Are Cervical Exams Required in Prenatal Care and Labor ?

What is a Cervical Exam?

As you get closer to your due date and approach labor, the shape and consistency of your cervix starts to change. During this time, normally between weeks 37-40 most providers will offer a cervical exam as part of your routine prenatal care to assess the following:

1. Dilation: measured in centimeters from 1-10 cm., 
2. Effacement: measured as a percentage from 0-100%, 
3. Fetal station: a measurement from -4 to +4, indicating how far down the baby’s head is in the pelvis
4. Fetal presentation: determined examination to determine  fetal positioning; head down is the ideal fetal position, however some providers are comfortable delivering a breech baby vaginally. 

Are Cervical Exams Required in Prenatal Care and Labor?

Did you know vaginal exams are not a mandatory part of your prenatal care?  A pelvic exam is normally done in early pregnancy to assess the shape of the pelvis. If the pelvis is very narrow, vaginal delivery may be complicated especially considering baby’s weight. Cervical exams in the final weeks of pregnancy can be unpleasant but are routinely done to check for changes that occur in the early stages of labor such as dilation, the opening of the cervix and effacement, the thinning of the cervix. However, these signs alone are not always a good indicator of pending labor.

Furthermore, agreeing to a cervical exam is your personal decision. Every woman and pregnancy is different, one woman can remain 1-3 cm dilated for weeks, whereas another woman could have a closed cervix one day and deliver her baby the next day. If a woman has a planned C-section and is not displaying any signs of labor, a cervical exam is unnecessary.

 When are Cervical Exams Necessary?

Correspondingly, there are times when cervical exams are deemed appropriate. If a woman is in labor and having symptoms such as contractions, vaginal bleeding, loss of mucus plug, or breaking of water a cervical exam will be necessary to determine dilation and effacement. This information will help your healthcare team plan for a safe delivery. Also, if a woman is induced for a medical reason or electively a cervical exam is performed to determine If cervix is ready for induction. Inducing a patient whose body “is not ready”, could potentially increase the length of labor and lead to a C-section delivery. Hopefully you trust your provider and feel comfortable openly communicating your needs and concerns for your pregnancy and birthing process. You have the right to decline any procedure or examination you are uncomfortable with and your provider should explain risk, benefits, and options. Consider making a birth plan to help communicate your wants such as only having cervical exams when medically necessary, intermittent fetal monitoring vs. continuous, birth attendees, etc. A doula can help your create a birth plan and most hospitals and birthing centers have standard forms you can use. 

Alternatives to Determine Progression to Labor

Moreover, if there are no pending signs of labor and no induction, then there is no reason to do a cervical exam if you do not wish to. A midwife, doula or other supporting person can assess dilation with a less intrusive tactic, the purple line theory. There is a correlation between the appearance of the thin line and cervical dilation in later pregnancy. The line will start at the anus and go up toward the gluteal crease. It is good to note that the appearance and color of the line may vary based on the complexion of the birthing person. Furthermore, the line grows as your labor progresses and may vary by 1-2 cm. per individual and is therefore not a perfect measure for cervical dilation.  

Purple Line of Dilation Rule of Measurement:

• 3-6 cm. line (starting at anus and moving up toward lower back)= 1-2 cm. cervical dilation

• 5-8 cm. line (lengthening along the gluteal crease) = 3-6 cm. dilated

• 7-9 cm. line= 7-8cm dilated

• 8-11 cm. line= 9-10cm dilated

To measure the line, floss can be used to measure the length of the purple dilation line and a flexible tape measure can be used to measure the length of the floss for an exact measurement.

Takeaway

Moreover, if you notice that you have the “purple line” but have not gone into active labor, it is likely that the process is beginning or will begin soon. It is important to remember that the time between dilation and the start of labor vary per individual. A woman can go from a closed cervix to birthing a baby in a matter of hours, whereas, another woman could be dilated 1-2cm. for days or weeks. 

Listen to your body, and trust the process. As always, well wishes and happy waiting!

–Jas