Cervical exams can be one of the most unpleasant parts of late pregnancy and labor. As an OB-GYN, I have performed countless cervical checks in practice and in private practice and found a many of different responses. For some people, the test is just a blip. But for many others, it’s a stressful thing to deal with when they’re already uncomfortable from the pregnancy itself.
So why do OB-GYNs perform cervical exams in the last weeks of pregnancy? In my years of training, this is something that some of our counselors have done because that’s just what they’ve always done. But many OB-GYNs who care for pregnant women today, including myself, have concluded that while there are cases where cervical screening late in pregnancy can be beneficial—and sometimes essential to the care we provide— in many cases, there are no good results at all. reason to do so. So when do you really need a cervical exam late in pregnancy? And when can you opt out? I’ll explain that and more below.
Related: Sometimes pregnancy is the worst, so let’s stop romanticizing it
What is a cervical exam?
Let’s start with the basics. A cervical exam—aka the cervical check or sterile vaginal exam (SVE)—involves the provider inserting a gloved index and middle finger into the penis to examine the cervix. Sounds uncomfortable, right? Well, it is especially during the last few weeks of pregnancy when there is increased blood flow, swelling and sensitivity in the genitals.
What do cervical exams test for?
Simply put, cervical tests are used to find out how dilated, or open, the cervix is. Traditionally, the reason many OB-GYNs routinely examine the cervix in the last weeks of pregnancy is to check for changes in the cervix that may indicate the early stages of labor. These changes include not only dilation but also effacement (how thin the cervix feels) and position in the pelvis (where the cervix is in relation to the pelvic bones and the baby’s head).
While these signs can sometimes give us an idea of how close a person is to giving birth, they are only guesses at the end of the day. In my own practice, I saw a patient with a closed cervix one day deliver their baby the next day, while another patient walked around with a 5 centimeter cervix for over a month before giving birth! There are many other factors that we don’t yet understand about what kick starts labor and unfortunately, the cervical exam is only one part of that equation.
Related: What experts want you to know about your due date
When are cervical tests necessary in late pregnancy?
Over the years, my attitude toward cervical exams in late pregnancy has revolved around one rule: A cervical exam should only be done if it will change the way I manage the patient. What does that mean? Basically, I will only examine a patient’s cervix if it affects my final decision on their delivery plan. For example, if I have a patient scheduled for a C-section but she’s feeling fine and has no symptoms, there’s no reason for me to check their cervix.
This leads to the question: when must is a cervical exam done in late pregnancy? Here are the most common reasons.
- Suspected labor: If a person is having labor-related symptoms such as contractions or pain, bleeding, fluid loss, or has lost their mucus plug (a clear, pink, or brown sticky discharge), then a cervical check is reasonable. In this case, knowing how large or thin the cervix is will affect delivery planning.
- Scheduled induction for medical reasons: If someone needs to be induced for a medical reason—such as growth concerns for the baby, high blood pressure or other laboratory or test abnormalities—then knowing what the cervix can be very useful. Depends on them Bishop pointsI can better assess which induction method(s) are most likely to be effective for them and plan accordingly.
- Scheduled elective induction. Many patients choose to be induced when they are past full term even though there is no medical reason to do so. The earliest we will allow this type of induction, known as elective induction, is 39 weeks. A cervical exam for these patients helps me determine if their body is ready for induction and if so, the best way to begin that induction safely and effectively.
In both induction cases, starting with a cervix that isn’t as far along as it should be can potentially increase the length of labor, which in turn increases the chance that they’ll need a C-section. In elective cases, this sometimes means that I advise people to wait a few more days before proceeding with an induction so that we minimize those risks.
Related: 10 tried-and-true ways to naturally induce labor
When are cervical checks optional in late pregnancy?
Outside of the situations above, most cervical exams aren’t necessary and won’t change how we manage someone’s delivery, so it’s up to you whether you want to do it or not. Some patients even request a cervical check either out of curiosity or excitement, to relieve anxiety as their due date approaches, or based on symptoms they may have noticed between appointments.
Importantly, there is a fairly common concern that cervical exams can cause a person’s water to break early, but this is highly unlikely. Even performing a membrane sweep, that alone does not cause a person’s water to break. A membrane sweep is a procedure done after the cervix begins to dilate where we use a gloved finger to gently release the membrane attached to the cervix. It releases hormones that can cause contractions, which can lead to labor.
Related: Does stopping walking induce labor?
The bottom line
If you are in the last stages of your pregnancy and you do not have any symptoms of labor and are not scheduled for a medical or elective induction, then there is absolutely no medical reason to have a cervical check and you have every right to refuse.
Advocate for yourself
That said, it can be scary to go against what your provider recommends, but there are ways to make sure you’re making the choice that’s right for you—and to feel more confident about that decision.
- Make sure you fully understand the recommendation. Before saying no, make sure you ask your provider to explain clearly why they think your cervix needs to be checked. Get all your questions out there so you have all the information you need and feel comfortable before making your final decision. If the provider gives you a reason consistent with the above or one consistent with your desires and needs, then go for it! If not, you can say “I don’t feel comfortable having a cervical exam today but thank you for offering.”
- Be firm in your decision. If your provider is pushy in trying to persuade you, stick to your decision. At the end of the day, no one can force you to take an exam you don’t want. You can say things like “I understand the points you made but I still don’t want to get tested right now.”
- Have someone to support you. Having a roommate with you can serve two useful purposes. First, it helps you feel lighter having someone you trust with you. Second, that person can also advocate for you and support your decision if you feel you need it.
Related: The 5 doctor appointments to make for yourself every year
It is always your choice
There’s a lot of anxiety and excitement in late pregnancy as you prepare for your baby’s arrival. Worrying about unnecessary and uncomfortable tests should not be added to that. Armed with the information above, you should have the tools you need to understand what a cervical exam does and when it is needed. And using self-advocacy tips can help you navigate your appointments more easily. The decision to get a cervical check is always yours.
This story is part of The Motherly Collective contributor network where we showcase stories, experiences and advice from brands, writers and experts who want to share their perspective with our community. We believe that there is no single motherhood story, and that every mother’s journey is unique. By amplifying each mother’s experience and offering expert-driven content, we can support, inform and inspire each other on this incredible journey. If you are interested in contributing to The Motherly Collective please click here.
