Today Andie and Jaelin talk about cervical exams during pregnancy and labor, answering questions from their followers.

Points from the video:

The cervix is the opening of the uterus, a bit like the mouth of the uterus. We “look” at the cervix in a exam with our fingers, checking for three main things: dilation, effacement and station.

What is dilation?

Dilation is the opening or widening of the cervix. It ranges from 0-10, where zero is not dilated or opened at all (not even a pinhole) and 10 is all the way open,wide enough for a baby to push through.

What is effacement?

Effacement refers to the thinning of the cervix. Normally, the cervix is thick and has the consistency of a tongue. During pregnancy and labor, it thins as the cervix is pushed aside. You are considered 100% effaced when your cervix has reached a paper thin consistency.

What is station?

Station refers to the position of the baby’s head within your pelvis during pregnancy and labor. In your pelvis, there are two bony parts at the bottom of your pelvic bones. When your baby’s head is above these bones, your are at a negative station (-1,-2, etc.). A station of zero is when your baby’s head is resting right on those bones. As your baby’s head moves past the bottom pelvic bones, it is considered a positive station ranging from 1-4. A station of 4 is when you are going to have a baby very soon.

What is Friedman’s Curve and why is it incorrect?

In the mid 1950s, Dr Friedman, from Columbia University, came up with a curve to show how women should be progressing in labor based on a study he had undertaken of 500 first time mothers who had given birth at full term. In his graph, he stated that women should be dilating 1 cm every hour during labor, based on the averages he saw from these 500 young women. However, this curve did not fit every woman because early labor is considered to be when a woman is between 1-6 cm. He would typically begin interventions after a woman was dilated to 4 cm because he thought her labor was not progressing. The babies delivered with him were mostly delivered via c-section or forceps. Although his methods and research are very flawed and don’t take into account the whole picture of labor, his standard is still used in many hospitals today.

It’s not a one-stop shop. There are so many different circumstances that contribute to labor progression and birth. Some women can be dilated to 10 cm and still take hours before they feel the need to push, while others can be dilated to 4 cm and then feel the need to push in 20 minutes. Every woman’s body is different, so as midwives we trust the process of natural labor. All 3 components (dilation, effacement and station) effect labor, not just dilation. Everyone has their own timeline. Don’t get caught up in dilation.

With a midwife, you generally won’t have your cervix checked until you go into labor because it can come with risks.

What are the risks of cervical exams?

  1. Breaking the water, while a low risk, can happen.
  2. Checking the cervix can introduce an infection. Every time fingers are pushed in, it can push bacteria up to the baby.

We want to decide with women about checking the cervix. There’s not really a reason to check if everything is moving along properly.

Questions from guests:

  • My OB says I need to be checked at 36 weeks. Why? There is no reason or research to back up checking your cervix at 36 weeks or any time before labor. You are the boss of your body and there is no need to be checked that early.
  • Can you refuse the cervical exam? If you refuse, will insurance still pay? Yes, you can refuse anything and everything. It is your body and your baby. Insurance can’t decide based on services you didn’t receive, they pay for the services you did receive.
  • Why might you want to be checked? If you are going in for an induction or are about to be induced, you might want to be checked to make sure your cervix is favorable.  If it is closed and thick, it’s not favorable and wont respond well to an induction, natural or not.
  • Should women get discouraged if they get checked and are told they haven’t ‘made change’? It’s natural to feel discouraged, but as midwives, we are not discouraged. Every woman is different and labors on her own time table.
  • Off topic a bit, but I need to know because of a recent hysterectomy. What if I don’t have a cervix or uterus anymore? Do I still need to be checked annually? It depends on the reason it was taken out. You won’t need a cervical exam, but you would want to still get your regular vaginal exams.

Resources:

Friedman’s Curve

Your Cervix Is Not Psychic

Birth Statistics

Check out last week’s talk on Fetal Monitoring

If you are in Houston and surrounding areas, check out hhhomebirth.com!

 

About the Author

Jaelin married her high school sweetheart (Ted) in 1984 and is the proud mother of 3 grown children (2 boys & a girl). She has a Bachelor’s degree from the University of Texas, a Master’s Degree from Georgetown and holds several other professional certifications related to health and wellness; currently, she is working on her Doctorate degree. Jaelin works as a Midwife and Nurse Practitioner with her business partner Andie Wyrick at Holistic Heritage Homebirth in the Woodlands Texas.

A certified nurse midwife and doctorate student has been in the Houston birth community for over a decade. Her experience includes elementary school nursing, hospital L & D, birth center, and home birth. Andie is confident in a woman's ability to grow and birth her baby. She feels a partnership in care is empowering and hopes to foster that relationship with families. She has a tender, lighthearted, and hands off approach to the evidence based care she offers. She has been joyfully dating her husband of 16 years since junior high and has five children. Her passions beyond bellies, birth, and breastfeeding are mission work and reading.