Let’s tackle a question that a lot of patients have as their pregnancy journey is nearing completion-

“Do I need to have cervical exams?”

Short Answer:

You don’t. Your cervix tells us about as much your big toe does regarding when you’ll go into labor.

Expanded version:

It is a long-standing tradition to check the cervix in late pregnancy to assess if it’s posterior(pointing to your spine-it’s usual spot before active labor), anterior or somewhere in the middle, if it’s thinned (or effaced) and if it’s opening or dilating. Many times the provider will snap off their gloves and say, “I think you’ll have a baby by this weekend.”

Nope. That’s not how this works.

In my doula years, I did a lot of clean-up after a provider said this to a mom. There’s just no way to know how soon a woman will go into labor with a “ripe” cervix and many times the weekend would come and go with no baby- but lots of tears instead.

Maria Pokluda, a doula colleague in the Dallas Fort Worth area said it best when she said, “Your cervix is not a crystal ball.” I’ve seen women get checked at a prenatal visit, be 1cm with a high, thick cervix, and have a baby in her arms within 24 hours. Even more frequently, I’ve seen women walking around living life, not in labor, with their cervix open to 4-5cm for several weeks (especially if she’s had a baby before). It’s just what the body does before labor-sometimes days before… and sometimes moments before.

“But I want to see if I’ve progressed at all!”

I know this is a common concern but there is no such thing as pre-labor progress.

Read that again: There is no such thing as pre-labor progress.

Moving from 1cm to 2cm in a week means absolutely nothing. As does not changing at all. This is probably the most anxiety-causing myth surrounding pregnancy and birth. It has set women up to fail at an imaginary test that has zero meaning. I’m not saying it means nothing to make you feel better, to sugarcoat bad news and console you. I’m saying you’re at risk for a needless cycle of anxiety because of a medicalized myth. (PS: You’re also at risk for infection and your water accidentally breaking during the procedure. )

Here’s the cycle I see:

Stress from not progressing —> stress hormones that block oxytocin —> Labor doesn’t start —> You think your body is a lemon and won’t work right —> stress increases —>oxytocin is blocked even more

There is much freedom in realizing the myth is strong but it is 100% false.

Recently, a client wanted her cervix checked (and she’s the leader of her care, so it was checked). Her cervix was so stretchy, dilated to 4-5cm or so and very effaced. Surely labor would start soon, maybe even that night- we all fell for it! I think I even stayed around the office late instead of driving the hour home.

Her baby didn’t come that night… or the next. It didn’t come for over a week!

This cemented it in my mind that birth can not be predicted by what the cervix is doing any more than it can be predicted by what the big toe looks like. So next time you wonder when you’ll go into labor, take off your shoes, prop your feet up and gaze at your toes for the answer while you trust that your baby will come on exactly the date he or she is meant to be here.

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