Is cervical dilation the all-important thing we play it up as? Here are some things to consider.
How dilation is measured:
Do you know how dilation in labor is assessed? It is assessed by nurses, doctors, and/or midwives inserting their fingers into your vaginal and feeling the cervix. It is so subjective that one nurse might say you’re eight centimeters dilated and five minutes later your midwife might check the same cervix and call you a five. Did your cervix suddenly shrink by three centimeters?
Nope! People assess dilation differently, and after a certain point (about five centimeters, actually) it’s more about assessing what’s left than it is about how far open your cervix is. Even though your providers call out your dilation in centimeters, there’s no ruler going up there to check their work, they’re just making their best guess.
Dilation is also only one of the things being assessed during an internal exam. Your care team is also checking cervical position, baby’s position, how thick the neck of the cervix is, and how soft or firm the cervix is. Dilation is one number out of many, so please don’t feel discouraged if your dilation seems to get “stuck” at a certain number.
Ask good questions of your care team. “Is my baby any further down this time?” or “Has my cervix softened at all since you last checked?” Especially if you have been checked by more than one provider, don’t feel discouraged if your dilation seems to go backward.
When should I get my cervix checked?
Cervical exams are so embedded into our culture that even people who “know nothing” about birth know enough to ask dilation. (As an aside: why is it suddenly okay to ask about someone’s reproductive organs because they are pregnant? You would never ask someone if their prostate was swollen!) While not necessary for a physiological birth, there are a few reasons cervical exams make sense.
- If you’re planning to be induced, it might be a good idea. Especially if you have no pressing medical needs. But here’s the kicker: do you remember how I mentioned that dilation is only one piece of the puzzle? If you get assessed before induction, you’ll want to ask for the entire puzzle. This can help you self assess for your odds of having a “successful” induction (meaning an induction that progresses at a typical rate and ends in a vaginal birth- I don’t love that terminology). You’ll calculate your odds with a Bishop Score. Ask your provider for:
- Your effacement: How thick or thin your cervix is.
- Your cervix’s texture or consistency: Starts firm like your nose, eventually gets as buttery smooth as the inside of your cheek)
- Your cervix’s position: They may answer this in posterior meaning toward your tailbone or anterior meaning closer to the front of your body (anterior is what you want). You may be able to answer this for yourself. A posterior cervix is much harder to reach, and therefore means a more painful exam. If you have been checked before and it’s suddenly less painful, there’s a good chance that your cervix has moved forward.
- Baby’s station: How low is baby in your pelvis?
- Before making decisions about medication.
- Being in active labor before getting an epidural can increase your odds of a vaginal birth, so getting a cervical check to make sure you’re making good progress in your labor might be the right call for you. If you’re still too early in your labor for an epidural but need or want pain relief, there are still options for you such as IV pain medication.
- On the other hand, if you had planned to go unmedicated and things just got really intense, it makes sense to check for progress before getting medication that might not take effect as soon as you’d like anyway.
- Before a big change of plans.
- If you are considering transferring to the hospital from your home birth, getting checked makes sense. If you are considering an epidural or having your provider break your water, getting checked first makes sense. If for any reason you are feeling stuck, a cervical exam may help you make a decision. Whether it helps you rally your strength or gives you the peace of mind that this change is the right thing, information is not a bad thing. I remind clients that asking for a vaginal check does not equal asking for numbers. You can ask if there was positive change, including all the criteria I laid out above. If there is positive change and you want numbers, ask for it after knowing that there was positive change. Few things are as defeating as hearing, “I’m sorry, but you’re still a five”, especially when you find out afterward that your baby had come down a lot lower in the meantime.
- If you really want to.
- Some people really like numbers and information. While checks are not generally “recommended” by the physiological birth crowd, I know from personal experience as well as experience with clients how helpful a check can be. When approached with knowledge and confidence, there’s no reason a cervical check should cause harm.
Sometimes they cause harm.
Every cervical exam theoretically poses the risk of infection, which can be dangerous for you and baby. If your water hasn’t broken, this risk is minimal. Once it does, the risk of infection rises with each exam. And since each check also poses the risk of accidentally breaking your water, it’s definitely something to be mindful of.
Unfortunately, there are providers who use consent to internal exams as blanket permission to strip membranes or rupture amniotic sacs. If you chose to allow internal exams in pregnancy, be very clear what you are and are not consenting to. It’s okay to choose membrane sweeping, too, but that should be a choice you’re actively making. Hopefully you have a respectful provider! Having a care team you can trust is so important.
After your water is broken, best practice is to avoid vaginal exams, but many hospitals just space them out instead. Remember that it is your body and ultimately your decision. If you don’t want vaginal exams, keep your underwear on and be very clear with your care team.
So, do I have to get dilation checks?
That is an excellent question. The answer: you don’t have to. With or without internal exams, your labor will most likely progress perfectly normally. Your fundus will build and your cervix is open. It is entirely possible to labor and birth without once needing a care provider to put their fingers inside you. In fact, from a physiological point of view, your labor may actually function better without the discomfort and interruption of cervical exams.
She’s a 10, but that doesn’t really matter.
In all the media we consume, including a lot of birth videos, ten seems to be the magic number. Make it to ten centimeters and it’s time to push! Well, maybe. Just because your cervix has moved out of the way does not mean that your baby is aligned for effective pushing. It doesn’t mean that your fundus (the top of the uterine muscle) has grown enough to make much progress with pushing. It literally just means that your provider can no longer feel your cervix during an internal exam.
While ten centimeters is a great landmark during your labor and birth, it does not necessarily mean it’s go time. In fact, some people experience a short period of rest at ten centimeters dilation. Sometimes it’s possible to have a short nap!
Just like everything in birth and life, there are pros and cons to cervical exams. Dilation only really tells you where you are in the moment, and it is incredibly limited by itself. With the addition of other criteria, your dilation may tell you how likely you are to have a “successful” induction. It may help you know what stage of labor you’re in. Each person reads dilation differently, so be aware of that when opting into checks.
Be mindful of risks and make the best choices for you and your birth. It’s like I always tell my clients: I don’t have to live with your decisions, you do. So make the best one for you, no matter what that looks like.