Today, we’re demystifying the oh-so-talked-about cervical exams, also called cervical checks or pelvic exams. Now, I know what you might be thinking - “Isn’t it just about measuring dilation?” - but hang tight, because there’s so much more to it! We’re taking a deeper dive to understand the beautiful intricacies of labor that empower us to make informed decisions. Let's get to it!

Understanding the Trio: Dilation, Effacement, and Station

Navigating the landscape of labor involves understanding three critical factors that cervical exams evaluate: dilation, effacement, and the station of the baby. Let's break down these aspects to shed more light on their significance:

Dilation (1-10 cm): Dilation refers to the opening of the cervix, preparing for the baby's passage during birth. It is measured from 1 to 10 centimeters. While this measurement often receives the most attention, it's merely one piece of the labor progression puzzle.
Effacement (0-100%): Effacement indicates the thinning of the cervix, an essential process that facilitates smoother delivery. It is measured in percentages, with 0% representing a cervix that hasn't yet begun to thin and 100% signifying a completely thinned cervix, comparable to the thin skin between your thumb and pointer finger. This progression often occurs alongside dilation, paving the way for the baby's descent. You can not get to 10 cm without being 100% effaced!
Baby's Station (-5 to +5): The station of the baby provides insight into the baby's position within the pelvis. Measured from -5 to +5, it indicates how far the baby has descended. At 0, the baby is aligned with the ischial spines (your sits bones), ideally where they should be when you commence pushing. As you progress towards +5, you are nearing the moment of birth, with the baby moving further down the birth canal, preparing for their grand entrance into the world. This measurement helps in determining the most comfortable and effective positions for labor, allowing for a smoother delivery process.

Celebrating Every Change: It's All a Big Deal!

I really want to drive this home: EVERY bit of progress matters. Imagine you were 4cm dilated, 50% effaced, and at -2 station at one check, and at the next, you're still at 4cm but now 80% effaced and at -1 station - guess what, that's fantastic progress! It's all about celebrating each small victory and recognizing the intricate dance of dilation, effacement, and station working harmoniously.

It's also crucial to remember that cervical exams hold a certain degree of subjectivity. Typically, a provider carries out these checks without visual aid, relying solely on touch to gauge the dilation, effacement, and the baby's station. This touch-based method means that different providers might have slightly varying assessments, influenced by the different sizes and experiences of their hands and fingers. Therefore, to get a more consistent tracking of your labor progression, it’s beneficial to have the same provider perform your checks each time, if possible. This continuity can offer a more accurate depiction of your labor's progression, helping to craft a birthing experience that is both informed and empowering.

Risks and Benefits of Cervical Checks in Labor

Just like any intervention, it’s important to approach cervical checks with a well-rounded perspective. The risks associated with cervical checks include discomfort during the procedure (which can disrupt the flow of oxytocin), the possibility of your provider accidentally breaking your water, and a small increased risk of infection, particularly if your water has already broken.

The benefit, of course, is to see where you’re at right now! You may have heard the saying “Your cervix is not a crystal ball!”. And it’s sooo true. Contrary to what the medical model of care teaches and expects, labor is not linear and these checks can not tell us how fast or slow labor is going to progress. The mindset shift that knowing the numbers can cause is definitely something to take into consideration! It can be so encouraging to find out that you’re far along if you’ve been working hard, but on the opposite end of the spectrum, it can sometimes be disheartening to find out you’re not as far along as you expected to be. But like I said, it only tells us where you’re at RIGHT NOW. I have seen people go from 3 cm to baby in an hour, and I’ve also seen people stay at 7 cm for 8 hours. Keep this in mind if the numbers are not what you thought they would be. It's important to approach these checks with a balanced mindset, considering the potential emotional ebb and flow they can bring along.

Can I Refuse Cervical Checks?

ABSOLUTELY. Just like any intervention in labor, you have the right to refuse a cervical exam that you do not want. “No” is a complete sentence. Remember that YOU are at the center of this journey, with the autonomy to make informed decisions regarding the inclusion of any intervention, including cervical exams, in your labor story. You deserve to feel empowered and safe during your labor and birth experience, and if a cervical exam disrupts that, please do not feel pressured into the procedure.

If you’re on the fence about whether or not to get a check, a good question to ask your provider is “Will this information change my plan of care?”. If not, there’s really no need to intervene. There are plenty of ways to check for labor progress without doing an internal exam.

Dive Deeper with Me

Ready to learn more? I'd love to welcome you to one of my private classes where we unravel the world of childbirth together, in a completely personalized and custom way! Click here to learn more about the private classes I offer, either on zoom or in person if you’re in the Denver area!

Or, if you’re into group vibes, join me at Lucina Rising Birthwork for my 5 week birth course that is packed full with information and community. Click here to get more information on this course!