What is a Cervical Exam and when is it Useful?
Until pregnancy, you may not have thought twice about your cervix, only remembered it when receiving a pap smear, or perhaps not even known of its existence. For a lot of women, after becoming pregnant, this organ receives a lot more attention and especially near the end of a pregnancy. But what can the cervix really tell us about our labors and birth?
What is the cervix?
First, let’s discuss what the cervix is, where its positioned and what its job is in the context of pregnancy, labor, and birth. To understand the cervix, we have to acknowledge the uterus which is the organ that houses a pregnancy. The cervix is the opening to the uterus and is located at the bottom of the uterus. Together, these organs almost resemble a light bulb in their shape, with the cervix representative of the screw in base and the uterus representative of the glass bulb.
Throughout pregnancy, the cervix should remain closed, long and act as a protective barrier between the vaginal canal and the fetal head. As your pregnancy approaches the weeks and days leading up to your labor however, it’s not uncommon for your cervix to start to change shape and consistency. In other words, your cervix can start to soften, shorten and even open in the days leading up to your labor.
This can happen as a result of many factors. One being the dropping of your baby lower into your pelvis creating more pressure on the cervix. Other hormonal factors can begin to influence the consistency of your cervix, softening it in the days leading up to labor. External influences including intercourse and orgasm can also start to change the shape of the cervix. Certain foods including dates have also been proven to soften the cervix. And lastly, whether you’ve had a baby or not can influence how your cervix changes in the last days of your pregnancy.
And although all of that is true, your cervix can also not change in the days and weeks leading up to your labor and only do so when you are in actual labor.
The reality is that labor is defined as consistent regular uterine contractions AND cervical change or dilation. So, until you are having both happen at the same time, you’re not in labor. And as much as science and research can inform us, the onset of labor and what causes it still isn’t fully understood.
So what does a cervical exam actually tell me?
Cervical exams can be common practice in the later weeks of pregnancy but the truth is that they are not predictive and won’t be able to tell you when your labor will onset. If you would like to know what your cervical exam is, by all means have one performed! But understand that it won’t be able to tell you anything about your labor or when it will start.
A cervical exam will tell you 5 aspects about your cervix and I’ve outlined them here:
Even in the context of labor, the exam will tells us the same 5 aspects and can’t tell us when water will break, how much longer labor will be, and other factors described in this video.
How is a cervical exam performed?
In order to assess your cervix, your provider will place sterile gloves on and use their hand to assess the dilation, effacement, station, consistency and position of your cervix. This exam is invasive and can be triggering for some individuals. If you find the idea of this exam to be triggering, please have a conversation with your provider prior to the exam to construct the best approach for your specific care.
So when do I get a cervical exam?
Well, this is totally up to you!
Now knowing what the exam does and doesn’t communicate, you can make an informed decision that is best to you and your family.
I will say, in the context of an induction, whether it be medically indicated or elective, an exam is necessary to determine what medication would be best to start the process. If your cervix is closed, hard, and high into the pelvis, cervical ripening medication is needed prior to using other medications or mechanical methods of induction. Additionally, if you desire to have a membrane sweep performed in hopes of initiating spontaneous labor, an exam is done prior to the sweep.
Additionally, if a cervical exam will help you to make a decision or change management such as… your decision to ask for pain medication or receive an epidural… or your decision to go back home and labor there vs. at the hospital in the hours of early labor… or your decision to move in different ways and positions based on your baby’s head and position in the uterus, than that information can be very informative and empower you to make the decision that’s best for you.
Lastly, cervical exams can become necessary in circumstances where assessment of the cervix will help to determine and potentially help prevent maternal and fetal complications. These instances can include: pre-term labor, cord prolapse, and placenta previa (use of a speculum vs. your providers fingers) to name a few.
When or whether you choose to have a cervical exam is a decision only you can make and one that can be formed in conjunction with your provider. The most important aspect is that you understand what the exam will and won’t tell you and that you’ve given consent to receive one.
Stay well momma, you’re worth it!
Skyler Jacobs, CNM