Cervical Check in Labor
The Process
During labor, the attendant (a doctor, midwife or nurse) will insert their gloved fingers into the vagina to feel for changes in the cervix. The most common position for a woman having a cervical exam is lying on her back with knees bent, although some attendants are comfortable checking in other positions.
Cervical Changes
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Before labor begins, the cervix drops into the vaginal canal at an angle that makes it point toward the back (posterior). One sign of progress is that the cervix has become anterior, meaning that it's position has realigned to allow the baby to drop into the vagina (birth canal). This is generally a change that happens early in labor.
Dilation and effacement work together to open the cervix to allow the baby to drop into the vagina. During pregnancy the cervix lengthens and thickens to protect the baby. During labor, the cervix softens and shortens to allow the baby to pass through. Effacement refers to the thickness or thinness of your cervix. Effacement is measured by percentage, with 0% being a thick and hard cervix and 100% being a very soft thin cervix that is "gone."
During labor, the cervix opens wider to allow the baby to pass through. Dilation refers to how big the opening of the cervix is and is measured from 0 (closed cervix) to 10 (fully opened cervix). A cervix will need to efface before it will have any great progress in dilating.
The station of the baby refers to the progress of the head through the pelvis. The attendant will try to estimate where the baby's head is in relation to the ischial spines of the pelvis (the narrowest part). Before the baby's head reaches the ischial spines, the station is given in negative numbers. At the ischial spines the station is measured as 0. After the top of the head has passed through the area of the spines, station is given in positive numbers.
Some attendants will also use a cervical exam to confirm the position of the baby in the pelvis. By feeling the position of the bones on the top of baby's head, the attendant can determine which direction the baby is facing (to the front, back or leaning to a side).
Concerns About Cervical Checks
In the traditional method of measuring progress in labor, progress is based on the information learned during a cervical exam. For this reason, some attendants will do many cervical exams during a labor.
However, it is important to remember that the information gained during a cervical check does not always line up with true labor progress. The traditional progress is for the cervix to dilate one centimeter per hour during labor. Yet, many women will have two or more hours without dilation, and then two or three strong contractions that open the cervix fully. Information gained during a cervical check should be used in conjunction with information gained from the physical and emotional reactions of the mother, not in place of them.
If cervical exams show no progress (no dilation) for several hours, some mothers become frustrated and concerned for no reason. Some attendants also become frustrated and concerned since they have been taught that a normal labor will produce dilation along a regularly spaced interval. In these cases, women are encouraged to use medications to speed labor, so that their labor can progress "normally."
Another drawback of cervical exams is that every exam increases the risk for infection in the mother. Having the hands washed and gloved makes little difference, since the fingers must pass through the opening of the vagina. The cervical mucus washes all bacteria down and out of the vaginal canal to rest at the opening of the vagina. A cervical exam pushes that bacteria right back up to the cervix. Because of this, most attendants will not do vaginal exams more than once or twice if your bag of waters has broken (another risk factor for infection).
Cervical exams are also uncomfortable, especially during contractions when the most information can be gained. Some attendants feel justified in asking laboring women to change position so they can perform a "necessary" cervical check. The most common position for a cervical check, lying on the back, is the most uncomfortable position for laboring.
You May Also Be Interested In:Learn what normal labor is like. Practice your new labor skills with virtual labor. The Natural Childbirth Directory can help you find more information about birth and locate childbirth professionals. The Coach's Notebook helps you learn tools and techniques to manage labor. The Birth Planning section can help you put the finishing touches on your plans for labor. |
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