PREGNANCY

Cervical Check During Pregnancy: The 36 week check

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Cervical exams during pregnancy have changed over the years.  Today we’re going to discuss routine examinations at 36 weeks.  Why they have done them in the past, what they mean and why you might want or not want one.  

pregnant woman being examined

We here at Pulling Curls® (and our sister site The Pregnancy Nurse®) sure do want you to be informed about ALL the choices you make in pregnancy and labor. Starting communication like this early on at prenatal appointments is SUCH a good practice. If we haven’t met yet, I’m Hilary — and I’ve been a nurse since 1997 and I have 20 years of labor and delivery nursing experience! I’ve checked a LOT of cervixes in that time, and I’ve talked with a lot of patients about why it is or is not necessary.

It can be hard to talk with providers about WHY they are doing something, but you want a provider that’s a good educator (as well as a good doctor), so be sure to have these types of conversations with them. This has a bonus video on provider communication if that’s hard for you.

If your provider is recommending a cervical exam at 36 weeks please talk to them about why that is the case for YOUR specific circumstances, and then make a choice after you have that information for you at that time. Do not take anthing in this article as medical advice. 🙂

Why do they do a cervical check at 36 weeks?

The reason may vary patient to patient, but at around 36 weeks you normally have your GBS culture done at your prenatal appointments (I have a whole post on Group Beta Strep Screening).  At this time, since you were already in the stirrups many providers checked cervixes at that point, just to get an idea if there are any changes.

Over the years, this has become a routine practice for providers (in some instances, because patients wanted to know, or felt like it would tell them if they would have the baby soon).

However, not every patient wants them and it should be a discussion before the exam of what it will tell you.

Now is the time to mention that your cervix is NOT a crystal ball. Just because you’re closed right now doesn’t mean it can’t start to open in an hour. Or, just because you’re 4 cm right now doesn’t mean you can’t stay that way for another few weeks!

What is a cervical check?

A cervical check is a medical procedure used to examine the cervix, the narrow passage that connects the uterus to the vagina during pregnancy (it is the bottom of your uterus, similar to how your rectum is the bottom of your intestines).

As far as I know, they only do cervical checks during pregnancy.  They do other types of exams in that area at other times — but a cervical check is pretty specific.

During an exam the provider is checking for:

  • Cervix Dilation – how open the cervix is
  • Cervical Effacement – how thin or thick the cervix is
  • Fetal Station – measures the position of the baby in your pelvis (high or low)
  • Cervical Consistency – how does the cervix feel
  • Position of the Cervix  – if the cervix is towards the front (anterior) of your birth canal or in the back (posterior)

If the cervix is open or thin, the provider may also be able to tell which way baby is facing.  They may also be able to tell if baby is head down.

These measurements are also combined into something called the bishop score that tell us how “ready” your cervix is for labor (this is more important if you are being induced).

I have heard some people (thank you social media) saying that you can tell cervical dilation by a purple line that appears and goes up between a person’s buttocks cheeks.  But studies have shown that this line doesn’t appear for everyone and can’t always be used as an indication of cm dilation.

Quick question — if you’re 36’ish weeks, have you taken your prenatal class yet? It is NOT too late, in fact now is a GREAT time so it’s all fresh in your mind before delivery. I recommend this one.

What do we learn from a cervical exam?

This is where it sort of gets tricky.  Many pregnant women dilate to 1 cm by 36 weeks — just by baby’s weight pushing down on the cervix.  They may stay 1 cm for weeks and weeks (and may even need to be induced later on).  So, just because you’re 36 weeks and 1 cm doesn’t mean that you’re going into labor any time soon.  

We’re going to talk about why you would, or would not want an exam by a medical provider at 36 weeks, so keep reading!

I also have a whole post on what to do if you’re 36 weeks and 1 cm dilated you might find helpful.

How are cervical checks done?

This type of check is usually performed by a provider in the midwife or doctor’s office, or by an RN at the hospital. To perform a cervical check, the woman will need to lie down and the health care provider will insert fingers (usually the middle finger and the pointer finger) into the vagina to feel the cervix.

Most often cervical exams are done while the patient is on their back because it is the easiest way for us to get the information we need (and accurately measure station).

After consent to the procedure, the provider uses a gloved hand (most often they will use sterile gloves just to prevent infection, although this is not a sterile procedure) and most often lubrication to enter the vaginal canal. They will feel for the cervix and feel the opening to get the information they need.

Cervical exams can be difficult to learn for new providers as it is all done entirely with their hand with no vision, and can vary a bit between providers.

Are cervical checks painful?

They can be.  This is for a few reasons:

History of Trauma – If you’ve had an issue with trauma in that area, often it brings up a lot of feelings at that time.  It is a good idea to tell your provider if you’re having any feelings like that so we can help you through them, especially if the exam is necessary.

It’s tight – If it is your first baby, that area may still be very tight, and can be painful for the provider to put their hand in there.  In general, this isn’t as much of an issue after your first vaginal birth.

Muscle Tension – If you tense up your pelvic floor it makes it more tight and more painful.  The more you can relax the easier it is to do, it will be quicker, and less painful for you.  This, of course, is easier said than done — and I have some tips to make cervical exams less painful that you might find helpful.

The Cervix is Posterior – This means that the cervix is behind the baby’s head, so the provider often will need to push on the baby and get their hand as far back as it can reach.  

One thing that can help this is if you put your hands into fists and sit on those during the procedure (or, in the hospital sometimes we elevated your hips using an upside down bedpan).  That can bring the cervix more forward, and  give the provider a bit more room to perform the exam.

The good news for most people is that the further you get into labor the cervical exams aren’t as painful (mostly because the cervix moves closer forward and we don’t have to reach as far to find it).

I have a whole post on what to do if cervical exams are painful that you might find helpful {so many good tips in there, many that I got from readers}

This is our first child and we were very nervous, not knowing what to expect even after all OB/GYN visits. Hillary took almost all of that away. Her humor and knowledge made this a wonderful experience. Highly recommend for those expecting!

How long does a cervical check take?

In general, not very long — especially if you relax.  Often, if you’re early on (like 36 weeks) I would just have you put your fists under your bottom to start off with so we could make it as quick and easy as possible.

While exams may FEEL like they’re taking quite a while, a simple cervical exam should be under a minute.

There are other VAGINAL exams that you may have that take longer — things like:

  • Pap Smears
  • Uterine and ovary exams
  • Other vaginal testing
  • Membrane sweep (we’re going to talk about that in the next section)
  • Ultrasounds using a vaginal probe

Those exams are different, and most often aren’t directly to ascertain information about your cervix.  They have other reasons (but may feel somewhat similar).

Remember, a cervical exams is NOT done with a speculum, it is done with just the provider’s hand. But, some of those other exams are done with a speculum.

Can cervical checks induce labor?

Cervical checks alone typically do not induce labor.  However, if you are in preterm labor we may be very gentle as we check as we don’t want to “disturb” anything in there.  Also, when you are in preterm labor they mostly just need to know you’re not dilating, so once they know that, they don’t need more information.

Once you are close to your due date (at least past 37 weeks), your provider may ias if you want something that is called a membrane sweep (this is also called stripping your membranes) in an effort to get labor going.

Your OBGYN or Midwife will use their gloved and lubricated finger to go between the cervix and the amniotic sac.  The hope is to separate the two of them, and possibly sweep-up some hormones in the process that might start labor.  The studies are mixed as to if this actually does make labor happen earlier.  Most women do find this pretty uncomfortable, but worth it if they are done being pregnant.

But, as we do an internal exam during labor we don’t see labor increase after we do them.

Oh, and if you’re at that point — be sure to get your hospital bag packed:

Are cervical checks necessary?

This is the big question — especially at 36 weeks.  The BIG question is if the exam is going to make any chances to your plan of care.  Or, if there is a medical reason they need to do a pelvic exam.

Times cervical exams change a plan of care:

If you think you are in preterm labor – If you think you’re having contractions prior to 36 weeks your provider should do a test called Fetal Fibronectin and then may check your cervix after that to see if it is opening.  We can’t just do the test as it takes a while to come back, and if you’re having painful contractions that are opening your cervix we would want to try to stop it (or need to know that the baby is coming).

If you think you are in labor – If you’re having regular contractions and you want to know if your cervix is dilating (as that is the main difference between “false” or  early labor vs “true” or active labor).  So, a cervical exam is the main way to do this.  We can measure your contractions, how firm and frequent they are — but the true test is if your cervix is dilating.

Wanting to know if baby is head down – If a provider isn’t sure if baby is head down a cervical exam is the most efficient way of checking baby’s position.  If the provider can reach the baby’s head they can tell if it is a head, or a bottom.  The gold standard to know position is an ultrasound though (but not all offices have those readily available).

If your water is broken – If you think your water breaks they will do a test called Amnisure to see if that is true or not (it can be confusing).  While this isn’t a full cervical exam, it does require access to this area.

If you need/want to be induced – If you are having an induction of labor, it is important that your healthcare provider know what your cervix is so that they can prescribe the right type of medication.  I talk about this more in my post on Pitocin vs Cytotec.

During labor there are a lot of times they will need to check your cervical dilation, and those are for different reasons having to do with baby’s progress and health.

do you REALLY need to take a prenatal class, is The Online Prenatal Class for Couples worth it?

Don’t forget that they will often do a vaginal exam at your postpartum visit just to check on healing.  They may also want to do a pap smear at that time as well.  While different from a cervical exam, many women are nervous about this because of a tear during delivery.  But, it is important to know that you are healing well (because sometimes you don’t heal well and it can have serious consequences).

So, if you don’t believe that the results of them performing a cervical exam will change your plan of care (or aren’t worth it) you can definitely refuse cervical checks.  

The problem is that people decide in advance they won’t have any exams, and that just isn’t smart.  You don’t know what will happen, or why you might need an exam. You can’t always decide things in advance (but you can be aware you’d like to limit them when possible — that’s why a birth preferences are great).

The good news is that most facilities are no longer doing routine cervical checks where they do it on EVERYONE at a certain number of weeks, or every X hours of labor.

Pro Tip: Because cervical exams are not done with a ruler, they can vary a bit if you have a different provider check your cervix.  Often, we find it’s best to measure cervical change by having the same person check you (although not always possible).

When should cervical checks start?

It would just need to start when it changes your plan of care.  Some women come in very early on due to preterm labor and need a cervical exam.  However, most women don’t need a cervical check until the end of pregnancy. I have a whole post on when cervical exams start.

What if I want my cervix checked?

This is valid too.  You may have had contractions and you just want to know what your body is doing.  In that case, the 36 week exam is a handy time to do it since your pants/underwear will already be off, you may be in the stirrups and your provider is already there.  Just tell your provider you’d like a cervical exam.  Not a problem.

You can literally just say “hey, can you check my cervix while you’re down there — I’d just like to know if it’s opening).

Are there risks to cervical exams?

There are a few risks to a cervical exam.  However, if your water isn’t broken they are pretty minimal.

The main risk is infection — meaning some of the bacteria in your vagina could be swept up into the uterus.  This would be rare early on as your baby is still within an intact amniotic sac.  

Once your water is broken, most providers are more hesitant to do a cervical exam unless more necessary due to this increased risk of infection. However, most likely at an office visit your bag of waters will not be broken (and if it is they’re sending you to have your baby asap).

There can be the risk of preterm labor, which we talked about above.

It can cause a little bit of vaginal bleeding, although not usually much (however, if you have a previa it is important that you not have an exam).

There is also the risk of you having a traumatic experience with it which may flavor your view of care in that area going forward.  No one wants that (which is why I think providers are working to obtain a good consent for exams and limit them when possible).

So, do I need an exam at 36 weeks?

The bottom line is that most often you do not.  You may want one, and your provider may offer one at this time — but if you don’t really care (and you understand it most often doesn’t tell you much at all) then you can refuse it and go on about your day.  Or, if you’re feeling symptoms of labor you may want want.  Up to you!

Note: Partners, and family may want to know what your cervix is as though it were a crystal ball.  But, it is not — just tell them you didn’t think the information would be all that helpful and you and your OB decided against it.  And then move on.  

Your feelings may change as you get closer to the end of you pregnancy, and you may want an exam later on, and that’s fine too.

As you can tell, there aren’t always cut and dry answers to questions in pregnancy and labor. That’s why you need an expert to walk by you on this one. Get prepared with someone who KNOWS what they are doing.

The Online Prenatal Class for Couples can be done in just a few hours and is the best price all-in-one prenatal class online. With it’s 14-day return policy you have nothing to lose by signing up today!

Or, if you’re not quite ready for the full class (or want to make sure we’re a good fit for each other), check out my free prenatal class — It’s your first step towards being your own birth boss. BUT, don’t waste time, get a class in soon — you’ll be glad you did!

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