Hey, soon-to-be Mama! I’m glad you’re here to learn more about cervical exams during pregnancy. 

Pregnancy education is often overlooked, but I’m here to tell you everything you need to know about cervical exams during pregnancy. Including your rights! (You have them, and I'm gonna teach you how to use them- without fear of your provider being offended!)

What is your cervix?

Not sure where your cervix is? 

Your cervix is the opening between your womb and vaginal canal. The central cervical canal is narrow and runs along its entire length, connecting the uterus and vagina.

Here's how to find it: Sit on your toilet with your feet on a stool, prop your feet up on your toes, and knees relaxed out. Ok, ladies, it's ok to explore. Now insert two fingers, your pointer and your middle finger. Reach to the back. Your cervix feels like the tip of your nose! It's long and should be hard (ish) like your nose (touch it first to see what you're looking for!). 

During pregnancy, your cervix thickens and tightens to protect your baby. As your body prepares for birth, your cervix starts to soften, become thin, and open.

If you're worrying about whether or not your cervix is "healthy," you can read more about cervical incompetence on my blog.

Are cervical exams necessary during pregnancy?

Let's just get this out there; you are allowed to say no, especially if undergoing an internal exam is something you're not comfortable with.

Many women have been abused sexually in some form or fashion, so having a cervical exam is not top of the list. Here's the thing: you really don't need one during pregnancy. 

I teach my students inside Calm Labor Confident Birth Class and The VBAC Lab Birth Class that they can say no at any point. 

Now your healthcare provider (OB or Midwife) considers a cervical exam to be a normal part of prenatal care for several reasons:

• To determine if you're ready to be admitted to the hospital (This one is on a case-to-case basis  as a woman's behavior and pattern of labor can be more indicative of labor progress than cervical exams)
• Explore options for medical induction (things like high blood pressure and GDM!)
• To find out if you need to use pain medications (this is during labor before they say okay to an epidural or IV narcotics) 
• To ensure the position of the baby is not in a wonky position, which could make labor more difficult (This can be done with your provider feeling the baby's head during a cervical check)

Ultimately, it is YOUR decision to proceed with vaginal exams. What matters most is you have all the information you need to make the decision. Otherwise known as informed decision-making. 

What week do they start checking your cervix?

Cervical exams, also known as vaginal exams or pelvic exams, are often offered by gyns and hospital-based midwives during the end of pregnancy, usually around 36 weeks. 

Some gynecologists, however, may initiate this routine exam at an earlier or later period, depending on your health.

Another Trish soap box alert!! OMG, there is no reason for them to check you at 36 weeks; unless you have a medical induction planned soon. But other than that, hell-to-the-NO! 

Seriously, what does it matter if you are open or closed at 36 weeks? It doesn't it. I tell my girls that having a vag exam during pregnancy only leads to a messed-up mindset (mindset is everything in pregnancy and birth!). 

Consider these three scenarios:

Mama 1: At her 37-week appointment, her doctor tells her, get undressed; I will check and see what's happening with your cervix. (Inside, she cringes because she wants to say no, but she fears offending his expertise.) So she lays down and get's checked. He tells her well; you are 2 cm. Now she is like, hot dog, the baby is coming soon. She starts to get anxious, waiting for labor to start soon. But in fact, she goes to 41.3 days pregnant and then goes into labor. But the rest of her pregnancy, she worries that her body is broken and why she isn't going into labor??

Dilation does not matter before labor starts!

Mama 2: At her 37-week appointment, her doctor tells her, get undressed; I will check and see what's happening with your cervix. (Inside, she cringes because she wants to say no, but she fears offending his expertise.) So she lays down and get's checked. He tells her well; you are closed, thick, and high. Nothing is happening with your cervix. We may need to induce you at 39 weeks.

Now she is like, OMG, what is wrong with me? What if I can't go into labor? Why am I not dilated? She is anxious, waiting for labor to start and wondering when it will begin? She then makes a fear-based decision to be induced at 39 weeks, even though she dreamt of spontaneous labor.

Dilation does not matter before labor starts!

Mama 3: At her 37-week appointment, her doctor tells her, get undressed; I will check and see what's happening with your cervix. (Inside, she cringes because she knows this is pointless and could mess with her mindset, she fears offending his expertise, but she is a Calm Labor student and heard one of the other students talk about this exact scenario during a weekly group hangout!) So she politely says, no, thank you. He tells her, I would like to see what is happening; let's check and find out. She politely says no, thank you; I do not want to get checked; plus, studies show that dilation before labor does not matter. And he says ok, no problem!

And she leaves empowered. 

Dilation does not matter before labor starts!

Do they do cervix checks every week?

In short. It is the standard of care for most providers. However, many are leaning toward a new, more evidence-based way of practicing: waiting for labor (or an indication that says we need to check ). PRAISE GOD!

"The rationale for routinely doing cervical exams in the final weeks of pregnancy has been to check for changes in the cervix that occur in the early stages of labor. These include dilation (opening of the cervix) and effacement (thinning out of the cervix). But we’ve learned that these signs alone are not always a good indicator of how close someone is to going into labor. One patient could have a closed cervix today and deliver tomorrow, while another patient might walk around at 3 centimeters dilated for three weeks."

Does checking the cervix induce labor?

If you are going for medical induction of labor, having a cervical exam can help measure your Bishop score (a method that rates the readiness of your cervix for induction). The results from your cervical exam help identify your induction process and what medical options can be explored. In some cases, the Bishop score from your cervical exam if you want to go ahead with an induction.

Undergoing a cervical exam a day or two before labor inductions can give you a clearer picture of what you can expect during this process. However, note that a cervical exam that's done more than a few days before an induction date will not be able to provide that much actionable information since changes can happen quite fast.

How is a cervical exam performed during pregnancy?

Seeing all these Google answers on cervical exams can be nerve-wracking if you're a first-time mom. Don't fret! Word of advice: DO NOT GOOGLE.

Here's everything you need to know to have peace of mind.

Obstetricians, gynecologists, hospital-based midwives, and healthcare professionals usually do a cervical exam.

These healthcare providers conduct a cervical check by using their pointing finger and middle finger or ring finger and middle finger to measure the cervical dilation (cervical opening diameter), effacement (thinness), and the baby's location in the pelvis (baby's station). The cervical exam lasts for about 30 seconds to a few minutes.

The cervical exam begins with your health care provider asking you to undress from the waist down. Then, you will lie on the exam table and place your feet on the stirrups with your knees bent and legs wide open. (Think pap smear but no speculum) The cervical exam is performed manually with a gloved hand with lubricant. The provider then manually inserts two fingers into the vagina without using a speculum and reaches up to the cervix. 

During this process, your provider relies on touch alone as they cannot visually see the cervix. 

Check out a couple of posts I have on Instagram which will help you with relaxing during cervical exams!

What exactly are we hoping to accomplish by assessing the cervix prenatally?

A cervical exam assesses the following:

• POSITION OF THE CERVIX - To determine if your cervix still faces your lower back, which is the right pregnancy position, or if it has moved towards your pubic bone during pregnancy. It's like a satellite pointing to your back before labor begins, then rotates forward as labor starts.
• CERVIX DILATION - To check if cervical dilation has occurred and, if so, by how much. In some cases, the cervix starts to open by a centimeter or two (sometimes even more) during the latter part of pregnancy. (again, this is not too important unless being induced)
• CERVIX EFFACEMENT - To see if the cervix starts to thin out in preparation for labor and by how much.
• BABY'S STATION - (one aspect of their position in the pelvis). To check if the baby is in the right position for labor.

Check out these reels I made showing exactly what cervical exams are investigating!

What are the risks?

There are several risks that you have to keep in mind upon pursuing a cervical exam:

• Accidentally breaking your water, which increases the risk of infection. (due to bacteria entering the womb)
• The pressure of agreeing to a cervical exam can be uncomfortable and triggering for some, especially if the healthcare provider assigned to you is not used to handling the psychological aspect of conducting this routine check.
• Experiencing a painful cervical exam due to an unknown history of trauma, pelvic dysfunction, or floor pain. Some people only find out they are more sensitive when they undergo a cervical exam.
• Some providers perform a membrane sweep while conducting a cervical check without consent.
• Your mindset may be affected in a negative way.

Preparing For Your Exam

The fact that you're here reading up on everything you need to know about cervical exams is already an act of self-love and self-care. And I applaud you for that. Aside from the physical preparation and things to consider in coming to terms with your decision, I believe it's also important to put your emotions as a crucial factor.

Ask yourself. Are you ready to undergo a cervical exam? Is it something you're willing to go through 100%? Do you want it?

It's important to remind yourself that your pregnancy hormones will kick in, especially during late pregnancy. That being said, you must consider the possible emotional impacts that a cervical exam during pregnancy can give you.

Also, do not be surprised if you experience mild bleeding after a vaginal exam during pregnancy.

I'm rooting for you all the way when you say that you'll be ready and open to accepting the results and that they won't affect you mentally. However, you need to sit down and ask yourself if you're emotionally ready and capable of having a non-attachment to what your cervical exam will say.

Can I say no to a cervical check?

Hell yeah! Absolutely! Your consent should be the main priority above anything else. Being asked about getting a cervical exam can be pretty tense, so I've come up with phrases for you to establish your boundaries with your provider:

• "I don't want one, but I prefer to wait until labor."
• " No, thank you. I've researched and decided to opt-out of a cervical exam. I appreciate your concern."
• "I understand it is a routine practice during pregnancy, but I do not want one, thank you."

These phrases can help you say no without being uncomfortable about it.

In other cases, some patients change their minds during the appointment, which is fine. Feeling ready and being ready are two different things. You don't have to be hard on yourself if you suddenly feel like you're not up for the cervical check because this is a common experience. 

If you're 100% sure you're not in the right emotional state and energy to push through with the routine check, take a deep breath and calm your emotions. It is not your problem if your provider is unhappy with the decision. It is not about them. You hired them!

You can say no with the phrases above. Alternatively, I suggest you bring someone you trust with you during the appointment who knows you and your emotions well so they can speak up for you as needed. If it's impossible to bring someone physically, you can have them on the phone via call, FaceTime, or video call. (Our team doula offers virtual options to our students!)

When is a cervical exam needed?

Lastly, let's cover why it might be a good idea to have your cervix checked.

• There are indications that you are in labor and want to know.
• You are being induced for a medical reason (GDM, HTN, Preeclampsia, and other medical reasons.
• You want to be induced. (This is an elective induction.

If you are being induced, it is important for your provider to know your Bishop's score and what is happening with your cervix to make an induction plan. For instance, if you are not effaced, they will need to start with a prostaglandin-like Cervical.

I am here for you during your cervical exam journey. Remember that it will always be your body, your choice. If you're still unsure whether or not a cervical exam is something you're comfortable doing, send me a message!

If you're one of my mamas who has already undergone a cervical exam, don't be shy! Share your experience with me, and let's help other first-time mamas overcome their cervical exam anxiety.

Why I am here and who I am:

Hey mama, I am Trish— AKA Labor Nurse Mama. I am a labor and delivery nurse with over 15 years of high-risk OB experience. I am also a mama to 7 kids and have given birth to 6. This means I am quite familiar with the postpartum period and how to navigate it. I am the online birth class educator for Calm Labor Confident Birth and The VBAC Lab birth classes and the mama expert inside our Calm Mama Society a pregnancy & postpartum membership community! I am passionate about your birth and motherhood journey! You can find me over on IG teaching over 240k mamas daily. I am passionate about your birth and motherhood journey!

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As you prepare to bring your little one into the world safe and sound, let's chat about the dos and don’ts of cervical exams during pregnancy.