I’m going to preface this blog post by saying that I 100% do not think the cervix check is a great way to see how established or progressed your labour is - ESPECIALLY if you are in spontaneous and physiological labour. BUT, if you are birthing in a hospital (or anywhere with a medical professional really) you will be asked if you would like to have a vaginal examination to check your cervix. So firstly I’m going to go through what the cervix is, why and how it dilates, and when you might have it checked.

What is the cervix?

The Cervix is at the bottom of the uterus (womb) and forms a canal that opens into the vagina, which leads to the outside of the body. When you’re pregnant, it is closed firmly with a thick mucous plug. This mucous plug can come away and regenerate throughout pregnancy, sometimes with some pink or brown blood attached. It can mean labour is coming soonish, but not necessarily. The mucous coming away is sometimes called a “show” or a “bloody show”. Anyway, I digress - the cervix is made up of tissue that is sort of like your lips or nose (not cartilage) - firm but squishy? It’s a weird one to try to explain with words - but you can actually usually feel your cervix if you want to, just make sure your hands are clean. It’s about 2cm thick and is like a tiny firm donut cushion. If you want to look at real life pics of cervixes you can check them out here. Then you’ll know they look nothing like donuts!

How does the cervix open?

There are 2 things that happen as you progress to the end of your pregnancy - effacement (thinning) and dilation (opening). Effacement can happen without you even knowing, sometimes during braxton hicks or during practice labour. This is when your uterine muscles are pulling upwards to build an amazingly thick fundus (muscle layer) at the top of your uterus to eventually push your baby out. This fundus grows thicker with every contraction as labour progresses, and as the uterus pulls up, the cervix can’t help but open gradually.

What is a Cervical check?

While on your back with knees up (usually with a modesty drape if in hospital/birth centre), a sterile gloved exam is done to determine the degree of cervical dilation and effacement. The measurement of cervical dilation is made by locating the cervix inside the vagina, spreading one's fingers in a 'V' shape, and estimating the distance in centimetres between the two fingers. This measurement is not always accurate and research has shown that between one care provider and then next there can be up to 50% difference in estimated measurement.

When will you be offered a Cervical check?

Before admission to a maternity ward
Every 2/4 hourly depending on the hospital policy
If asking for medical pain relief
If you request a caesarean section while in labour
If you say you feel “pushy” or pressure in your bottom

The key word here is OFFERED but I use that lightly - as most providers in our maternity system will broach the subject with a statement instead of providing risks and benefits and asking for consent. Things like - “we’re just going to check where you’re at”, or “after this contraction we’ll see if you’ve progressed”, cue glove on and ready.

That being said, you can and should say no if you don’t want a VE - to which you can expect there to be pushback or “you have to”’s in some birthing facilities. This is why I encourage all mums to map out all their decisions during pregnancy so that discussions can be had and everyone is on the same page well before you go into labour.

What risks do cervical checks have?

Cervical checks are always invasive, usually uncomfortable, and sometimes painful - some women even report being traumatised by the experience
They aren’t predictive, therefore they are not a great way to help inform your decisions
They are inconsistent between providers - sometimes by up to 50%!
They can be disempowering and disappointing - sometimes in your heart you know you are further along but if you have a number given to you that you weren’t expecting - you can start to doubt your instincts
Sometimes membranes can be accidentally ruptured when the midwife or OB does a check. This can alter the whole trajectory of a birth, and take a decision that was yours to make. When birthing in a facility, time frames are put around labouring women who have ruptured membranes, and lots of pressure can be applied to have further intervention. If you have made this call yourself knowing these risks, amazing! Many mums don’t realise these risks though, until it’s too late.
Increases the risk of infection, especially if membranes have already released.

When can cervical checks be beneficial?

In a medicalised labour (induction) to ensure that the induction method is working as needed
In a long labour (over 24 hours active labour), to check if all is well or if you want to try any new coping techniques or pain medication
If you as the birthing mum, ask for one - it’s your call mama!

With all of this in mind, you might ask - if a cervix check isn’t accurate for assessing labour progression, then what is? Well, good midwives and OB’s can tell how far you are progressing by watching you labour for even a short amount of time. They watch for the sounds you are making, the things you are saying (or how you are saying them), the positions you are instinctively moving into, the feeling of the top of your fundus and how your lower back is looking (look up Rhombus of Michaelis or “the purple line” during labour). There are so many ways! This is another reason to chat to your care provider in pregnancy if you will be declining VE’s - you might want to know if they have these skills.

The reason VE’s are offered so often is because it’s easier to measure or track a labour of many women at once if you have numbers to work with. Routine VE’s are just another indicator of our medical system trying to mechanise birth unfortunately. But we are unique HUMANS BEINGS, not man made machines - and we can’t be predicated or graphed!

My experience with VE’s

I wanted to pop my own experience with VE’s here because well… I don’t have any! After doing a lot of research during my first pregnancy and asking for the support of my private midwives, I asked how they felt about not doing VE’s and they said they absolutely didn’t need to do them. They knew they would be with me in the room for hours as I progressed through labour, and would know if labour wasn’t progressing as “normal”. I am so grateful to my first pair of lovely midwives Peta and Vanessa for teaching me about how women should be cared for in labour - they were truly “with woman” and that was the best and safest care I could have asked for. Obviously for my next 3 babies it wasn’t even a question! Even when my last baby decided to turn sunny side up while in labour - still no need for any checks! They trusted me, and I trusted myself. I think it totally would have interrupted my labour focus and had me in my thinking brain instead of my labour brain. I was so glad that once I declined in pregnancy, it wasn’t even offered - allowing me to ask if I ever felt the need.

Some extra homework for you guys is to look into cervical recoil (yep, that’s right - your cervix can recoil if you don’t feel safe!) and to listen to any of the Podcasts below… they will educate you on so much more than I can fit into a blog post

The Midwives’ Cauldon “Vaginal Examinations”

The Midwives’ Cauldron “Dr Clare Davison Interview”

The Midwives’ Cauldron “Pushing & Cervixes”

The Great Birth Rebellion “The Labour Process”

The Great Birth Rebellion “Vaginal Examinations”