Cervical Exams are a hot topic of conversation around labor and birth. Dilation tends to be at the center of that conversation, but that's not all that it's about!
Dilation is a very important part of labor progression, but your body has to do some work before it can reach full dilation, or 10 centimeters. During a cervical exam they are checking for three main things, dilation, effacement, and fetal station. Occasionally, depending on the baby's position, they may be able to tell which way the baby is facing.
Effacement is the softening of the cervix. It is measured in a percentage from 0% to 100%. The softer and more pliable the cervix is, the higher the percentage. Effacement is very important as the softer your cervix is, the easier it is for it to continue to dilate. Effacement can start days or weeks before labor begins. Most will hit 100% effacement much sooner than 10 cm dilated.
Fetal station refers to the position of the baby in relation to the pelvis. Going from -4 (really high) to +4 (very low in the birth canal), fetal station can be very insightful information to have during labor. If the baby is higher up, it is most effective to use positions that help to open the top of the pelvis. If the baby is lower, it's recommended to use positions to open the lower part of the pelvis. This can help to keep labor moving and help your body to progress.
It is possible to be 100% effaced and 10 centimeters dilated while the baby is still very high. Some will “labor down” at this point to allow contractions to bring the baby down. This process can shorten pushing times by allowing the body and labor to push the baby down before beginning the pushing phase.
How often are cervical exams performed?
Cervical exams may be done in the couple weeks leading up to full gestation. These exams at appointments are not entirely necessary and can be waived. Cervical exams before labor begins are mostly used to determine a bishop score. Bishop scores are used to determine how likely one is to go into labor spontaneously.
If birthing at a hospital or birth center, most providers will do an exam to establish a baseline when you are admitted. From there, it varies from provider to provider with how often they perform cervical exams. Most of the time they are done every 4-6 hours. There is always the option to wait longer as long as everyone (baby and birthing person) is doing well.
Cervical exams can be a great tool for decision making. If deciding on interventions or pain medication, a cervical exam can be used to help make the decision on whether to intervene or not based on progression from the previous exam.
In conclusion, cervical exams can be helpful and insightful during labor but are not necessary to perform very often. Physical signs such as nausea, shakiness, and pressure can be indicators of progression without an internal exam.