Why not have cervical checks during labor?

[WindyCityMom]

I've seen written in many birth plans parents refusing cervical checks (or requesting a bare minimum) during labor. I was just wondering if there is any reason for this other than it being an intervention.

I don't see it being an intervention that can stall or slow labor, but correct me if I'm wrong. I had about 4 cervical checks during my 14hr labor with DD and I don't see much wrong, but then again, she was a pretty high-intervention hospital birth

So... why, or why not?

[kcparker]

Why not:
- it can be discouraging to the mom if she doesn't hear a number she's hoping for;
- you can dilate from 4 to 10 in 1/2 an hour or 1/2 a day or over 24 hours;
- providers may diagnose "failure to progress" if they are wanting to see linear progress, which might lead to suggestions of pit. augmentation or a section;
- it introduces bacteria into the vagina, and especially if your water is broken, you don't want extra bacteria in there;
- it's not very comfortable;
- it can feel very invasive psychologically and can get you out of 'the zone';
- if your BOW is intact, a check carries the risk of rupturing it.

Why:
- to know how far along you are or have to go;
- you are maybe in prodromal labor, or maybe the real deal,and you or provider wants to know if you are making progress;
- you are getting pushy, and provider wants to check for dilation before you push in earnest;
- wish to ascertain baby's station/position;
- checking for bulging bag, or breaking the BOW.

That would be my basic list, anyway. HTH.

[XanaduMama]

My thoughts on this:

1. It's unnecessary, and only contributes to the "on-the-clock" approach of many hospitals/OBs. How does it help to know if you're at 4cm or 7? The only thing that matters is when you start pushing... I might (and did) accept a check if I felt like pushing and wasn't sure whether I was fully dilated, so as to avoid swollen cervix etc. Otherwise, it doesn't tell you anything useful.

1b. Again--it puts pressure on the mom to "perform": to dilate at a specified rate, or risk being labeled "failure to progress". Everyone labors at a different rate--there's no standard beyond which one is a "failure."

2. It risks introducing infections, especially after ROM. Any foreign object in the vagina poses this risk, whether of introducing external infections (which, in a hospital setting, is really scary) or of forcing GBS or whatever from the labia/external vagina up toward the cervix. Again, highly risky (esp after ROM), and unnecessary.

3. It reinforces the notion that the doctor is the "expert", and the one in control, when (a) s/he's the one deciding whether "progress" is being made or not, and (b) when mom is being made to stop laboring, lie on her back, and submit to such a check in this situation. It's just one part of the array of "interventions" that serve the hospital/doctor's interest way more than the mother & baby's.

[WindyCityMom]

Thanks a bunch, that helped a ton!

[beckyand3littlemonsters]

because they are uncomfortable and unnessacery imo with my 1st i stayed at 4cm for 7hours then dialted the remaing 6 in 2 hours, with cameron only an hour before he was born i was 4cm. how dialated you are really doesn't mean anything imo

[CrunchyChristianMama]

KCParker gave a great list, but I will add to it that it that usually the nurse or dr. won't do it anywhere but with you on your back in the bed. Some will check you in the tub or wherever you are, but they are few and far between. I didn't want someone telling me to climb back into bed every hour just to check my progress.

[GoBecGo]

Because for me it doesn't impart useful information. I was at 2-3cm 3.5hours before DD was born, and i only pushed when her head was crowning. So it's not as if i dilated fast and then had a decent/normal 2nd stage. In fact i think her head came through my cervix about 30mins after that VE, but i was too inexperienced at the time to figure out what was happening.

[Sheryl1678]

I also don't want someone's hands in my vagina who I am not in love with (and vice versa) without a darn good reason.

[caro113]

they can also induce the worst contractions of all. It's also like a test. "I'm going to check you now" and then you're told whether you passed or failed .. ugh. I feel some doctors want to do them more and more as labour progresses because they want to have another reason to pressure women into either breaking their waters or just cutting the baby out.

[WindyCityMom]

Thanks for the input everyone!

Sheryl- I totally agree with that, and I think my Dh is well on board with that as well, lol.

[mwherbs]

well there is some evidence that more than 7 checks can increase infection rates.

[MsBlack]

mwherbs--

Do you mean, increased infection rates after 7 VE with ruptured membranes only--or not? Just curious here.

Also--7 VEs! That number is astounding to me. The thought of it gives me a twinge of nausea or something--as a mother and mw both. SEVEN? Do women really get that many VEs in the hospital? Or more, I suppose?

[mwherbs]

it was a Canadian study a while back I will have to look- 7 exams or more was the number at which they found increased risk-- it is a very Under studied thing- I remember it because someone who was being raked over the coals in Washington- needed evidence for her practice of minimal cervical checks and I couldn't find much ---

[Bluegoat]

Here are my answers:

If different people are doing the checks, you can get different answers, which can be disconcerting.

I don't want to feel someone else's pressure to progress at 1 or 2 cm per hour like a clock.

Risk of infection.

They cause stress which can actually slow or even reverse labour.

[Youngfrankenstein]

Originally Posted by MsBlack

Also--7 VEs! That number is astounding to me. The thought of it gives me a twinge of nausea or something--as a mother and mw both. SEVEN? Do women really get that many VEs in the hospital? Or more, I suppose?

HA! They try to do them all the time. I know you've read Pushed, she describes that new device the goes on either side of the cervix to electronically check dialation. Just wait until that comes into vogue!!!

I have heard Ina May Gaskin say that just by doing a rough check or being "startled" that women can "close up" more. Sometimes a VE can do that if it's in an uncomfortable way.

[crunchy_mama]

Originally Posted by Sheryl1678

I also don't want someone's hands in my vagina who I am not in love with (and vice versa) without a darn good reason.

That is a big one for me! I am very thankful to have a mw who is not VE happy and hopefully will make it to baby without any checks!

[*MamaJen*]

I've heard some women feel pushy sometimes before they're fully dilated, which is why midwives like to do checks? But still, for my next labor I'll definitely specify no checks during active labor. I'm okay with one at the very start just to get a baseline, but I find them really intrusive during active labor. My super terrific midwife whom I adored wanted to do one as I was in transition, and I was so far off in laborland I didn't really have the words to refuse it. It was mildly uncomfortable and really knocked me out of the zone. Turns out I was nine cms, and again, I was so far off in laborland that number meant absolutely nothing to me. I had gone out and plotted all the elements of my labor, but I had no idea cervical checks would be something I wouldn't want.

[goldfinches]

Originally Posted by MsBlack

Also--7 VEs! That number is astounding to me. The thought of it gives me a twinge of nausea or something--as a mother and mw both. SEVEN? Do women really get that many VEs in the hospital? Or more, I suppose?

Well, in my experience, that number is really high. I only had 4 with my first daughter, after nearly 48 hours of labor, and only 2 with the second, whose labor was much faster.
They're right, it is a let-down when they check you after a few hours and you haven't progressed

[Burnindinner]

I had ONE during labor, when the mw was pretty sure I was completely dilated but I was freaking out labor "like this" was going to go on all day. Probably transition, but what did I know? I didn't want anyone to check before because if I was only at a 3 or so it would have been soooo discouraging.

[rachel65655]

I am refusing them with this birth because they don't mean much to me and only cause me to stress.

With my first DD I was 5 cm and then pushing her out 20 minutes later...with my last child I was 2 cm and she was born less than 45 minutes later. First DD was a pitocin induced labor, FWIW.

It would send me into tears to know that I've been in so much pain and to think that my body isn't doing anything. I usually don't make much progress "dilation wise" until I hit transition which is usually less than an hour long. I don't have any pain during contractions usually until transition.

Even with my last child I tried to tell the nurses this and that I was starting to be in a lot of pain and wanted my epidural (long story as to why I wanted one). I came to hosp at midnight and was 2 cm, having contractions every 3 minutes from the time I got there. I was checked several time and again at 5:30 and still at 2 cm. I had gotten up to go to the bathroom at about 6:05, laid back down in bed and felt by bag of waters protrude with my next contraction. Nurse dawdled getting down to my room because according to her, "I wasn't really in labor because I wasn't progressing",(she told me this at 5:30 when I requested her to call my OB and I wanted my epidural) and by then I needed to push and I had her right there in the bed at 6:15. My last four children have been born with only one push. They hadn't even called my OB to tell him I had come in to the hospital this last time. He got there to deliver the placenta and boy did he look pissed off.

Then the nurse has the audacity to ask me if my labor usually go this fast....duh, I don't know how many times I tried to tell you that!