Skip this Routine…

REPOST: From June 2009 Your Birth Right Blog…

It never ceases to amaze me the information that women are given and the procedures they undergo prenatally and during labor all in the name of “routine.” One of those things that always annoy me is the frequency of unnecessary vaginal exams/cervical checks.

While I personally don’t do frequent/multiple vaginal exams on a woman in labor, I do understand why some nurses, doctors, and midwives feel the need to do them. I don’t agree with their rationale but I understand it because I used to be a “frequent checker.”  What I have NEVER understood is the routine checking of a woman’s cervix prenatally when she has yet to have ONE contraction or any sign of labor.  Many providers do routine cervical exams on every pregnant patient  starting as early as 37 weeks.  Some wait until the 38th week and by the 39th week women are walking around wondering “Why haven’t I dilated past 1cm. I’ve been 1cm for 2 weeks now?”   These are often women who have had a FEW contractions that they might call “crampy” or “slightly uncomfortable” and otherwise have no signs of any sort of labor.  This sets up a cycle of fear of the inability of her body to have her baby. It is so important for a woman to have unwavering faith in her body and her baby.  The moment this faith is shaken, the cascade of fear can take over.

Let’s take for example the following…  The other day I received an email from a pregnant woman I have been doing some private consulting with.  When she emailed, she was 39 weeks pregnant.  She said…

“From my last week’s weekly OB appt {which means she was 38 weeks at the appointment}, my cervix is/ was still posterior and the station was high (-3).  I’m hoping to be somewhat dilated soon and am trying to get my cervix to be anterior. I’ve been swimming, walking, climbing stairs sideways and doing the head down with butt in the air wiggle wiggle exercise. Do you have any recommendations on how I can get my cervix to be anterior? I am going to have an unmedicated vaginal birth, so any advice you can give me will be totally appreciated.”

I took a deep breath before responding and then I said to her ….

“First I want to answer your question and I hope this does not sound too blunt…. you CAN’T get your cervix to be anterior.  When your body is in active labor it will naturally move anterior.

Now I have a question for you… Why did you have a cervical check last week?  Was it because you wanted one or because they said you needed one? The reason for my question is this…

Remember when we spoke, we talked about the importance of continuing to have full faith in your body and removing any outside forces that undermine your faith.  Well… unnecessary vaginal exams when you are not in labor and before your due date is one of the early/many ways that women begin to lose faith. When your body is ready to go into labor you will dilate and your cervix will move anterior. If it is not ready it won’t. If you are not in labor and contracting regularly with strong contractions you should not expect cervical change.  The question I always ask is this…. ‘Will the information gained from THIS vaginal exam change what we are going to do today?’ In your present situation, unless you are considering being induced a vaginal exam is irrelevant. What do I mean irrelevant…it does not change what we are going to do TODAY and things can literally change overnight.   Because of this, I encourage you to avoid all vaginal exams until you think you are in labor and are having a labor check or you are preparing for an induction.  I encourage you to let go of your current cervical change expectations and focus on getting your mind ready for labor and motherhood.  You can go from closed to delivered overnight.  It will happen. Don’t start to doubt and don’t start to worry.  Your body and your baby know the perfect time to move to birth. “

She responded, thankful for my reminder that her body knows best. She also let me know this…

“As for checking the cervix, I had no idea…the dr. just did the examination and said it was routine, so I didn’t question her until the whole posterior/anterior subject came along…”

Yep….  You read it right and it happens all the time … “I had no idea … the dr. just did the examination and said it was routine…” When did it become routine to violate a woman’s body without her permission? Why is it routine to check the cervix of a woman who has not passed her due date and has no signs of labor? Why do we continue to make women feel inadequate and incapable of having their babies? ROUTINE does not mean REQUIRED.  ROUTINE does not mean RIGHT.  Routine is a regular habit one that is done habitually. It does NOT mean something that has to be done.

Don’t let the Routine get in the way of RIGHT.  Your baby and your body know when the time right. Have faith.

In Birth and Love
Nicole

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23 responses to “Skip this Routine…

  1. I realize this is an old post, but I just had my first manual cervical exam at L&D at 24 weeks when I presented with menstrual-like cramping, lower abdominal pain, and lower back pain. It had been on and off for three days. I questioned the need for a manual exam but ultimately agreed to it, thinking it was in the best interest of my baby. It hurt like heck–I ended up spending the next day with my OB anyway running all sorts of checks on my cervix to make sure things were still fine. They appear to be, but this hasn’t changed the fact that for the next four weeks (and probably beyond) until my next appt, I will be a worried sick mess about the possible damage the exam could have done. Thanks to Dr. Google, I know that this exam could lead to preruptured membranes and a whole host of other problems. I feel like a failure for not saying “no” like my gut told me to do–but I put my trust in the person in the white coat. Never again. I’m a wreck now!

    • Let me make some clarifications here… in your situation.. it sounds like a cervical check was NEEDED. The cervical checks I was referring to are the ones that take place in a full term or close to term mother who is going in for a routine prenatal check up. When you show up to the hospital with complaints that sound like preterm labor a cervical check is definitely needed. There is no other way to determine if you are dilating and having labor too early. In this case, they did the right thing. I’m sorry for the stress that it has cause you but it was a necessary IMO

      • Thank you so much for your kind and reassuring words! Is there any way that pushing on the cervix during one of these exams can damage an anterior placenta? And is there any cause for concern re: infection or preterm rupture of membranes since my cervix was closed and mucus plug was blocking everything? I have learned so much from this blog and I will definitely be declining the optional end of term exams!

      • While I was not there and don’t know all the circumstances… I would say you are most likely safe from damage. Do cervical exams have risks? Yes. Are those risks minimal? Yes… VERY minimal. Women can continue to have sex throughout their entire pregnancy. If there was significant risk we would not consider this safe. I hope that you can be reassured throughout the rest of your pregnancy and know that you are fine. During labor, with stripping membranes, and once a water bag has broken, that’s when the risks begin to increase.

  2. This issue is rampant in the UK too. I have many mothers emailing or calling me on whether or not their cervix should be posterior or anterior by week 40. Mothers become despondent if the cervix is not anterior. They take on what is imparted to them by the professionals. Based on my one-to-one short antenatal class they are much more confident about HOW their body works. It is sad that mothers are being instilled with fear very early into pregnancy. If not this, then a ‘low placenta’ at 20 weeks! Mothers need continuous support by professionals who understand the labour process and know how to share the information to EMPOWER.

  3. I was 11 days “late” with both my babies (by the med calendar, clearly not my body/baby’s calendar). Both were born looking great, at healthy weight. I’m glad I didn’t worry that second time (and I’m so, so sad I allowed myself Pitocin that first birth, because I bought their line that I needed it).

    By the way @Marylyn, I switched practitioner models between my children and during my second birth the practitioner performed ONE cervical check in my entire birth, about four minutes before the baby was born. I can’t stress enough how awesome it was to not be lying on a bed in some weird hospital garb regularly having hands up my vagina (like in my first birth).

    There are so many routines and practices that attitudes promoted by medical and larger cultural factors that many USian women are convinced their bodies won’t “work”. This is why we apparently accept so much drugs and a 32% c-section rate.

    Thanks for your post.

  4. I teach my moms about this too! Such a silly routine that tells you nothing of importance and usually leads to an emotional roller coaster ride.

  5. Hello

    Awsome article bdw, I am 20 weeks pregnant and must say progressing well hehe it’s my first baby and am scared, cos I don’t know what to expect but trust myself.
    So bascically, the whole story of cervical checks can be reduced to while you are/or think you are labouring more or less. Also can they prove harmful if the waters have already broken….?
    Bsw, is it true that during labour some nurses, practitioners etc..perform a cervical check every 4 hours????? – don’t think I can handle that I just don’t think it will help that is all.
    Thanks :)

  6. Thanks for posting this! It always drives me NUTS when I hear women get discouraged about not making “progress,” or get encouraged by their “progress” (only to get discouraged later when they stay at 3cm dilated for weeks on end…)

    When I was pregnant with my daughter, my OB insisted on doing cervical checks. His reasoning was that if I showed up at the hospital 3cm dilated and I had NOT had a recent cervix check, then they would have no way of knowing whether I’d been 3cm for weeks (and therefore likely not in active labor) or whether I had just been 1cm a few days before (in which case having dilated to 3cm was likely a sign of active labor). Just curious, do you agree with that?

    At any rate, we compromised… first of all, he held off on starting the checks till 39 weeks, rather than starting at 37 like he usually does. Then, he checked my cervix and note my “stats” in my record (so they could be called up if need be), but I asked him NOT to tell ME what they were. That allowed me to keep that all-important full faith in my body. I didn’t ask for my “stats” until 41 weeks, when we were talking induction.

    • Hi Lisa… No I don’t agree with your MD’s rationale for wanting to do cervical checks. Active labor can be diagnosed without having previous cervical changes. Active labor means a woman is having contractions with cervical change and it generally means cervical change of 4cm or more. Sooooo if you did show up at the hospital with a regular contraction pattern and you were 3cm I would say that you were in early labor. After a few hours if your cervix was unchanged, we would have our answer. No need for the previous checks weeks before.

  7. Thanks for this post. I am 38 weeks pregnant, and though I did my research and KNOW that vaginal exams are not necessary late in pregnancy, and that no exam can tell you when you’re going to give birth, I still found/find myself WANTING to be checked, to have some sense that I am “progressing” or “getting close.” I am having enough trouble maintaining my resolve with birth attendants (midwives) who are fully supportive of natural birth and avoiding unnecessary procedures. I can’t imagine how difficult it would be to have to advocate for such with a birth attendant who is unsupportive.

    • Hi Emily, thanks for reading. I would enourage you to just KNOW that you are progressing AND you are getting close. You have no choice. You body is doing what it is supposed to do!! Progressing and getting close… a vaginal exam has no bearing on that… :-)

  8. Pingback: Why having your cervix checked before labor is pointless « Welcome to Birth a Miracle Services weblog!

  9. Thank you for writing this! I completely agree with you and I hope that more women will get this kind of information while they are pregnant. I will be linking this on my blog!

  10. Great article! So true!!!

  11. I will more than likely request to not have this done this time around. I hate the pelvic exams and you’re already uncomfortable when you’re preparing to give birth, not to mention how self-conscious women feel when they can’t see to shave/trim or what-have-you.

  12. This is an issue with health care in general now. Doctors are performing unnecessary & sometime very expensive procedures.
    As usual, I’m more informed after reading your blog. Keep it up!

    • This is certainly an issue all over health care and one that is definitely being discussed as a part of this “health care reform” Lets hope the right decisions are made about the right interventions. Thanks for reading!

  13. Pingback: Keep Your Pants On! «

  14. Pingback: Think About Keeping Your Pants On! « ICAN Seattle

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