cervical exam doesn’t tell us much of anything at all before birthing time actually begins, there are also risks involved.
What are the risks?
They can be extremely uncomfortable, especially in the weeks leading up to your birthing time when the cervix is supposed to be high, firm, closed, and posterior.
They can give us an unnecessary, false sense of hope or discouragement.
An increased risk of infection.
Bleeding and cramping.
A signal to your body that there is a threat.
A chance for premature rupture of membranes, especially if there is a “stretch and sweep”, or stripping of membranes performed. (Sometimes additional consent for a sweep isn’t always obtained first, and is thought of by some providers as “part of the exam” which is unacceptable.)
It’s not uncommon for providers to begin wanting to check the cervix in the last few weeks of pregnancy. Sometimes as early as the 36th week of pregnancy. Usually well-meaning providers are looking for information to share with you as you approach the home stretch. Sometime they are requested because people falsely believe the information is important. Most times this is done out of tradition and routine.
What exactly are we hoping to accomplish by assessing the cervix prenatally?
Let’s ask ourselves a few questions.
What is the purpose of the exam?
What is it that we are looking for?
What are we going to do with this information?
Does the information we gather change the intended course of action?
If not, then why are we doing it?
If we know that cervical dilation is only a very small part of the equation, what are we expecting to gain by learning of the cervix’s current status — and what the cervix is doing before birthing time even begins?
If we know that the cervix can change very quickly, or stay unchanged for an extended period of time... even during birthing time, what exactly are we able to do with the information before birthing time even begins? There are many other important, and often unmeasurable things at play.
In my experience, a cervix can go from completely closed to 10cm in four hours. In contrast, a cervix has the ability to remain at 3/4cm for a few weeks before birthing time even begins. Both are normal scenarios.
The #1 reason for prenatal cervical checks is pure curiosity, and tradition.
If you would like to know your cervical status in the weeks leading up to your guess date, and before birthing time begins, that’s your choice. Just keep in mind that it doesn’t mean much before labor begins. It ONLY tells you what your cervix is doing at that exact point in time and that’s about it. As long as you are aware that your cervix is not a crystal ball, and will not indicate when your birthing time will begin or how your birth will go in terms of length or difficulty. The cervix has a mind of its own and can be very unpredictable before and even during the early and active phases of the birth process.
Besides, who wants to hear their provider say, “You’re only 1cm dilated.”
ONLY???
The word “only” has a negative connotation when speaking in terms of progress, which is what most people are hoping is going on. It can be very discouraging and counterproductive.
Photo by Nathan Dumlao on Unsplash
Your cervix has a job. That job is to do nothing until it’s time to do something!
But it’s not exactly doing nothing. It has a few main functions in relation to pregnancy and birthing. One main function is to keep your baby protected and safe until it’s time to be born. I’d say a cervix that was “only” 1cm dilated before the baby was ready to be born is doing a great job at performing one of its main functions. When the baby and the body are ready, the cervix will assume its other very important function which is to soften and dilate - usually in conjunction with (and not before) a continuous pattern of uterine surges.
For the data driven, here are a few quotes about the underlying mechanisms and functions of the cervix.
“During pregnancy, the primary biomechanical function of the cervix is to maintain the fetus within the uterus. This requires withstanding multiple forces from the uterus, including the weight of the growing fetus and amniotic sac, as well as passive pressure from the uterine wall.”
“The structure of the cervix is integral to the maintenance of pregnancy, keeping the developing baby in utero and forming a barrier to the ascent of microorganisms from the vagina.”
“The function of the cervix from this moment is to retain and protect the growing conceptus. An effective barrier is primarily accomplished through retaining a sufficient length of closed cervix within which the mucus plug can deter ascent of microbes from the lower genital tract. This is aided by maintaining sufficient strength at the level of the internal os to discourage descent of the fetal membranes and conceptus down the cervical canal, which may shorten this barrier and/or dislodge the mucus plug.”
“Throughout the latter stages of pregnancy, the cervix undergoes this process as a result of increased collagenase activity. Labour onset at term is governed by fetal and placental endocrine signalling, which triggers an inflammatory cascade of cytokines, prostaglandins, and oxytocin release. In response to uterine contractions, the already softened cervix begins to efface and dilate as a result of the pressure being exerted either by the fetal membranes and/or the presenting part.”
Your cervix is performing its job - Isn’t that great news?!
Remember…
It is your right to refuse cervical exams if you are not comfortable or don’t see a point with having them.
You can simply say, “No thank you, I will not be having a cervical exam today.”
And if you’re a go-with-the-flow kind of patient, and it makes it easier, you can just keep your pants on if the only reason for undressing during your appointment is to receive a “routine cervical exam.”