Cervical Checks

Are they necessary? Should you do your own? You decide!

Published 21st Nov 2020, updated 21st Nov 2020

What is the cervix?

The cervix is the lowermost part of the uterus that extends into the vagina and connects the uterus to the top of the vaginal wall.

The cervix opens in labour to allow the baby to descend out of the uterus into the vaginal canal to be birthed.

(If female anatomy is unfamiliar to you, read more here or here)

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What are cervical checks?

Depending where you're from, these are also known as vaginal exams, pelvic exams, or internal exams. 

You'll be familiar with hearing about them in a medical setting, mainly as a way to measure dilation, and if you've had babies before, you may have been subjected to one (or many) cervical checks. They are often done without informed consent. Nearly all women find cervical checks invasive or painful. They wonder if they even need to be performed. And will the baby even come out if you don't know what your dilation is and when to push?

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First: you can always say NO. To your midwife, nurse, or doctor. Hospital policy is not law. You don't have to consent to "just one VE" for admittance, or "Let me just check for baby's head so you know when to push" 

Wherever and however you choose to birth, please know this. You do not need to have anyone examine you if YOU don't want them to, ever. No one should put their fingers into your vagina without your consent - ever.
If you choose to have someone examine you, it should be on your terms, when you are comfortable, and if you decide it is beneficial, in the case of suspected complications, for example, like prolapsed cord.
You want to be sure that the vaginal examination is really necessary and will add important information to the decision-making process, and that the person doing the exam will ensure your privacy, dignity and comfort, and explain the findings and their impact sensitively.

Second: baby will come out without you ever knowing your dilation. You can monitor labour progress, and know when to push without ever having a hand up your vagina.

Women all over the world birth every day like this! In fact, a woman in a vegetative state has even given birth without ever being conscious or pushing!

Why check the cervix?

The cervix is presumed measurable and somewhere along the line, medical professionals fixated on it as a way to chart labour. They forget that all women are different and that cervices open at different speeds. You could be dilated to a 4 for weeks, or go from 1-10 in an hour. It's true that the cervix needs to be open for the baby to come out, but it can open up more as the baby's head puts pressure on it. You don't need to be fully dilated for your body to start giving gentle pushes. 

They forget that the cervix opens UP not out. Your contractions are building the fundus ready to push, and so the strength of the fundus is more important. 

"The cervix is pulled up as a result of the building of the fundus. Assigning a number to cervical dilation is of little consequence and we make a huge mistake by interpreting progress or predicting time of birth to that number." - Carla Hartley, Trust Birth and Thinking in accurate pictures

Relying on dilation to gauge labour progress is not necessary.
Not just because they can’t measure dilation correctly, but because even if known, dilation will not tell you how long until baby is born! “Your cervix is not a crystal ball”

But checks aren’t just about dilation. There is some other information to be gained. A trained person will be able to assess and learn many things. You may be able to feel some of these yourself, too.

• Position of baby (Whether they are engaged in the pelvis, how far down (station) and whether they are facing the back or front )

• Presentation of baby (whether the baby is breech, or head down, and if head down, is the brow, face, or skull presenting)

• Bag of waters (if the membranes have ruptured or are still intact and bulging)

• Prolapse (Uterine, vaginal, rectal)

• Cord prolapse (A freebirther recently intuitively checked herself after her waters broke in active labour. She was surprised to find a prolapsed cord. They immediately transferred by ambulance. When the hospital told her that the baby was stable, but they recommended a C section, she was able to advocate for a vaginal forceps birth. Her early detection and quick, informed thinking helped her be in control of own her birth)

• Cervical lips and cervical swelling (if the cervix is pinched or dilating unevenly, it may swell or otherwise impede baby’s descent. Repositioning baby to stop the pinching (through an inversion) , massaging the cervix with arnica oil, or holding the cervix back during a few contractions so the baby’s head can pass may help the labour progress) 

If someone wants to check you in pregnancy or labour, or you want to check yourself, ask what you’re looking for and what you will do with the information. Are you checking intuitively? Proactively? Reactively? Use your B.R.A.I.N.S (decision making tool).

Self Checks

You may see well meaning freebirthing women advising you to never check your own cervix; that it's pointless and risky (and we'll cover the risks in a minute).

But I subject that many women actually like to check it themselves. It could confirm labor for someone with preterm or prodromal. It can be a way to be in tune with your body, or feel for your baby's head, or feel the bag of waters, or any number of the reasons listed above. Feeling your baby’s head might encourage you, and getting personal with your vulva might remind you of your inherent femininity and strength.
Many women check their cervix pre pregnancy if using a fertility awareness form of birth control (FAM), and know the changes that the cervix goes through in a monthly cycle. Checking in pregnancy and labour satisfies their curiosity and is the completion of that cycle.
For whatever reason you choose, you should feel that you can check yourself IF YOU want to.

“The thing is you are all speaking of cervical checks in its medicalized form. A woman touching her own cervix, of her own volition, comfortably and gently, with her own strength and feeling is NOT the same as a cervical check being done TO a woman by someone else, unable to feel the strength of their touch, the woman feeling tense and uncomfortable, etc. I doubt anyone in here would say that cervical dilation dictates labor. But is a part of a mother’s body in the journey through labor? OF COURSE. If SHE feels intuitively to feel her cervix, she should. For those who haven’t felt that need or desire, fine. But saying a woman shouldn’t  be feeling a very beautiful part of her body that is so important to the birthing process seems silly, particularly for fear based reasons.” -freebirther

Risks/When to leave alone

As with any procedure, you should do your own risk assessment in the moment (remember, BRAINS for labour)

• Static measurement (Measures the now, and doesn’t tell you what happened previously, or what will happen)

• Discouraging (Because of the single point in time measurement, this can discourage a woman who has been labouring for hours with no “obvious” progress)

• Painful (If measured by another person, or measured during a contraction, cervical exams can be quite uncomfortable)

• Inaccurate ("Medical providers gauge cervical dilation by feeling the cervical opening with two fingers. They place their two fingers on either side of the cervical opening and estimate how far apart their fingers feel. They can’t see the cervix during the exam since the cervix is located at the back of the vagina. Providers must blindly estimate how far apart their fingers feel.
  Unfortunately, there is currently no better way or tool to measure cervical dilation. As you might have guessed, measuring cervical dilation is an imprecise science. In one study, when two experienced OB/GYNs examined the same woman’s cervix, they agreed on dilation only 49% of the time. Several other clinical trials using cervical simulators also found that clinicians correctly estimated the dilation only half the time, regardless of years of practice or type of education." - Dr Eva Martin, Dilation Matters  

• Dilation itself, and the rate it happens is based on the outdated, racist, and inaccurate Friedman's Curve study, which measured labours in women that weren't even natural, as many had Pitocin or were sedated.

• Dilation can reverse or stop (If the woman is stressed, and the cervix messed with, she can tense up and labour and dilation can slow and stop, prolonging labour by potentially many hours)

• Past sexual trauma (Someone else giving a vaginal exam to a woman with past sexual trauma can cause more unnecessary trauma. It might be okay if the woman does her own exam though, or she may prefer to avoid it altogether)

• Irritation (It’s common to have some spotting or blood streaked mucus after a cervical check)

• Waters broken (If the membranes are not already ruptured, there is the risk of breaking them prematurely)

• Infection (There is the potential for introducing bacteria, especially in a less than sterile environment, either by bringing in new bacteria on dirty hands, or by transferring existing bacteria from the outside of the vagina up into the cervix and uterus where it can do harm. This can cause an infection in either the mother or the baby, and the risks are higher if the waters are already broken)

I personally don’t believe the risks to self are as high as those we know come with a medical professional. Firstly, you’ll be more gentle, and your body is already accustomed to your own home’s bacteria. I don't believe self cervical checks are any more dangerous than having sex during late term pregnancy. If you would normally put a penis or partner’s fingers inside you then, (and many women do, even to start, or progress labour), then you should not feel uncomfortable putting your own fingers inside your vagina.

How to check your own cervix
Here’s what you actually came here for, the HOW.

• Wash your hands and make sure your fingernails are trimmed.

• Get comfortable in a position with one leg slightly up. The easiest position when pregnant is to sit on the toilet with one foot on the floor and one up on the seat with you. You can also put a foot up on the edge of the bathtub or a stool if you’re not flexible enough with a huge bump.

• You can also check by squatting in the shower, or immediately after. This has the added benefit of making sure everything is clean.

• Insert two fingers into your vagina back towards your bum. The longest two work the best. (You may like to start with one finger, then add the second if required to measure)

• Now gently feel around the edges of your vagina and down, into the middle. 

• (On some women, your cervix will be slightly off to one side, or even tilted, so feel to the left and right as you search.)

• Your cervix may be quite high, and you might not be able to reach it until closer to birth.

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• When not pregnant, and before dilation starts, your cervix will be easy to tell apart from your vaginal walls, as the vaginal walls are very soft and supple, and may be slightly ridged. Your cervix protrudes down into the vagina. Your cervix feels slightly rubbery, and like touching the end of your nose.

• In late pregnancy, your cervix will feel smushy and not as round. It will feel like your lips puckered up for a kiss, and you may be able to slide your finger easily into the middle. 

• Dilation is measured by the diameter of the inner os (inside of the cervix). The outer os can often be open, with the cervix funneling to closed at the inner os. This does not indicate dilation, but does indicate cervical "ripening" and effacement.

• Early on, you may feel the mucus plug still inside, if you haven’t been loosing it, or had your “show” yet.

• As you continue to dilate, the inside of the hole will feel a bit like a tight elastic band, and by 5cms (4 fingers wide, depending on the width of your fingers) it is a perfect rubbery circle like a Mason jar ring for canning, and about that thick.

• In the middle of that open circle is the unbroken waters (amniotic sac) and it may feel like a balloon filled with water. They might be bulging a bit, or they might be tighter, and if you push on them gently, you can feel the baby’s head like a hard ball behind, ( like a cricket ball).

• If your waters are broken, you can feel the baby’s head directly.
  
  

• You will feel effacing before dilation, that is, the cervix thinning and flattening.

• Instead of a nub at the end of your vagina, as you may be used to from pre pregnancy checks, it might just be flat.

• As dilation progresses, that is, the cervix opening and drawing up it will stay flat, and the hole will get wider until you may not be able to distinguish it at all from the vaginal walls.

• When providers can't feel all of the cervix, they stop measuring by distance between fingers, and just estimate dilation based on the thickness and tightness of the anterior lip that they can feel.

• So if you’re checking right at the end of labour, don’t be discouraged if you can’t find your cervix. You may be already fully dilated.

• You’ll definitely be fully dilated if you (with a mirror) or someone else can see the baby’s head just inside the vagina.

• If you can’t reach, or want someone else to check for you, lay on your back with your legs butterflied open. Place your fists under the bones you sit on, as this will tilt your pelvis and bring your cervix forward to allow your helper to reach it more easily. You can also use a rolled up towel instead to keep your hands free. (And you can request a towel if a care provider is doing a check).
  
  

• Remember, the cervix effacing (thinning), and dilating (opening) is transferring the muscle to the top of the uterus to build the fundus. The cervix opens UP not out.
  Every contraction is making progress, and combined with oxytocin, will eventually kickstart the uterus into pushing for you (FER) or with you. Be patient. You'll meet your baby soon!