A cervical exam can give you and your provider helpful information for what is going on in regards to labor — so, when do they start doing them? We’re going to talk about why they may do them early on and what you should expect as you get closer to going into labor.
But first, how do I know so much about going into labor?
First off, hello! I’m Hilary — many people know me as The Pregnancy Nurse 👩⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind this website Pulling Curls and The Online Prenatal Class for Couples. 🩺 I’ve checked thousands of cervixes and talked to lots more patients about why we do or don’t do cervical exams at certain points, so I’m a great expert to listen to on this!
Before we get going, your cervix dilating isn’t the only sign of labor — so grab my labor signs checklist right here:
At what week do they start checking your cervix?
While certain signs and symptoms may necessity a cervical check earlier, most providers don’t even offer a cervical check until about 36 weeks of pregnancy. Even in that case many providers don’t offer them until it will change the plan of care — so, going into labor, or needing an induction…. So, in some cases they won’t check for dilation until you’re in labor.
Why would they need an earlier exam?
If you think you’re having preterm labor or have previously had preterm labor they may either:
- Order an ultrasound to check your cervical length (this usually involves a vaginal probe)
- Or check your cervix by hand (in some cases they may use a speculum instead)
Prior to this they will often do a fetal fibronectin test that checks for preterm labor better than just an exam.
Some people have what is called an incompetent cervix where the cervix doesn’t hold the weight of the growing baby and will just open much earlier than is good. Those people may need a cerclage where they sew the cervix shut (they then clip that open once you get to 36’ish weeks).
Cervical Exam vs Pelvic Exam vs Pap Smear/Swabs
It can be easy to confuse the different types of exams that can be done in that “area”. To a normal person they all seem really similar:
A cervical exam (which is what we’re talking about here) is done to check the cervix and all that entails (more on that coming)
A pelvic exam usually is done to monitor the pelvic floor, the uterus and ovaries — either just one or all of those. This should be done yearly at any woman’s check-up (even if not sexually active as ovarian cancer can be a silent killer)
A pap smear or other swabs are done to send to the lab to check for infection or cancerous cells (depending on what is ordered). Often this is done also with a speculum that looks like this:
Are cervical checks necessary at 36 weeks?
Most often, not. They’re usually done because:
- The pregnant person wants to know if their cervix is opening or if they are going into labor at all (usually this is pretty vague information and doesn’t tell them much at all)
- It is routine for the provider to do them.
In the past this really has been routine in which they do the GBS culture, and then check your cervix at 36 weeks, just to see what is happening (possibly because you’re already naked and it is a handy time to see if anything is happening).
However, the more recent practice has been to just do the GBS culture, possibly over a vaginal exam if the patient wants it and then move on to the rest of the appointment.
Most often your cervix is closed, 1 or 2 centimeters at that 36 week check and that doesn’t really tell you anything at all. It doesn’t mean you’ll have the baby any sooner than if your cervix was closed.
Remember an open cervical can stay that way for a long time without productive contractions.
And a closed cervix can always open when it’s ready, which can often happen quite quickly.
BTW, if you’re 36 weeks be SURE that you’re doing your kick counts:
What the heck is the Cervix?
Valid question. It’s just the end of your uterus. Similar to how your rectum is the end of your intestines (before the poop comes out) the cervix is the end of your uterus that keeps baby in until it’s time for baby to be born.
We can really boil this whole thing down to the question: Will this exam change my care in some way? If the answer truly is no, then there really isn’t a need to have them, but if you’re curious you can always ask them to do it.
The reality is that a LOT of pregnancy and birth is simple (even though people seem to make it super complicated). This really is the easiest way to get prepared for birth. It simplies it, makes it easy to understand and make choices in your own care. I can’t recommend it more!
What does the Cervix Check Tell You?
So, if we only want a cervical exam, if it is going to change our care — what does it tell us?
A Cervical exam includes a lot more than just how dilated your cervix is. It also includes:
- Effacement – how thick or thin the cervix is
- Position – is the cervix at the front of the birth canal (vagina) or towards the back?
- Station – how high or low the baby is within your pelvis
- Consistency – is the cervix hard or soft?
These things, along with dilation are composed into something called the Bishop score that is an easy way for practitioners to tell each other how ready your cervix is for labor. I talk more about that in my post on having an unfavorable cervix.
In the hands of a skilled practitioner a cervical exam can tell you a lot about how you’re progressing in labor or if labor has started.
However, at a random prenatal appointment where you are not in labor it doesn’t tell us as much. Which is why routine cervical checks at the end of pregnancy have started to go out of fashion.
For example: Even if you were four centimeters (which you likely are not), if you aren’t having any contractions you’re still going to go home and see if labor begins soon — which is the same thing you’d do even if you were 1 centimeter. The exam didn’t change anything!
Note: At any point you can refuse a cervical exam if you don’t feel like it will change what you’re going to do. Some people say they plan to refuse ALL cervical exams, but that doesn’t give your providers much information about your labor and what is going on.
Grab my tips to saying no to providers right here to help you out if you’re hoping to have less cervical checks:
Cervical Exam FAQ’s
Here are a few questions we get a lot about cervical checks:
Can cervix checks start labor?
They CAN but more often providers do what’s called a membrane sweep at a 39+ week appointment. That is where they place their finger between the cervix and the membrane. This is thought to sweep-up some hormones and irritate the uterus a bit to start labor (although studies are mixed on this).
Most often a simple vaginal exam won’t start labor, although if you are in perterm labor we try to minimize them as they may encourage more preterm labor.
Can I be dilated at 36 weeks?
Sure you can. In fact, if you had a baby recently there’s a chance your cervix never fully closed. You may have been 1 cm since then.
But, as I said above being 1-2 cm isn’t usually a huge deal. It doesn’t change much in your care.
AS I have said a cervical exam (also called a vaginal exam or pelvic exam) should mainly be done when it will change something in your plan of care, or you just really want to know. If neither of those is true you’re good to wait a bit longer.
That being said — there’s nothing wrong with wanting to know what your cervix is. If you really want to know you can always ask. While there can be a chance of infection the more frequent we do cervical exams, having one at an appointment isn’t much of a worry — so just ask. 🙂
There’s nothing wrong with WANTING a cervical exam, or NOT wanting a cervical exam — just letting us know helps us help you the best we can!
In The Online Prenatal Class for Couples we go through many of the difference choices you might have leading up to your birth. It really easily prepares you to make those choices with confidence!
Or, if you’re not quite ready for the full class, check out my free prenatal class — It’s your first step towards being your own birth boss.