Can I Say No to a Cervical Dilation Check during Labour?

It all started when I put up a post with this image about checking cervical dilation on Instagram. Over 150* Mums shared their experiences and many answered B – getting measured to see how dilated they were was very, if not more painful than labour! One mum said she was checked about 10 times – ouch.

I had prepared the post based on my own experiences of getting checked during labour with my miss3 and missnewbaby, too. I wondered why I had heard so little about the pain associated with cervical dilation checks and if I was alone. It was reassuring to know that it was a common feeling – the intrusion and the pain.

I also shared it because I love to remind everyone, myself included, that you have a say during the birth of your babies, contrary to how you may feel at the hospital. Your views can and should be heard (as long as they don’t put you or baby in danger). If your suggestions are not a good idea, the medical team present  should explain why that is. You should also be treated with dignity during your birth. This is not something that should be an extra, it’s really the bare minimum we should expect during such a sensitive and vulnerable time.

The responses to the post prompted me to go read up on the cervical dilations check. Ok, you can say ‘no’ – great, but what everyone was wondering was, what are the alternatives that the midwife or Doctor can use to gauge how your labour is progressing, if they do not perform an internal exam?

I share my findings with you below.

A quick reminder: checking your dilation does NOT tell your birthing team how fast your labor will be, or how easy or challenging your labor will be. It is only a snapshot that tells where you are at that point. So your midwife may deduce you are 1cm dilated or 5cm – half way there or 10cm – baby is about to make their grand entrance.

If your midwife checked you and you were measuring 2cm, she may check again a few hours or minutes later. Taking the measurement twice or more, allows her to compare where you are now, to where you were earlier, and she can then see if your labour is progressing. But, what if I told you I found other signs that can be used to gauge that too.

Other indications of how your labour is progressing include:

1. Smell. Apparently women in labour emit an earthy smell just before they start to transition (move from 7 to 10cm).

2. There’s something called the rhombus of michaelis. This rises as your labour progresses to the pushing stage. It shows your baby’s head entering into the pelvis and pushing against the sacrum and can be seen by a midwife.

3. The purple line. I don’t know if this would show for dark skinned ladies. It’s basically a line that rises up your bum crack and when it’s a the top you’re fully 10cm dilated. The line may start to shape when you’re about 3-4cm.

4. Emotions. Apparently mothers get more quiet and retreat within themselves blocking out noise around them as the dilation is increasing. This was not really the case for me though. I actually was easily irritated (was requesting a bath and a birthing ball and felt like everyone was not quick enough). This is also another obvious sign you’re progressing through labour and close to the end.

5. Bloody show. At about 6cm apparently most women get their first or a second bloody show. It could be a Gish if fluid, mucus and blood.

So these signs can be used to monitor the progress of your labour in place of a cervical exam.

However, please note that there is a BUT.

An internal check might be required if your labour does not seem to be progressing in a way that your Doctor or midwife expects. They may then want to check to see if there is a reason for this, for example position of baby’s head or limbs. In this case, saying no, may endanger your baby and even your life too. This is a situation where it would  be wise to allow the check to be done, to rule out any big issues, or to identify and try to solve if there is one.

Here’s a little summary:

You can say no to a cervical exam during labour, if it’s simply being use to measure how your labour is progressing. The team could let you progress and over time check you progress using the methods. Or if your contraction stop, that would be another indicator. But if your Doctor suspects something is not as it should be while you’re labouring, you will have to open those legs for an internal exam. You can always politely ask whoever is carrying out the exam to please be gentle.

Ps the instagram post is here: pain cervical exam.


Let me know your thoughts below, did you find cervical dilation checks more painful than labour?


*from main page @mummyfix and @mummyfixnewbaby too.

 illustration is courtesy @theeducatedbirth.

1 Comment

  • Hi, I am a final year medical student. What you said above about cervical dilatation are some what true but there some parts of the article i dont fully agree with. Cervical exam should not be done a lot in order to avoid infection. However it needs to be done every 4 hourly. The cervical dilatation can be used to monitor progress of labour and also estimate roughly time of birth. This why the doctors can tell if a woman is not dilating enough. A new mother dilates the slowest at the rate of 1cm per hr after 4cm has been reached. Apart from progression of labour it can also be used to determine whether a woman cervix is ripe for labour when inducing a patient. It is also used to determine whether if the baby’s head is being squished in the birth canal. A vaginal exam needs to be done when rupturing the membrane. WHO has a chart called the partograph which is used to monitor the progress of labour. It has a line in which when crossed action needs to taken to augment labour or do a c/s. Cervical examination is a major tool for this graph.
    All the other signs u mentioned above can only tell that patient is in active phase of labour but not help in the monitoring of labour which is highly important. There is more to vaginal exam than just cervical exam in labour and this is highly important in managing a patient. Doing 10 VE in 1 labour is too much and pose a risk of infection to mum n baby but it should be done every 4hours except if there is complications. The extra benefit of cervical exam is that it mechanically dilates the cervix making labour shorter. Although it is painful (I have experienced it), but the benefit outweighs the pain

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