Do I Need Cervical Checks in Late Pregnancy?

vaginal exams in pregnancy

If you’ve had a baby before or even talked to friends who have, it’s likely you’re aware that many prenatal healthcare providers routinely perform cervical exams in the last few weeks of pregnancy. Questioning this practice could very well have never even crossed your mind. Maybe you’ve even been led to believe that the results of these cervical checks are an important piece of the information needed to determine how your pregnancy is progressing and how soon you may deliver your baby. The truth of the matter is though that while yes, a cervical exam can assess effacement and dilation, it is not a reliable predictor of when you may go into labor. Instead, these cervical exams are more of a relic of prenatal care of the past and are done out of routine rather than out of true clinical need. While cervical checks can be useful in the case of an upcoming induction to determine how favorably one’s body would respond, there’s no true evidence-based reason to do repeated routine cervical exams in a typical pregnancy. 

Aside from the lack of necessity, cervical checks do also hold some level of risk. The risks associated with cervical checks include possible infection as well as the potential for premature rupture of membranes (breaking of water prior to labor-onset). 

When any foreign object, in this case, the gloved finger(s) of a healthcare provider, is inserted into the cervix, there is a risk of infection. The act of entering an area that otherwise is biologically sealed off and meant to dilate in its own time, can be problematic. Bacteria from the provider’s hand or even from your own vagina can be pushed into the cervix and create an infection. Infection is obviously something one would want to avoid at any time but certainly during the last weeks of pregnancy.

The premature rupture of membranes or PROM, the breaking of your water prior to the onset of labor, is another risk that cervical checks introduce. PROM can lead to longer labor, infection for the parent and/or baby, and possibly the need for induction. Cervical checks have been linked to PROM. In fact, a study done on this exact issue, revealed that people who had routine cervical checks starting at 37 weeks were three times as likely to experience PROM as those who did not have the routine cervical examinations. A second study (mind you, shockingly, only two studies have been done on this specific subject) showed that there was no risk nor was there a benefit to routine cervical checks. The potential reasons for the discrepancy are beyond the scope of this post but it certainly indicates the need for more research to be done on this topic and should act a red flag for this procedure. 

Whether there is truly a significantly higher risk of PROM and infection when having routine cervical checks or not, a procedure that carries no benefit should always be considered a potential risk and deserves to be weighed thoughtfully by the patient. If your provider does not need the information to plan a potential induction or for a valid reason that goes beyond simple routine, you may want to ask questions and consider if it’s a procedure you’re confident in having done. You always have a choice in the matter. Refusing a cervical exam is your right and a healthcare provider cannot compel you to consent to such an exam (or any other medical procedure for that matter). Informed choices only exist when “no” is an acceptable response. 

For more information, visit Evidence Based Birth.

 

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