Do you really need cervical checks in late pregnancy?

Cervical exams can be one of the more unpleasant parts of late pregnancy and labor. As an OB-GYN, I’ve done countless cervical checks both in training and in private practice and seen a lot of different responses. For some people, the exam is just a blip. But for many others, it’s a distressing thing to have to deal with when they’re already so uncomfortable from the pregnancy itself. 

So why do OB-GYNs even perform cervical exams in the final weeks of pregnancy? During my training years, it was something that some of our mentors did because that’s just what they had always done. But many OB-GYNs who care for pregnant people now, including myself, have concluded that while there are cases where a cervical exam late in pregnancy can be useful—and sometimes crucial to the care we provide—in many cases there’s not actually a good reason to do it. So when do you actually need a cervical exam late in pregnancy? And when can you opt out? I’ll explain that and more below. 

Related: Sometimes pregnancy is the worst, so let’s stop romanticizing it

What is a cervical exam?

Let’s start with the basics. The cervical exam—aka the cervical check or sterile vaginal exam (SVE)—involves the provider inserting a gloved index and middle finger into the vagina to check the cervix. Sounds pretty uncomfortable, right? Well, it’s especially so in the last few weeks of pregnancy when there’s increased blood flow, swelling and sensitivity in the vagina. 

What do cervical exams check for?

Simply put, cervical exams are used to figure out how dilated, or open, the cervix is. Traditionally, the reason many OB-GYNs did cervical checks routinely in the final weeks of pregnancy was to check for changes in the cervix that could indicate the early stages of labor. These changes include not only dilation but also effacement (how thin the cervix feels) and position in the pelvis (where the cervix is relative to the pelvic bones and the baby’s head). 

While these signs can sometimes give us an idea of how close someone is to going into labor, these are just guesses at the end of the day. In my own practice, I’ve seen a patient with a closed cervix one day who delivered their baby the next day, while another patient walked around with a 5 centimeter cervix for over a month before going into labor! There are many other factors that we have yet to understand about what kick starts labor and unfortunately, the cervical exam is just one part of that equation. 

Related: What experts want you to know about your due date

When are cervical exams in late pregnancy necessary?

Over the years, my attitude towards cervical exams in late pregnancy has revolved around one rule: A cervical exam should only be done if it would change the way I would manage the patient. What does that mean? Basically, I will only check the patient’s cervix if it would affect my final decision on their delivery plan. For example, if I have a patient who’s already scheduled for a C-section but they’re feeling fine and have no symptoms, then there’s no reason for me to check their cervix.

This leads to the question: when should a cervical exam be done in late pregnancy? Here are the most common reasons.

• Suspected labor: If someone is having symptoms associated with labor like contractions or pain, bleeding, loss of fluid, or they’ve lost their mucus plug (a clear, pink, or brown sticky discharge), then a cervical check makes sense. In this case, knowing how dilated or thinned out the cervix is would affect delivery planning.
• Scheduled induction for medical reasons: If someone needs to be induced for a medical reason—like growth concerns for the baby, high blood pressure or other lab or exam abnormalities—then knowing what the cervix is doing can be very helpful. Depending on their Bishop score, I can better assess which induction method(s) are most likely to be effective for them and plan accordingly.
• Scheduled elective induction. Many patients choose to be induced once they’re past full term even if there’s no medical reason to do so. The earliest we will allow this type of induction, known as an elective induction, is 39 weeks. A cervical exam for these patients helps me determine if their body is ready for induction and if so, the best way to begin that induction safely and effectively. 

In both induction cases, starting with a cervix that’s not as far along as it should be can potentially increase the length of the labor, which in turn increases the chance that they eventually need a C-section. In the elective cases, this sometimes means that I counsel people to wait a few more days before moving forward with an induction so that we can decrease those risks. 

Related: 10 tried-and-true ways to induce labor naturally

When are cervical checks in late pregnancy optional? 

Outside of the situations above, most cervical exams aren’t necessary and won’t change how we manage someone’s delivery, so it’s up to you if you want to do it or not. Some patients even request a cervical check either out of curiosity or excitement, to relieve anxiety as their due date approaches, or based on symptoms they may have noticed between appointments. 

Importantly, there is a relatively common concern that cervical exams may cause someone’s water to break prematurely, but this is highly unlikely. Even when performing a membrane sweep, that alone does not cause someone’s water to break. A membrane sweep is a procedure done after the cervix has started to dilate where we use a gloved finger to gently free the membrane that’s attached to the cervix. This releases hormones that can cause contractions, which may then lead to labor.

Related: Does curb walking induce labor?

The bottom line

If you’re in the last stretch of your pregnancy and you are not having any symptoms of labor and aren’t scheduled for a medical or elective induction, then there’s really no medical reason to have a cervical check done and you have every right to decline.

Advocating for yourself

With that said, it can be daunting to go against what your provider is recommending, but there are ways to ensure you are making the choice that’s right for you—and to feel more confident in that decision. 

• Make sure you understand the recommendation fully. Before saying no, make sure you’ve asked your provider to explain plainly why they feel the need to check your cervix. Get all your questions out so you have all the information you need and feel comfortable before making your final decision. If the provider gives you a reason that aligns with the ones above or one that aligns with your desires and needs, then go for it! If not, you can simply say “I don’t feel comfortable having a cervical exam today but thank you for offering.”
• Stand firm in your decision. If your provider is insistent in trying to persuade you, stick to your decision. At the end of the day, no one can force you to undergo an exam that you don’t want. You can say things like “I understand the points you’ve made but I still don’t want to have a cervical check today.” 
• Have a support person with you. Having someone with you in the room can serve two helpful purposes. First, it helps you feel more at ease having someone you trust with you. Second, that person can also advocate for you too and back your decision if you feel like you need it. 

Related: The 5 doctor appointments to make for yourself each year

It’s always your choice

There is so much anxiety and excitement in late pregnancy as you gear up for the arrival of your little one. Worrying about unnecessary and uncomfortable exams shouldn’t add to that. With the information above, you should have the tools you need to understand what a cervical exam does and when it’s needed. And using the self-advocacy tips can help you navigate your appointments a little easier. The decision of whether to get a cervical check is always up to you.

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