Everyone talks about cervical dilation in labor, but did you know that there is more to the cervical exam than just dilation? The cervical exam is used to determine where you are in the labor process. The provider places two gloved fingers into the vagina to determine the cervix’s characteristics. The exam may be uncomfortable, but you can always tell your provider to stop if it is too painful.
Including dilation, the cervical exam consists of effacement, station, consistency and position. In the first phase of labor, all five components may be used. Once you are in active labor, dilation, effacement and station are likely the only things that will be assessed.
What does station, effacement, and dilation look like in active labor?
The non-laboring cervix, which is the opening bottom part of the uterus where it meets the vagina, is similar in shape to a mini doughnut. Effacement happens when the cervix begins to thin (the doughnut “flattens”). Dilation happens as the cervix starts to open (the center of the doughnut starts to open). Station is where the baby’s head (or bottom) is in relation to your ischial spine, which is a bony structure in your pelvis right above the sitting bones. As the baby drops down past the pelvis, changing the fetal station, the baby starts putting more pressure on the cervix. First-time birthing people generally efface before they dilate, while second-time-or-more moms often dilate before effacement. Either way, the cervix must be 100% effaced and 10 centimeters dilated before one can give birth vaginally.
What about the cervical exam in early labor?
A cervical exam without labor, or in early labor, may take more positioning, and may be more uncomfortable than one in active labor. This is because the cervix is often positioned posteriorly (toward the back), making it more difficult for the provider to reach. Your provider may ask you to sit on top of towels or your fists to bring your pelvis in a posterior tilt to reach the cervix easier. In addition to dilation, effacement and station, the provider will most likely be checking for cervical position and consistency. For example, a cervix that is anterior and soft often signifies that it is more prepared for labor than one that is posterior and firm. If you plan on inducing labor, the characteristics of the cervical exam will play a significant part in which medications your provider will recommend for induction.
As cervical exams are uncomfortable, it’s important to remember you can always ask your provider if the exam is necessary. Cervical exams are utilized to determine management in labor and induction, so if there is no decision that needs to be made at that moment, the exam may not be necessary. Just as with any interventions in pregnancy, labor and birth, your provider should engage in a shared decision-making approach, where you have all the information and time to ask questions before making a decision.
Reviewed by the Ovia Health Clinical Team
Sources
- “Cervical effacement and dilation.” MayoClinic. Mayo Foundation for Medical Education and Research, 2016. Web.
- Healthwise Staff. “Cervical Effacement and Dilatation.” UofMHealth. Regents of the University of Michigan, Nov 2011. Web.
