It never ceases to amaze me the information that women are given and the procedures they undergo prenatally and during labor all in the name of “routine.” One of those things that always annoy me is the frequency of unnecessary vaginal exams/cervical checks.
While I personally don’t do frequent/multiple vaginal exams on a woman in labor, I do understand why some nurses, doctors, and midwives feel the need to do them. I don’t agree with their rationale but I understand it because I used to be a “frequent checker.” What I have NEVER understood is the routine checking of a woman’s cervix prenatally when she has yet to have ONE contraction or any sign of labor. Many providers do routine cervical exams on every pregnant patient starting as early as 37 weeks. Some wait until the 38th week and by the 39th week women are walking around wondering “Why haven’t I dilated past 1cm. I’ve been 1cm for 2 weeks now?” These are often women who have had a FEW contractions that they might call “crampy” or “slightly uncomfortable” and otherwise have no signs of any sort of labor. This sets up a cycle of fear of the inability of her body to have her baby. It is so important for a woman to have unwavering faith in her body and her baby. The moment this faith is shaken, the cascade of fear can take over.
Let’s take for example the following… The other day I received an email from a pregnant woman I have been doing some private consulting with. When she emailed, she was 39 weeks pregnant. She said…
“From my last week’s weekly OB appt {which means she was 38 weeks at the appointment}, my cervix is/ was still posterior and the station was high (-3). I’m hoping to be somewhat dilated soon and am trying to get my cervix to be anterior. I’ve been swimming, walking, climbing stairs sideways and doing the head down with butt in the air wiggle wiggle exercise. Do you have any recommendations on how I can get my cervix to be anterior? I am going to have an unmedicated vaginal birth, so any advice you can give me will be totally appreciated.”
I took a deep breath before responding and then I said to her ….
“First I want to answer your question and I hope this does not sound too blunt…. you CAN’T get your cervix to be anterior. When your body is in active labor it will naturally move anterior.
Now I have a question for you… Why did you have a cervical check last week? Was it because you wanted one or because they said you needed one? The reason for my question is this…
Remember when we spoke, we talked about the importance of continuing to have full faith in your body and removing any outside forces that undermine your faith. Well… unnecessary vaginal exams when you are not in labor and before your due date is one of the early/many ways that women begin to lose faith. When your body is ready to go into labor you will dilate and your cervix will move anterior. If it is not ready it won’t. If you are not in labor and contracting regularly with strong contractions you should not expect cervical change. The question I always ask is this…. ‘Will the information gained from THIS vaginal exam change what we are going to do today?’ In your present situation, unless you are considering being induced a vaginal exam is irrelevant. What do I mean irrelevant…it does not change what we are going to do TODAY and things can literally change overnight. Because of this, I encourage you to avoid all vaginal exams until you think you are in labor and are having a labor check or you are preparing for an induction. I encourage you to let go of your current cervical change expectations and focus on getting your mind ready for labor and motherhood. You can go from closed to delivered overnight. It will happen. Don’t start to doubt and don’t start to worry. Your body and your baby know the perfect time to move to birth. “
She responded, thankful for my reminder that her body knows best. She also let me know this…
“As for checking the cervix, I had no idea…the dr. just did the examination and said it was routine, so I didn’t question her until the whole posterior/anterior subject came along…”
Yep…. You read it right and it happens all the time … “I had no idea … the dr. just did the examination and said it was routine…” When did it become routine to violate a woman’s body without her permission? Why is it routine to check the cervix of a woman who has not passed her due date and has no signs of labor? Why do we continue to make women feel inadequate and incapable of having their babies? ROUTINE does not mean REQUIRED. ROUTINE does not mean RIGHT. Routine is a regular habit one that is done habitually. It does NOT mean something that has to be done.
Don’t let the Routine get in the way of RIGHT. Your baby and your body know when the time right. Have faith.
In Birth and Love
Nicole
Thanks for posting this! It always drives me NUTS when I hear women get discouraged about not making “progress,” or get encouraged by their “progress” (only to get discouraged later when they stay at 3cm dilated for weeks on end…)
When I was pregnant with my daughter, my OB insisted on doing cervical checks. His reasoning was that if I showed up at the hospital 3cm dilated and I had NOT had a recent cervix check, then they would have no way of knowing whether I’d been 3cm for weeks (and therefore likely not in active labor) or whether I had just been 1cm a few days before (in which case having dilated to 3cm was likely a sign of active labor). Just curious, do you agree with that?
At any rate, we compromised… first of all, he held off on starting the checks till 39 weeks, rather than starting at 37 like he usually does. Then, he checked my cervix and note my “stats” in my record (so they could be called up if need be), but I asked him NOT to tell ME what they were. That allowed me to keep that all-important full faith in my body. I didn’t ask for my “stats” until 41 weeks, when we were talking induction.
Hi Lisa… No I don’t agree with your MD’s rationale for wanting to do cervical checks. Active labor can be diagnosed without having previous cervical changes. Active labor means a woman is having contractions with cervical change and it generally means cervical change of 4cm or more. Sooooo if you did show up at the hospital with a regular contraction pattern and you were 3cm I would say that you were in early labor. After a few hours if your cervix was unchanged, we would have our answer. No need for the previous checks weeks before.
Thanks for this post. I am 38 weeks pregnant, and though I did my research and KNOW that vaginal exams are not necessary late in pregnancy, and that no exam can tell you when you’re going to give birth, I still found/find myself WANTING to be checked, to have some sense that I am “progressing” or “getting close.” I am having enough trouble maintaining my resolve with birth attendants (midwives) who are fully supportive of natural birth and avoiding unnecessary procedures. I can’t imagine how difficult it would be to have to advocate for such with a birth attendant who is unsupportive.
Hi Emily, thanks for reading. I would enourage you to just KNOW that you are progressing AND you are getting close. You have no choice. You body is doing what it is supposed to do!! Progressing and getting close… a vaginal exam has no bearing on that…
[...] dilation, labor, posterior, pregnancy, station, vaginal exam, women's health I came across this post by It’s Your Birth Right! tonight and wanted to pass it on. She gives a specific example of [...]
Thank you for writing this! I completely agree with you and I hope that more women will get this kind of information while they are pregnant. I will be linking this on my blog!
Great article! So true!!!
Thanks for reading Taryn!!
Amen!
I will more than likely request to not have this done this time around. I hate the pelvic exams and you’re already uncomfortable when you’re preparing to give birth, not to mention how self-conscious women feel when they can’t see to shave/trim or what-have-you.
This is an issue with health care in general now. Doctors are performing unnecessary & sometime very expensive procedures.
As usual, I’m more informed after reading your blog. Keep it up!
This is certainly an issue all over health care and one that is definitely being discussed as a part of this “health care reform” Lets hope the right decisions are made about the right interventions. Thanks for reading!
[...] over to read this entire blog post by It’s Your Birth Right; Skip This Routine and think about keeping YOUR pants on if you are not in [...]
[...] this blog and read the entire article! At your next appointment, think about keeping your pants on! Skip This Routine!<a Possibly related posts: (automatically generated)Over at Organic Schmorganic ~I’m not a [...]