Cervical Checks on your Hospital Birth Plan

By: Aunt Doula (10/17/2022)

Beginning routinely as early as 36 weeks, the cervical check has become a standard in modern western obstetric medicine to monitor supposed labor readiness, and during labor, your progression.

Many people are familiar with the term and idea of dilation of the cervix, however a cervix check is also determining the softening of the cervix, the effacement or thinning, determining the presenting part of the baby, the baby's station, and often putting all of these factors together to calculate the Bishop Score - which is a score that is used to indicate the likelihood of an induction being successful for a vaginal birth or the necessity of a C-section.

Most pregnant people don't know they can refuse a cervical check, let alone the risks and psychological drawbacks that the checks can present. Your right to refuse extends broadly in the labor room, and part of the empowering momentum behind your birth plan is learning what you can refuse, what you want to refuse, and what you are okay with, before it happens.

An important part of cervical checks is knowing exactly what your hospital is going to use to lubricate their glove when performing checks. Some use a water based lubricant, some use nothing - some use Johnson and Johnson baby shampoo. Putting on your birth plan that you don't wish baby shampoo to be used at any point in your labor my seem like something you shouldn't have to do, but it may be! Irritation from the shampoo has been a problem for some birthing people, and it is your right to request water based lubricant. J&J shampoo is also used just prior to the baby crowning, and it is your right to request povidone iodine instead.

The risks of accepting cervical checks are often considered so low that it often isn't offered as a choice. It falls again under the "standard of care" which is presented as an action that requires no discussion - however you do have a right to refuse any procedure presented to you whether it is asked as a question or given as a command. From cervical checks to a C-section, you have the right to refuse, the right to informed consent, and to have it not impact your ongoing care.

The risks to multiple cervical checks include:

• Irritation of the cervix, leading to swelling that can stall progression.
• Pain, discomfort and bleeding
• Increased risk of premature rupture of the amniotic sac
• Increasing infection risk with each check
• Psychological detriments impacting labor progression
• Loss of autonomy when consent is not obtained
• Determination of 'Failure to Progress' made on too narrow a criteria and the Cascade of Interventions beginning earlier and earlier in labor.

Like all other choices on your birth plan, there is a spectrum you can choose from to communicate what you are comfortable with in terms of cervical checks, starting at your late third trimester appointments. Examples on the spectrum include:

• Cervical Checks Approved - No restrictions and determined by the staff when they need to be performed. Consent to perform preferred.
• Cervical Checks Conditionally Approved - Consent before each check requested, and right to refuse will be exercised as determined by the patient.
• Cervical Checks Conditionally approved - Checks to be kept to a minimum, please do not ask more than every 4 hours.
• Cervical Checks Declined - Except in the case of an emergency such as a suspected prolapsed cord, please do not ask to perform cervical checks during the course of labor.

There have only been two studies performed to determine the benefits or drawbacks of cervical checks and it has not been found to improve outcomes to begin checks before labor has begun, nor does it improve outcomes during labor to be checking progress. As with many monitoring procedures done in obstetric management or in the hospital setting, the cervical check has very little value in routine or frequent use and should be reserved for specific situations in which a problem is suspected.

Whatever you choose for your birth plan, remember that the birth plan is a fluid document - it is not written in stone. If you say you approve cervical checks unconditionally and then find them unbearable, you can amend your choice and decline the rest of them! Being flexible in that way doesn't mean you have to throw out all the choices you made! Each item on the plan is its own item, it can be changed independently of the others. The plan is there to give you confidence and guidance for what you want to aim for and what you want your labor team to try and provide. You are doing the best you can to know what you want, but once you are in the middle of your labor, the choices may change. Your conviction may be tested, too. The plan is there to be a tool - it is a guiding path, not a strict gospel. Be prepared to move with, adjust accordingly, and rely on, your birth plan. Let it be a source of strength in a vulnerable time.