A cervical check, often called a vaginal exam during labor, is a procedure used to determine how far labor has progressed. It involves a healthcare provider inserting one or two gloved fingers into the vagina to manually assess the cervix. Discomfort experienced during this procedure is a common and valid concern for many patients throughout labor.
What is the Purpose of a Cervical Check?
The primary reason for performing a cervical check is to gather information about the status of the cervix and the baby’s position in the pelvis. This assessment helps the care team make decisions about the progression of labor and the need for possible intervention.
The provider measures three main characteristics that indicate readiness for birth. Dilation is how open the cervix is, measured in centimeters (cm) from zero to ten. Effacement describes the thinning and softening of the cervix, measured as a percentage from zero to 100%. Lastly, the provider checks the fetal station, which indicates how far the baby’s presenting part, usually the head, has descended into the pelvis.
The Direct Answer: Dilation and Pain Sensation
The assumption that the cervical check becomes less painful with increased dilation is generally true, though the relationship is not linear. Pain is often most pronounced during early dilation, specifically from zero to about four centimeters. This early stage requires the provider to stretch a thick, relatively firm cervix that is highly resistant to opening.
As labor progresses, the cervix dilates and the tissue becomes thinner through effacement. By the time a person reaches late active labor (around eight to ten centimeters), the cervix is nearly 100% effaced, meaning it is thin or barely present. Since the provider’s fingers encounter minimal resistance or tissue to stretch at this point, the physical mechanism causing discomfort is significantly reduced.
Other Factors Influencing Discomfort
While dilation plays a major role, the degree of pain is not solely determined by how open the cervix is. The position of the cervix is a significant variable; it often starts high and posterior (tilted backward) before labor. When the cervix is posterior, the provider must apply more pressure and reach further back, which is more uncomfortable than when the cervix has moved to an anterior (forward) position.
Effacement and fetal station also contribute to the patient’s experience. A highly effaced and soft cervix may yield to the exam more easily, even if not fully dilated. If the baby’s head is still high in the pelvis (a negative station number), the provider must reach deeper, increasing the feeling of internal pressure. The specific technique used by the examiner, including speed and lubrication, also influences the patient’s sensation of pain.
Techniques to Minimize Discomfort During the Exam
Patients have several ways to proactively reduce the discomfort associated with a cervical check. The first strategy is to focus on relaxation and deep breathing, which helps prevent the pelvic floor muscles from tensing up in response to anticipation or pain. This focused breathing can help regulate heart rate and divert attention away from the procedure.
Communication with the healthcare provider is also beneficial. The patient can request a change in position to make the cervix easier to reach; placing a fist or small object under the hips can slightly elevate the pelvis, making the cervix more accessible. Patients can also request that the provider pause or stop the exam entirely if the discomfort is too intense.