Cervical Check

A cervical check (digital vaginal exam) is a physical exam that a healthcare provider can do to check the status of your cervix during late pregnancy and labor. They use their fingers to check:

• Dilation: Your cervix needs to open to 10 centimeters to have a vaginal delivery.
• Effacement: Your cervix thins and shortens. Your provider measures this as a percentage.
• The consistency of your cervix: A softer, more flexible cervix is more likely to dilate.
• The position of your cervix: Before labor, your cervix is usually higher and tilted backward. It typically moves closer to your birth canal as labor approaches.
• The location of the fetus’s head in your pelvis: Providers give a number based on whether the head is above or below that point. It’s called the fetal station.

These measurements can provide some helpful information about how labor is going. But providers try to use cervical checks sparingly — only when necessary.

When will my OB start doing cervical checks?

Some pregnancy care providers may offer a cervical check in late pregnancy (around 38 weeks) at a prenatal visit. But your provider may not offer you the first cervical check until you’re in labor.

Specific situations in which your provider may recommend one in late pregnancy include:

• To see if you’re in labor
• If you have a history of fast labor and deliveries
• If you’re having an induction, so they can calculate your Bishop score (to help determine how to begin your induction)

Each hospital may have its own rules for how often they do cervical checks once you’re in labor. In general, your provider may offer a check:

• Within 4 hours of being admitted to the hospital
• Every 4 hours when you’re in active labor
• If they think your labor is stalling
• If they have any concerns about fetal health or your health

Do I really need a cervical check?

As with all medical procedures, you decide whether to receive a cervical check. It’s up to you. Your healthcare provider should always explain:

• Why they’re recommending one
• How the information gathered may change your labor experience
• The possible consequences of refusing a check

They must get your consent to do the exam.

There are some rare situations in which a cervical check can identify a complication that needs emergency care. But for the most part, cervical checks provide “nice to know” info, not “need to know” info.

Labor is hard to predict. No one knows exactly how long it’ll last. Cervical checks just give a glimpse into where you are in the moment — they can’t predict the future.

Some women don’t want cervical checks due to:

• A history of trauma
• Discomfort
• Privacy concerns
• Wanting as few medical interventions as possible

Talk to your healthcare provider about what you want. Together, you can come up with a plan that honors your needs while ensuring the health of the fetus. You can also ask that only female providers do the checks.

What happens during a cervical check?

You can generally expect the following during a cervical check (digital vaginal exam):

1. You’ll lie on a bed.
2. Your healthcare provider will ask you to bring the bottoms of your feet together and let your knees fall to the sides.
3. Your provider will wear medical gloves and apply a lubricating gel to their fingers. They’ll insert a finger or two into your vagina. They’ll reach up to feel your cervix. Your provider will tell you exactly what they’re going to do before they do it.
4. Once they’ve assessed the effacement, dilation, fetal station, and position and consistency of your cervix, they’ll remove their fingers.
5. They’ll tell you what they felt and if and how it’ll affect your birth plan going forward.

Cervical checks typically take up to a couple of minutes. You can tell your provider to stop the check at any point.

There may be a chaperone — another healthcare provider — in the room during the check. If there isn’t and you would like one, you can ask for one. A loved one can also be in the room with you.

Are cervical checks painful?

A cervical check may be uncomfortable or painful. Your cervix is more sensitive during pregnancy due to more pressure and blood flow to the area.

But everyone experiences pain differently. For some women, cervical checks don’t bother them. For others, cervical checks are one of the most uncomfortable parts of labor.

Several factors can affect the level of discomfort you feel (if any), including:

• The position of your cervix: The check may be more uncomfortable if your cervix is still high up. It’s more difficult for the provider to feel your cervix in this position.
• If you have pain management: You likely won’t feel much during the check if you have an epidural, for example.
• If you’re tense: Squeezing your muscles from being nervous or anxious can make a cervical check more uncomfortable. Try to relax your muscles during the exam, even if it’s hard. Deep breathing and distractions may help.

You can tell your provider to stop the exam at any point. Let them know if you feel pain.

What if I have bleeding after a cervical check?

It’s typical to have very light bleeding (spotting) after a cervical check. If you have more significant bleeding, tell your provider right away.

What are the risks?

Cervical checks are generally safe. Still, healthcare providers tend to do them only when necessary. This is because as the frequency of cervical checks increases, your risk of infection increases. This includes infections of the fluid around the fetus, the placenta and the lining of your uterus.

Your provider will wash their hands and wear gloves to minimize germs getting into your vagina, cervix and uterus. Despite these precautions, infections can sometimes develop.

If you have placenta previa or premature rupture of membranes (PROM), your provider may skip the cervical check. It could cause complications.

Why are they important?

Cervical checks can help if there are signs of complications or halted labor. Your healthcare provider can better assess the situation by doing a cervical check.

In some rare cases, a cervical check can identify a complication that needs immediate care. For example, the umbilical cord may be sticking out of your cervix (umbilical cord prolapse). Typically, a big change in the fetal heart rate signals a complication like this.

Cervical checks are also important for inductions. They can help your provider recommend the next intervention to kickstart labor or keep it going, like a Foley bulb or an oxytocin infusion.

Cervical checks can help you feel more informed or encouraged. They may also help you determine if or when you want pain management.