What’s my cervix doing?

 

baltimoredoula

You’re waiting, getting so tired of being pregnant, and can’t wait to meet your baby.  You walk into your 37 week prenatal appointment, and your doctor or midwife says, “Well, let’s see what your cervix is doing!”

Sounds like a good idea, right?

But, is it, really?

Many women receive routine cervical checks during the last few weeks of their pregnancy and assume that there is a good reason for this, or that will tell them something important (like when labor will come!)

So, will this examination of the cervix tell you something?  Of course it can – it can tell you the state of your cervix at that moment in time, and really not much else.  As a doula, I’ve had clients who walk out of an appointment after finding out their cervix is dilated to 3 cm, and cancel plans, certain that labor is imminent, only to wait another two weeks to give birth.  That’s psychologically tough to deal with!

And, on the flip side, a first-time mom who is 39 or 40 weeks pregnant and told that her cervix is still “hard and closed” can feel frustrated and dejected, and begin to doubt that her body really will go into labor on its own.  And, of course, it will – sometimes very shortly thereafter!

Cervical checks before labor begins, whether it be weeks or days, are not good predictors of when your baby is coming, and can sometimes wreak havoc with your mental state!

“When I found out that I was 6 cm, I thought that I was having the baby that very day! My midwife let me know that, in the absence of contractions and continuing cervical change, I was not in labor.  I went home and my baby wasn’t born until a week later!” – Amy

In addition to the negative psychological effect that these exams can sometimes have, they often cause physical discomfort, as well.  I don’t know of very many women who enjoy the feeling of a cervical exam – for some women, it’s quite painful!

There is also some evidence that these exams may increase the risk of premature rupture of membranes (PROM) – that is, the membranes rupturing (water breaking) before labor labor begins.  Here’s what one study (Lenahan, JP Jr., Relationship of antepartum pelvic examinations to premature rupture of the membranes. Journal Obstetrics Gynecology 1984, Jan:63(1):33-37) had to say about it:

In the 174 patients on whom pelvic examinations were done weekly starting at 37 weeks gestation, the incidence of PROM was 18%,   which was a significant increase (P=.001).  The primary cesarean section rate was comparable in both groups with PROM; however, the overall primary cesarean rate when PROM occurred was found to be twice that of the remaining population. The study suggests that routine pelvic examinations may be (sic) a significant contributing factor to the incidence of PROM. Women with uncomplicated pregnancies were randomly assigned to one of two groups. The author theorizes that the probing finger carries up and deposits on the cervix bacteria and acidic vaginal secretions capable of penetrating the mucous plug and causing sufficient low-grade inflammation or sub-clinical infection to rupture membranes.“  “It would therefore seem prudent to recommend that no pelvic examinations be done routinely in the third trimester unless a valid medical indication [sic] exists to examine the cervix … especially since the information gained from these routine examinations is often of little or no benefit to either the physician or the patient.” (Lenahan, 1984.)

So, before you hop up on the table and consent to an examination of your cervix, have a conversation with your care provider about the risks and benefits, and remember that you can simply decline, if you choose.   Your cervix will do it’s job and open up for your baby when the time is right, whether or not someone is checking on it.