What’s a Cervical Exam?
The how, why, and when of cervix exams before and during labor
- Cervical exams are ways to assess your body’s readiness to give birth.
- They can give you a snapshot of your progress at one point in time, but they can’t tell you how fast labor will progress.
- Cervix checks are most helpful if you might need an induction, but they aren't always necessary.
Your cervix is the part of your body that sits at the bottom of your uterus. It looks like a soft, squishy, pink donut. The cervix has many roles, but its main job is to act as the gate to your uterus. It draws semen in and lets menstrual fluid out. If you’re pregnant, it keeps the baby in and unwanted stuff out – until it’s time for birth!
What is a cervical exam?
A cervical exam is also referred to as a cervix exam or a vaginal exam. During a cervical exam, your provider will insert two gloved fingers through your vaginal opening until they feel the cervix. Once they feel the cervix, the provider will assess your cervix's dilation, effacement, station, position, and consistency.
Dilation of your cervix is how “open” it is in centimeters. If you imagine your cervix as a donut, dilation is how wide the center hole is. Most of the time, your cervix will be at 0 centimeters. As labor progresses, the goal is for your cervix to open to 10 centimeters.
Effacement is how thin the cervix is. If you’re being induced, your cervix may be 'long' at first (a whole donut). It will be measured in percentages as it gets thinner. For example, you may hear that your cervix is 50% effaced. By the end of labor, your cervix will be 100% effaced (a smashed donut!).
Station is how high or low the baby is in your pelvis. Station is reported as 'plus' or 'minus' numbers. The numbers for station start at 'minus' when the baby is high in the pelvis. They progress to 'plus' numbers as the baby gets lower in the pelvis and closer to the birth opening.
The position of your cervix is 'posterior,' 'mid-position,' and 'anterior.' Posterior means the cervix is towards the back of the pelvis. As labor progresses, the cervix will move to mid-position. Before giving birth, the cervix will be at the front of the pelvis (anterior).
Consistency is how hard or soft your cervix is. Your cervix will start as ‘firm’ and progress to 'soft.' A firm-consistency cervix feels like the tip of a nose, and a medium-consistency cervix feels like the outside of a cheek. A soft-consistency cervix feels like a lip.
Determining your Bishop score
Combined, these five descriptions of your cervix determine your Bishop score. A Bishop score is on a scale from 0 - 13. A high Bishop score (typically an 8 or higher) means your cervix is ready for labor and contractions. If you need to be induced, your Bishop score will typically be low (6 or less). A low Bishop score means you will benefit from cervical ripening.
What is cervical ripening?
Cervical ripening is sometimes needed before contractions begin. Ripening means the cervix is becoming more soft, thin, and dilated (a higher Bishop score). If induction is recommended, a person with a ripe cervix has a better chance of an induction that leads to a vaginal birth.
What does a cervical exam tell you?
If you’re already in labor, a cervical exam can give you a snapshot of where you’re at. Your midwife or physician might want to check your cervix while you’re in labor. You can ask your provider what information they will get from checking your cervix in labor and if your plan of care will change based on the results.
For your information
Your provider should get your verbal consent before each cervical check. You have the power to say no to a cervical check at any time, even partway through an exam.
If you aren’t in labor and your provider recommends labor induction, they may also recommend checking your cervix to see how soft and dilated it is before the induction.
Each provider’s attitude towards vaginal exams vary. Some providers may be comfortable starting an induction without doing a cervix check. However, some providers will strongly recommend a cervical exam.
Do you need a cervical exam?
A cervical exam can provide some helpful information. They can be useful when determining whether cervical ripening is needed before an induction. They can also be used to decide if interventions are needed during labor to promote labor progression. Your Bishop score can help you and your provider decide which interventions, if any, are needed.
There are also some reasons to not get a cervix exam. For some people, they can be physically or emotionally painful. A cervix exam may increase your risk of infection, especially if your waters have broken. They can also cause mental stress. If your provider checks your cervix again and your Bishop score hasn’t changed much, you might feel discouraged or scared.
Some providers start performing vaginal exams when you’re around 37 weeks pregnant, but this is becoming less common as vaginal exams are typically unhelpful this early. Unless there’s a medical reason for you to get a cervix exam, there isn’t much reason to check your cervix before labor begins. These exams can tell you where you are, but they can’t predict when your labor will begin or how fast it will progress. One way to limit unnecessary cervical checks is to stay dressed when you meet your provider. You can absolutely say no if your provider says they are going to check your cervix.
Remember, even if you choose to get a cervical exam, you can ask your provider not to tell you the result. Ultimately, the choice is yours!