Cervical checks, are they necessary?
Pelvic exams and cervical checks are something that many women consider routine. Cervical checks and pelvic exams are common practice in well-woman exams, labor, and birth. In fact lots of women don’t think twice about getting these done. Although, in some cases many women have lots of fear and anxiety around pelvic exams and cervical checks. Many women feel they are not needed, or maybe they feel like they’re not safe, and some women are uncomfortable surrendering themselves to a cervical check or pelvic exam.
First let me explain, what is a cervical check or pelvic exam? A cervical check is a vaginal exam used to check on the position and dilation of the cervix often during late pregnancy or labor. Your healthcare provider may insert their fingers into the vagina. This helps providers track your labor progression. For example, when you get to the hospital, they may perform a cervical check to establish a starting point of how dilated you are. Some women come in at 1-2 centimeters, while others come in at 7-9 centimeters because they chose to labor at home as long as possible. Typically women who don’t want pain meds will labor at home to reduce temptation of an epidural, and on the other hand, women who want an epidural may come in early in labor to allow for the epidural to be placed and get established before labor progresses.
Pelvic exams offer a bit more than just checking the cervix. Pelvic exams include checking on the health of the vulva, vagina, cervix, uterus, and ovaries. Providers may use a speculum inserted in the vagina to get a visual look at the health of your reproductive system. Pelvic exams are typically performed at your annual OB-GYN appointments. These are typically done to monitor your reproductive system. This is especially important for women who have diagnosed medical conditions such as PCOS, endometriosis, or a history of reproductive cancers in themself or their family history. Both exams are intimate and require informed consent from the woman. The woman receiving care has the right to say no if she feels uncomfortable or triggered by the experience.
Many women who experience anxiety and fear around cervical checks and pelvic exams likely have a valid reason for the fear. Some of the reasons include, and are not limited to, previous abuse, heightened pain in the area, fear of contracting an infection, concerns with triggering premature labor, and feeling like they lost their bodily autonomy. These feelings are more common in women who are survivors of sexual abuse, sexual trauma, or other forms of abuse. It may be difficult for survivors due to triggers including feeling vulnerable, physical touch in certain areas where abuse has occurred, the gender of the provider can be triggering, and even being in a medical office can cause triggers. In some cases where women have experienced medical abuse, she may have triggers in a medical setting, especially one similar to where the abuse occurred. If she experienced medical trauma from a previous birth or previous appointment, she may be triggered by the provider, certain medical smells, certain medical terms or phrases, and even sounds of machinery and the medical office itself.
In many cases the woman may feel like a cervical check or pelvic exam may not be needed at the time, or are against medical interventions. In cases where she is having an easy pregnancy with little to no complications, there may be no reason to perform a cervical check if she isn’t showing any symptoms that require one. It’s becoming more common these days for women to want an intervention free or minimal intervention labor. This includes little to no cervical checks during labor, or only when requested by the mom. In cases like this mom may want to rely more on how she feels versus the number of centimeters dilated she is.
Doctors have good reasoning behind needing to perform cervical checks. Some reasons where doctors may perform cervical checks and pelvic exams include suspected preterm labor, suspected active labor, vaginal bleeding, and suspicion of ruptured membranes. The doctors were educated to check these things to act in the best interest of the mother and baby.
As a trauma informed doula, I want all my clients to understand the importance of cervical checks and I want women to understand that they have the right to say no. It’s important in trauma informed care for women to feel like they have the autonomy and confidence in their body to make decisions on things like cervical checks. If a mom is uncomfortable with a cervical check or pelvic exam, it is my job as their doula to advocate for them and help their doctor understand that she doesn’t want the check or exam. Women have many options as far as bodily autonomy and the choices surrounding cervical checks. She can have the exam done, she can postpone the exam to a later time, or she can refuse the exam altogether. I would explain to mom that she has these choices, because not all women are informed of the choices they have surrounding labor and birth.
Studies show that there is almost a snowball effect when it comes to medical intervention in labor and delivery. The more interventions you have the higher the risk of maternal or fetal complications. When in the hospital they want to give you pitocin as soon as you arrive so you can induce labor. Pitocin triggers uterine contractions. One risk is that your uterus can get overstimulated and if the uterus doesn’t have time to calm down between contractions it can cause decreased heart rate in your baby. When baby’s heart rate slows they want to try and get baby out faster, thus leading to more medications, manual breaking of the amniotic sac, and in some cases an “emergency” c-section. The rate of c-sections have increased drastically in the United States.
Cervical checks are important in lots of ways, but women have the right to say no. I want women to feel empowered and feel like they have the choices to say no when the situation arises.
