PREGNANCY

Refusing Cervical Checks in Pregnancy

You may be wondering if you can refuse cervical checks from your care providers during your pregnancy.  It is important to know why cervical exams are offered and then decide if you need the information they can give.

woman with foot in GYN stirrup

But first, how do I know so much about cervical exams?

Hello! I’m Hilary — many people know me as The Pregnancy Nurse 👩‍⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind this website Pulling Curls and The Online Prenatal Class for Couples. 🩺​ I have checked thousands of cervixes (and had my own checked several times as well), and I’ve thought about the reasons behind these exams a lot — so you could say I’m an expert on this one.

Ok, let’s answer the question:

Can you Refuse Cervical Checks During Pregnancy?

Absolutely.  There is nothing offered during pregnancy that you can not refuse, but it is important to understand the reasoning they want to do one before you refuse.

Let’s talk a bit more about what they are and why providers use them.

Oh, but let me give you a helpful tip first — grab the Bump to Bassinet Bundle and jump in the Provider Communication bonus video where we play out stuff just like this to give you the words you need to get through scenarios like this (I know how hard it can be to find the words sometimes).

What are Cervical Checks For?

Cervical checks are a common procedure done during prenatal care and active labor. The cervix, which is the lower part of the uterus that opens into the vagina, is inspected through a cervical check to determine its dilation, position, and effacement, which are all important factors in monitoring labor progression.

During active labor, cervical checks are done more frequently to assess how quickly labor is progressing and whether interventions, such as pain medication, are needed. However, sometimes people may choose to decline cervical checks during labor due to personal preferences or medical history.

Cervical checks can provide essential information to healthcare providers to ensure safe and effective labor and delivery.

But the key is truly if they ARE providing essential information for you or your providers.

Why Providers Need Vaginal Exams?

A vaginal exam can be extremely informative when done by someone with the proper training.  We can learn:

Dilation – how open your cervix is

Effacement – how thin your cervix is (kind of like a turtleneck sweater the cervix is very thick initially, but thins out as the baby’s head applies pressure to it)

Station – how high or low your baby is in your pelvis

Consistency – how soft or hard your cervix is

Presenting Part – we can often tell if your baby is head down or breech when we do a cervical exam.  Experienced providers can also sometimes tell which way the baby is facing from an exam.

Depending on why we are doing the exam, things like this can really tell us what’s going on with your uterus and baby.  At times it can be a crucial key to taking care of both of you.

I have a whole video more on cervical exams and what we learn from them:

Are cervical checks painful?

While some women may find cervical checks uncomfortable , they are not necessarily painful. The sensation can be described as a pressure or mild discomfort as the healthcare provider inserts two fingers into the vagina and gently feels the cervix. I have a whole post on what to do if you find cervical exams painful (so much good info in there from other mamas too!).

Cervical checks are typically brief and should not cause lasting discomfort. However, it is important to communicate with your healthcare provider about any pain or discomfort you may be experiencing during the exam or have previously had. Overall, cervical checks are a common part of prenatal and birthing care and should not be feared or avoided. 

Many people like to learn coping skills to deal with them during their pregnancy.  Many find the support of a doula can help them if they find them extra painful.

It is important to differentiate cervical exams from a membrane sweep (which may happen with the first exam you have with your MD or midwife, although they should ask consent first). Many people say the nurses was “so much nicer” once they’re in labor, but I think that maybe their doctor swept their membranes without telling them (you can always ask if that is their plan if you think they won’t ask).

FYI a membrane sweep is where they take their finger between the cervix and the back of waters to separate the two and hopefully stir-up some hormones (and put you into labor). As I said, your provider should get consent to do it before they do it (but some do not).

"I absolutely love this course. I came into it knowing bits and pieces, but it has really given me more confidence in what to expect and things that can possibly happen. Hilary has an amazing personality and great knowledge and experience."

When do cervical checks start?

It can be a bit confusing because you may be offered a few exams in your pregnancy that are not cervical exams.

At your first appointment your doctor or midwife will likely do a vaginal exam to check uterine size and also check for any STD’s.  She may also do a pap smear if you are due for one. 

You may also have a vaginal probe placed for an early ultrasound.  Again, this is not a cervical check, but just an ultrasound with a vaginal probe (they just may seem similar to you).

If you have symptoms of preterm labor your provider may do a test called fetal fibronectin, and they may do a gentle exam to see if your cervix is opening.

But, if your pregnancy is otherwise unremarkable, some providers offer an exam after they do your GBS swab at 36 weeks.  If you are not having any labor symptoms would prefer not to have it done, you can easily refuse this, but many women want to know (which is why they often offer it).

Other than that, it really varies provider to provider as to when they offer a cervical exam as you get closer to your due date.

If you are considering an induction your provider will need to check your cervix to decide the medication best to use for the induction.

Beyond that, most cervical exams happen once you go into labor.  And we’ll talk more about those in a bit — so stay tuned!

Why Some Refuse Cervical Checks

There are several reasons why some women may refuse cervical checks during their gynecological exams.

Firstly, cervical checks can be uncomfortable or even painful for some women.

Secondly, some women may have had previous negative experiences with cervical checks, such as feeling rushed or experiencing discomfort or pain during the exam. Moreover, some women may feel embarrassed or uncomfortable with the idea of a healthcare provider examining their private parts. 

Also, some people have had issues with sexual assault in that area, and feel very threatened and it brings up a lot when we do the exam.

Finally, some women may simply be fearful of what the cervical check might reveal, such as preterm labor (or a diagnosis of something if gynecological testing is done).

Whatever the reason, it is so important for you to share your reasoning with us so we can best help you make choices for yourself during pregnancy and labor.

speculum exam/painful exams in labor

I actually have a whole podcast episode on this topic too if you want to listen

Questions to ask to determine if you want a cervical exam:

  1. What is the reason they want to do it (they may just be offering it because you might want it).
  2. Will it change my plan of care (for instance, if you’re in preterm labor and your cervix is actively opening that changes your plan of care a lot)
  3. Will it put my mind at ease?  It isn’t unusual to wonder for yourself what your body is doing, and in that case you’re welcome to get one!

All of the answers to these are valid things to consider.

the secrets of getting prepared for your birth

I want to talk through 4 of the times you may be offered a cervical exam and what the reasoning is.

Times You Will Be Offered a Cervical Exam

There are a few times that you are offered a cervical exam.  Remember, your provider may say “I’d like to do a cervical exam” but it’s just an “offer” — you can always refuse.

And honestly, knowing what to expect is going to help you feel a lot better moving forward.

During Prenatal Care

As I mentioned above, your provider may offer a cervical exam at your prenatal appointments.  Many patients want to know what their cervix is doing, and they have no idea if you do or don’t want to know — so they offer.

However, most cervical exams that are given when you are not in labor won’t particularly change your plan of care.  So, for me I’d prefer not to get them.  But again, if you think it will give you peace of mind — go ahead and get one!

Pro Tip:  Just because your cervix is 1 cm now doesn’t mean it can’t be a few centimeters in a few hours if you start having contractions, or it could stay 1 cm for days or even weeks.  Knowing what it is now doesn’t give us much info on what it will be later.

Preterm Labor

If you think you are contracting prior to 36 weeks your provider should do a fetal fibronectin test and then may consider doing a cervical exam to see if your cervix is opening.

If your cervix is not opening they don’t need to be as concerned about stopping your contractions (and can wait for the fetal fibronectin test to come back), but if it is opening you may need to be admitted to the hospital for monitoring and medications to stop your labor.

This is a time when a cervical exam is very warranted as we would like baby to stay inside a bit longer to develop in the womb.

Possibly in Labor

You may think that you’re in active labor, and in order to really tell that your provider will need to check your cervix.

The definition of active labor is that your cervix is actively changing.  So, if we check you now, in a hour or so we would check your cervix again and it would be progressing.  

At that point it is best for you to stay at the hospital and labor there.

If your cervix is not actively dilating your best bet is to stay at home for a bit longer until the contractions get more intense, closer together, more painful etc.

Check out Labor is Progressing

When you’re in labor we will check your cervix now and then to see how things are going.

Some facilities (although it’s seeming like less of them) encourage providers to check every hour to see how the patient’s progress is going.

But most places check:

  • Prior to pain medication administration (we want to make sure baby won’t be out too soon for the medicine to possibly affect them at birth, or to make sure baby isn’t too close for an epidural).
  • If your contractions have slowed down to see if you are still dilating
  • If baby’s heart rate drops we may check your cervix to see if you are dilating quickly or if the cord as possibly fallen out
  • If we think you are complete and ready to push

There may be other times that they check, but that is the majority of times that they will offer to check your cervix.

Sometimes they just want to check to “know” — but that is 100% up to you. I’ve also had patients ask me to check them every hour (and sometimes I’ve refused) because they wanted a very accurate play-by-play. So, communicate is ALWAYS the key!

How to Say No to a Cervical Exam

The best way is to make sure that you are totally informed on why we are doing it and that you are refusing it.

It isn’t a good feeling for your providers to know that you just plan to refuse all cervical exams for any reason in labor and delivery.  It may make providers unsure if you really want their care (as cervical exams can tell us a lot when done at the right time for the right reasons).

A good way is to say, “Ok, I really hate them and it doesn’t seem like that’s going to change my care or put me or my baby in an unsafe place so I think I’ll refuse it today (or for right now).  Please let me know if if I’m missing something or if things change.”

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Or, if you’re in the hospital you can ask to just delay it for an hour or so…. something like: “I understand you want to check me now, but I’d prefer if we wait an hour or so.  I’m not feeling the urge to push yet but my contractions continue to be really strong, so I think we’re good.”  That way we know you understand what we’re looking for and we feel safe that you are making a good choice for yourself. 

That’s better than… “I decided long ago I will not have any exams in labor and I won’t let you check me.”  That makes us worry that you don’t understand the possible consequences, and it’s a big part of our job to share the risks and the benefits of any procedure in labor and delivery.

Just be respectful and let the providers know that you have listened to the education they have provided you.  That’s all that they want.

Can I Refuse All Cervical Exams in Labor?

Yes, you can refuse everything in labor and delivery.  However, if you are going to the hospital for a safe labor and delivery of your baby I would encourage you to get the education from your providers about what interventions are used for and then you can decide if they’re right for you.

If you plan to refuse all exams in labor please talk with your doctor or midwife early on.  Most often the provider orders the exams and it will make it a lot easier on your team if they already understand where you are coming from.  Please be really clear about why you are refusing them and also times where you would think they are OK.

Finally, let me review the times that are really necessary:

  • Admitting you for active labor (it really isn’t the best place for you if you’re still in early labor, so a quick exam can help us make that choice)
  • If baby’s heart rate is having issues to check if there is an issue
  • Prior to pushing (while you may have the urge to push you may have cervix in the way that if you push down on can swell or even tear)

The good news is that almost every patient I’ve had has been a very reasonable human being.  In fact, most nurses and doctors are also pretty reasonable so as long as we keep our communication going we can always find ways to make things work for you.

Ok, now that you understand that, your next step is to get prepared for ALL of birth in The Online Prenatal Class for Couples. At your convenience, and in just a few hours you can be prepared for birth and feel so much less nervous about everything that’s going on.

great, informative experience

Or, if you’re not quite ready for the full class, check out my free prenatal class — It’s your first step towards being your own birth boss.

Originally Posted Here

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