64. How To Give Birth Without a Single Cervical Exam (or limited cervical exams)

Did you know that you can birth your baby without a single cervical exam during pregnancy or labor?

In this episode, we’ll explore how you can assess labor progress in other ways, understand the true necessity of these exams, and how to advocate for what you want during your birthing experience.

What to expect:

• Understand the frequency and routine nature of cervical exams in hospital births…
• Why cervical dilation is NOT a reliable predictor of labor progress...
• Possible risks and emotional impacts of frequent cervical exams…
• Other ways to assess labor progress without cervical exams you might not realize...
• How to advocate for a birth experience with minimal cervical exams if you want…
• … and so much more!.

Thank you for tuning in to Your Birth Bestie podcast today! Remember, your birthing experience is yours to shape. Knowing your options and understanding that cervical exams aren't the only way to assess labor can empower you to make the best decisions for your body and your baby. Join us next week for another episode! 

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👋 WHO AM I?

Welcome, friends! I am Beth, a certified nurse midwife, doula, and childbirth educator. My philosophy is rooted in autonomy, informed decision making, and positive mindset to help expecting parents plan for a beautiful, stress-free hospital birth. I am here to provide value to YOU through tips and practical advice, either to guide you through pregnancy or to help you prepare for childbirth, postpartum and beyond. There’s no fluff here - only info that adds to your positive experience and saves you stress and uncertainty.

Transcript

Hello and welcome back to episode 64 of Your Birth Bestie podcast. Today, we're diving into a topic that challenges a common hospital routine, which is giving birth without a single cervical exam. We'll explore how you can assess labor progress through other means, understand the true necessity of these exams, and how to advocate for a less invasive birthing experience.

Today we are going to be talking about something I know you will encounter if you are a pregnant mom, but if you’re a birthworker listening to this as well, this is something important for you to feel comfortable advocating for and understanding alternatives to the normal routine ways in the hospital. And this episode is all about cervical exams and helping inform others about ways we can assess labor progress without them and maybe why we would want to think about doing it this way! 

So first I wanted to dive right into the fact that cervical exams are so, so, so common in hospitals and was actually one of the many things that when I started as a labor and delivery nurse, trained on the job in the medical system, I remember questioning why we were doing them so often. I second thought it, but I also didn’t know any better at the time that there were other ways and that documenting a woman’s dilation in centimeters of how open the cervix is, the effacement or how thin the cervix is, and station or high or low baby is in the pelvis, was not all that helpful in predicting labor progress or when the baby would be born. It was a tangible number to show progress over time, but clinically didn’t really give good information to make next step decisions. I have learned a lot since those days as a labor and delivery nurse!

But in general, cervical exams or vaginal exams are a standard procedure in hospital births that entail a healthcare provider like a doctor, midwife, or nurse, inserting two fingers into the vagina and up to the cervix to feel and measure how dilated, effaced, what station the baby is at, how soft or firm the cervix is, and then the position of the cervix whether it’s more toward the front, back, or middle. This is done to assess and get an idea of how far along labor has progressed and usually are done every 3 ish hours when a woman is laboring in the hospital.

And you might be wondering why they would be done so often… and this is because they provide a quick and easy way for healthcare providers to gather information that can be documented. Hospitals are very data-driven places, and having measurable data like cervical dilation can be useful for documenting the progress of labor and even comparing it along Friedman's Curve, which is an outdated practice that puts expectations on labor progress in dilation over time. Every labor progresses differently and in my opinion and within the midwifery model, is not something that is valued. Women are individuals and their care in labor should be treated as such, not rushed along and compared to a standard guideline. Overall, it’s important to know that these exams are frequently done more for data collection and documentation purposes rather than out of medical necessity. It can absolutely be appropriate to assess this information in the plan of care may change, but just to “check” or because a certain number of hours has gone by and we’re looking for a reason to speed things along, then definitely not something I personally would practice or be in support of as a patient. Some people like to know this kind of information, but I want women to know that you have to agree to a cervical check, it is never required just because your provider wants to. I hope that makes sense and you’re not being difficult for declining or for asking for more time between checks. It is perfectly okay.

I also wanted to mention, which I kind of did before, but further talking about how cervical dilation is not a good predictor of labor progress. Many people think that if they know how dilated their cervix is, they’ll be able to predict when the baby will be born. It would be lovely if we knew when baby would be born, but this isn’t the case and cervical dilation is just a small piece of the puzzle. A woman can be dilated to 3 or more centimeters for weeks and weeks before going into active labor, or she can go from 1 centimeter to fully dilated in just a few hours. I am one that this happened to with both of my pregnancies so far and will report back with this birth story when the time comes, but I was 6-7 centimeters both times with no signs of labor. If it wasn’t for a cervical check at a routine prenatal appointment, I would have had no idea. But because I knew this information, I was pushed for interventions and augmentation of labor with breaking my bag of water and things like that, that I wouldn’t consent to this time around. I didn’t need to know this information and it really wasn’t helpful. This basically means that cervical exams don't actually give us a reliable timeline for when the baby will arrive, they can be an okay guess though by providing a snapshot of the moment, but don’t predict the future and also you don’t know how long that exam has been accurate. Were you dilated 2 hours ago, was it 10 minutes only, we really have no idea!

And then because of this lack of being able to predict the progression of labor, cervical exams can actually, a lot of the time, cause unnecessary stress for expecting mothers. What can happen is that you’re going through hours of intense labor contractions and then getting to the hospital to be checked for admission to a room and then told, “you’re only 2 centimeters dilated”. Moms hear this and if labor is really intense, may think how the heck are they going to do another 8 centimeters of dilation, knowing it probably will continue to get more intense. It can be disheartening and make you feel like you're not making progress, even if everything is actually moving along just fine. You don’t know if those 2 centimeters would take 10 hours and then 2 to 8 centimeters will be an hour. You have no idea! This focus on numbers and data can distract from the natural flow of labor and add anxiety to the process, which then of course doesn’t help at all with hormone release and helping labor progress. It is such a mind game that can affect physical performance and outlook of labor for moms and that is something that really bothers me for moms. It’s like we are sabotaging their experience by just being a little curious about dilation, even though remember, it’s not even predictive!

So yes, while cervical exams are a routine part of hospital births, their main purpose is often for data collection rather than medical necessity. Cervical exams don't reliably predict when your baby will be born and can sometimes cause more stress than reassurance. Understanding this can help you advocate for a birth experience that feels right for you, remembering there are other ways to assess labor progress that don't involve routine cervical exams, which is coming up soon!

So now that you know a little more about why cervical exams are done and how routine they are, I wanted to also mention the risks associated with these exams. Informed decision making comes down to knowing all your options and choosing the best one for you, so this conversation wouldn’t be complete without it. Some people are totally fine with getting checked every few hours and taking some risks, others would rather not and may have other risks as well from that choice. So basically everything comes with some degree of risk, and that choice is individualized and comes down to your values and wants for your birth experience. 

The most common risk that comes up is potential infection. Every time a cervical exam is done, there's a possibility of introducing bacteria into the vagina and cervix which can lead to infection and complicate labor and delivery, even though it is a sterile procedure and your doctor will use a sterile glove and lubricant with each check. Another significant risk is the accidental breaking the bag of water before contractions are established and labor is on it’s way, called premature rupture of membranes, or PROM. When the membranes rupture prematurely, it can increase the risk of infection for both the mother and the baby and may lead to interventions such as induction of labor or a cesarean section.

Beyond the physical risks, cervical exams can have a substantial emotional and psychological impact, a topic I don’t think is often considered enough. Many women find these exams to be uncomfortable or even painful, so the experience of having multiple exams over the course of labor can lead to feelings of discomfort, stress, and even a sense of violation. It's important to recognize that childbirth is an extremely personal and vulnerable time, and anything that adds to the emotional burden can negatively affect the birthing experience. The psychological impact of feeling exposed and the stress of anticipating the next exam can overshadow the empowering aspects of childbirth, which is really unfortunate when they are being done frequently, without medical indication. 

As we know too, labor is a delicate process that relies heavily on the mother's ability to relax and let her body do the work, and frequent cervical exams can disrupt this natural progression of labor. Interruptions for exams can break the concentration and natural rhythm of labor and when an exam is performed, it can pull the mother out of her focus, potentially slowing down the progress of labor. Of course then there is always the increased possibility of leading to the cascade of interventions, as healthcare providers may feel the need to 'manage' labor that appears to be stalling when, in reality, it just needs time to progress naturally. Usually a woman’s body will progress in spontaneous labor at a rate perfect for that person and that baby, it is a lot of times not giving mom and baby enough time and patience to find that out before interventions are recommended. I definitely see this way more often than not in the hospital setting and it happened to me personally too. The normalization of this scenario doesn’t help the cause either, but this is exactly why I want to spread information about it too!

Which leads me to the part that maybe you’re most interested in learning about, and that is exploring how you can assess labor progress without relying on cervical exams. And there are several effective ways to understand how labor is progressing, from observing contractions to recognizing behavioral and physical signs, and monitoring the baby. So let’s start by looking at the role of contractions in assessing labor progress.

One of the most reliable indicators of labor progress is the pattern of contractions. As labor progresses, contractions typically become more frequent, longer in duration, and definitely more intense. Early labor contractions may be spaced far apart, like 8 or 10 minutes, lasting around 30 to 45 seconds, and may not be very strong. As labor moves into active labor, contractions usually come every 3 to 5 minutes, last about 60 seconds, and progressively get more intense. Transition, that final phase before pushing, is marked by contractions coming even closer together, every 2 to 3 minutes, lasting 60 to 90 seconds, and being very intense. By paying attention to these patterns, this is just one example of how you can gauge how far labor has progressed without needing a cervical exam.

Another important part to consider is how mom is acting and how she sounds. This one became pretty obvious the more births I attended. You don’t need much more information when you here those deep, primal noises from mom that the baby is probably pretty close to being born. The sound of mom pushing too and bearing down is usually very obvious as well. So generally as labor progresses, a woman's behavior and vocalizations often change. In early labor, she might be able to talk through contractions and move around easily. As labor intensifies, she may become more focused and quiet during contractions, concentrating on her breathing and coping techniques. And then the more obvious one is during active labor and transition, vocalizations might include moaning, groaning, or other sounds that reflect the intensity of the contractions. These changes can provide some really accurate insight about how far progressed in labor mom is.

There are also specific physical signs that can indicate labor progress. One sign is the 'purple line,' a reddish-purple line that can appear pretty much right above the butt crack as labor progresses. This line can extend upwards from the anus and is thought to correlate with cervical dilation. There may also be changes in the perineum, such as bulging or increased pressure, that would indicate the baby is moving down the birth canal. These physical signs can be observed without the need for invasive exams.

Monitoring the baby is another part of assessing labor progress, specifically listening to the baby's heart rate and movements. A steady, strong heart rate and active movements are good signs that the baby is handling labor well and providers will normally use a doppler to assess this. This non-invasive monitoring helps make sure that both mom and baby are doing good, and again no cervical exam is needed. Of course if anything was off with any of these findings, a cervical exam is always a tool that can be utilized as needed.

And on that note, I just wanted to briefly point out reasons why you may agree to a cervical exam and when there is good information that it provides that may change the plan of care.

One reason would be if there is a concern about preterm labor. A cervical exam can help assess whether the cervix is dilating prematurely, which may require medical intervention to delay delivery and improve outcomes for baby. Also during pregnancy, if a medical reason comes up that induction is recommended, a cervical assessment helps determine the cervix’s readiness for induction method and is part of the decision making process about what is the best way to help your body safely get into labor, so something to be aware of. 

And then during labor, cervical exams might be needed to monitor the progression of labor more closely if there are complications such as fetal distress and it has to be assessed whether it is safe to continue laboring for a bit longer and help baby be born, or if birth is unlikely quickly and other interventions are needed to maximize the best possible outcome for baby. 

On the other side, there are medical scenarios where avoiding cervical exams during pregnancy and childbirth may be the best choice. For example, women with a history of premature rupture of membranes or those at risk for infections can benefit from minimizing the number of vaginal exams to reduce the risk of introducing bacteria. Additionally, some women with a history of trauma or sexual abuse may find cervical exams particularly distressing, and their mental well-being could be better supported by opting for less invasive monitoring methods. And in these situations like we’ve already talked about, in low-risk pregnancies where labor is progressing normally, healthcare providers may rely on other ways to assess labor progression, such as the frequency and intensity of contractions, how mom is acting, and physical signs, to monitor the process without routine cervical checks. By avoiding unnecessary interventions, the birth experience can be made more comfortable and respectful of the mother's preferences and needs.

The last thing I wanted to talk about was the impact of hands-on interventions, like cervical exams, on the birthing experience. I am passionate about physiologic birth and encouraging and supporting labor to progress naturally, and want to further explain how less intervention can empower mom in her experience. And what I mean by a hands-off approach to labor, I’m talking about minimizing unnecessary medical interventions and allowing the natural process of birth to unfold. This can include avoiding routine cervical exams, frequent monitoring, and other invasive procedures.

Empowering mom is such an important part of the birthing process because when interventions are minimized, mom can focus on what her body is telling her and use her instincts to guide her through labor. This empowerment comes from trusting her own body and the natural process of birth and doing things instinctively like moving freely, choosing positions that feel comfortable, and using coping mechanisms that feel most relieving. This active participation can significantly make her birth experience more positive and individualized, giving her a sense of control over everything.

So now that you know it is possible to labor without a single cervical exam, it’s important to talk about how to advocate for this, if it’s what you want.

Informed consent is something I talk about a lot and is a fundamental right in healthcare, especially important during labor and birth. This means you have the right to be fully informed about any procedure or intervention, including its benefits, the risks, and alternatives, before giving your okay to move forward. Understanding your rights and the reasoning behind different interventions allows you to make empowered decisions about your care so definitely don't hesitate to ask questions and request more information if something isn't clear. Remember, it's your body and your birth experience.

Also, communicating your preferences to the healthcare team is another part of advocating for yourself that for me is what I see families struggle with the most. Most people don’t like confrontation or feel like them declining something or asking more time makes them a “difficult patient” or the healthcares staff will be upset they have different views on what is recommended. But it’s okay, it’s your birth story, not theirs! 

The best way to do this is by creating a list of birth preferences and sharing it with your healthcare team before labor begins and review it with them to ensure they understand and respect your wishes. During labor, continue to communicate openly and confidently about your preferences, and this is a really helpful role of a doula as well if that is something you’re interested in. A doula, in particular, is trained to support you throughout labor and can act as an advocate, helping you navigate any challenges that come up and ensuring you feel empowered and respected throughout the process.

Thank you so much for tuning in to Your Birth Bestie podcast today! I’d love to wrap this up by reminding you that your birthing experience is yours to shape. Knowing your options and understanding that cervical exams aren't the only way to assess labor can empower you to make the best decisions for your body and your baby and have the experience that you are most comfortable with. I don’t want any mom to feel pressured into anything, especially an uncomfortable, possibly unnecessary exam in an intimate area. Keeping pregnant moms and families comfortable, confident, and feeling safe and respected should be the priority, and limiting or completely eliminating cervical exams when unnecessary is a great example of this! Thank you again for listening and I will be back here next week with another episode. Bye everyone!