Are Cervical Checks During Labour Necessary?

As a doula and birth educator, I’m often asked: are cervical checks during labour necessary?

A cervical check is when your doctor or midwife measures cervix dilation.

Care providers use this measurement to determine how you’re progressing during labour.

Many women, however, find cervical checks very uncomfortable or even painful.

Are Cervical Checks During Labour Necessary?

In hindsight, they might wonder whether cervical checks during labour were really necessary. Or whether they can just say no to cervical checks next time they are pregnant.

What Do Cervical Checks Tell Us?

Cervical or vaginal exams are the most widely accepted way for care providers to decide how labour is progressing. But are cervical checks during labour necessary?

A cervical examination provides information about:

• Dilation or widening of the cervix
• Effacement or thinning of the cervix
• Position of the cervix (whether it’s facing back or forward)
• How the baby is lying
• Position of baby in pelvis (high or descended)
• How the baby’s head is presenting on the cervix

When you go into hospital, your care provider will offer to do a cervical check. This is to help confirm that you are in active or established labour.

Generally, in women who are in active labour, the cervix has thinned and is around 3-5 centimetres dilated.

If you go into hospital too early, there’s a chance you will sent back home. If you stay, this can lead to interventions.

Care providers use the information from cervical checks to decide whether labour is progressing.

What Are The Problems With Cervical Checks?

#1: Lack Of Evidence To Support The Use Of Cervical Checks

Cervical examinations during labour are routine in many hospitals. We could assume there’s evidence-based research to show this procedure reduces poor outcomes for both mothers and babies.

In fact, according to this Cochrane review, there’s no convincing evidence to show routine cervical exams during labour are of benefit.

The reviewers looked for research and found two studies, both from the 1990s, and done in high income countries. The studies were small and the quality was unclear.

The authors noted their surprise in discovering cervical checks were so widely used without good evidence of their effectiveness.

#2: Cervical Checks Aren’t The Only Way To Decide If Labour Is Active

If you’re birthing at a hospital, you’re expected to have a cervical check when you arrive. This is done to make sure you’re actually in labour.

Most hospitals have a policy that says labour is regarded as active at 4cms dilation.

However, a cervical check isn’t the only way to tell you’re in labour. Women in early labour tend to move and talk through their contractions.

When they stop to concentrate or focus during contractions, this is a good indication that active labour is established.

#3: Cervical Checks Can’t Predict The Future

There’s a huge temptation for women to want to know how dilated they are – especially if they’ve had hours or even days of early labour.

They might be tired, or worried about how much longer labour will last. Or whether they need pain relief.

If they hear they are ‘only’ so many centimetres dilation, their resolve and confidence can melt away.

As a result, the stress they feel about not having progressed ‘enough’ brings oxytocin and endorphin production down. The knock-on effects are the slowing down, or even stalling of contractions, and more pain.

Remember, cervical checks can provide information about how dilated your cervix is at the moment the check is done.

It cannot predict how long labour will last, or when you will give birth.

Read more in How Your Cervix Dilates And Why It’s Unpredictable.

#4: Cervical Checks Aren’t The Only Way To Assess Progress

Patterns and speed of labour vary between women; and even between labours in the same woman. There is no ‘one size fits all’ approach to how labour progresses.

In today’s busy maternity hospitals, staff rarely spend one to one time with labouring mothers until the second stage of labour begins.

Care providers who observe women during labour are able to see signs of labour progression. These include:

• The strength, duration and length of contractions
• Changes in behaviour (during contractions, the woman is quiet, ‘in a zone’, wants quiet, and seeks privacy)
• The height of the fundus
• The purple line.

If care providers are paying attention, they can observe which stage of labour you’re in.

You can read more about these sigs of labour progression in How Do I Know If My Cervix Is Dilating?

#5: Cervical Checks Aren’t Always Accurate

Accuracy of cervical checks depends on whether the same care provider is performing each one.

Generally cervical checks happen every 3-4 hours, potentially done by different staff each time.

This can result in varying measurements, based on different perceptions.

During contractions, the cervix can feel more open and dilated than it does between contractions; this can also lead to variations in records.

#6: Cervical Checks Can Reverse Dilation

It might surprise you to hear the cervix has the ability to stop or reverse its dilation. Evolution has provided a biological ‘safety net’ for birthing mammals, to allow them time to flee from danger.

During labour, if a woman feels threatened, her body will release stress hormones. They prepare her to fight or flee.

They stall, or slow down contractions, and the cervix can stay at the same stage of dilation or even go into reverse. It gives the birthing woman time to get away from danger.

Read more in Undisturbed Labour – What It Is And Why Aim For One?.

#7: Cervical Checks Can Confirm Full Dilation

Cervical checks are often done during transition or when you start pushing. This is to see if the cervix is fully dilated.

In an undisturbed labour, the labouring woman will gradually feel more ‘pushy’ with each long, strong contraction.

She’ll make deep throaty sounds during contractions. She is likely to ‘wake up’ as adrenaline prepares her for the hard work of pushing.

If she’s not stressed or afraid, she will go with each sensation and let her body do the work. She might feel the urge to bear down with the contractions. Her body might even push the baby out with the fetal ejection reflex.

However, there’s a concern a woman will push against her cervix before it is fully dilated; this can cause swelling or even tearing.

This is unlikely to happen unless:

• She is lying on her back
• She is strapped to the bed because of fetal monitoring
• Stress is affecting the progression of labour.

Are Cervical Checks During Labour Necessary?

Cervical checks are procedures that have no evidence to support or reject their use.

They don’t improve outcomes for mothers or babies.

In spite of that, many care providers believe cervical checks during labour are necessary.

And if a woman needs interventions for medical reasons, a cervical check can help her make informed choices about her care.