Checking the cervix


Shieva Ghofrany: [00:00:00] Morning team. It is Sunday morning. I'm actually about to sh to do a podcast with a friend who invited me to be on her podcast, which is always fun. And I have like six minutes. So I am going to talk about cervical exams because a lot of people ask, do I need a cervical exam? Why do I need a cervical exam? 

And someone actually recently asked, am I legally allowed to decline a cervical exam? So I'm gonna separate these a little bit into two D. times, you would have a cervical exam in pregnancy. Okay, so one is towards the end of the pregnancy. Let's say you're 35, 36 weeks. I don't like to say old-fashioned, but for lack of a better world word. 

The old-fashioned times, women were checked weekly, starting at 35 or 36 weeks to see if they were dilated. Okay. I think maybe people didn't know better. I don't know. , actually, I really don't know the history of the teaching there. Um, but many of us, and I will speak for myself and the [00:01:00] doctors in my practice don't do that anymore. 

Meaning we do not do routine cervical exams after 35 or 36 weeks for patients. Now, are there some doctors who still. Probably yes, in fact, for sure. Yes, I hear it. And I don't wanna say that they're being old-fashioned or they're doing anything wrong. I'm merely gonna say my thoughts on this. My thoughts are that many of us are taught in medicine to only do something that will change the course of action next, right? 

I should do a test. I should do some intervention that is necessary, not only to either improve care or to be able to alter eye care. So let's say I check your c. At 36 weeks or 37 or 38 or 39, or literally on your due date or a week past your due date, . Here's what I can tell you. Are you dilated? Are you effaced? 

Which is how soft? Where is your cervix? Is it very far forward, which is what will happen closer to labor? Or is it still super far back behind, like kind of closer to your sacrum? How [00:02:00] high is the head? And I can glean a little bit of information about your pelvis and kind of the shape and maybe the space of your pelvis, but does any of that. 

When you're gonna go into labor, or if you're gonna deliver vaginally even, I would say no. And maybe yes, no, meaning I could check you today on your due date or a week past, and you could be three centimeters dilated and not go into labor. Or today, at 36 weeks, you could be walking around two to three centimeters dilated, especially if it's your second baby and not go into labor for weeks. 

or I could check and say, oh, your cervix is rock hard and closed. And really far away and really far back, which are terms we use. And guess what? You break your water that night or you go into labor that night. So there's nothing. from a temporal relation. There's no predictive ability from checking a cervix to tell you when you're gonna go into labor. 

Now, the caveat would be like if you're contracting, contracting, and I check you and I [00:03:00] say, oh, it feels like you're just still, let's say two to three centimeters and 80% thinned out, you're probably still in early labor. and you're going to end up going into labor in the next several hours. But even then, I give patients a span. 

I'll say like in the next one to two days, things might progress. Sometimes it's next hour they come back to the hospital or to my office, and other times it's literally two or three days. So again, to me and to many of us, there is no value in checking your cervix weekly because it's not going to help predict. 

sometimes at 36 weeks because we do the beta strep culture, that vaginal perineal culture that we do to see if you have that beta strep bacteria at that point, because you're already there. Sometimes patients will say, Hey, are you gonna check me? Or sometimes the doctor might offer, I actually don't usually even offer. 

I usually say, I'll check if you want, but by the way, You're probably not gonna want me to check you more than once because it's very uncomfortable and it doesn't help predict. And honestly, most patients don't even know that cuz I haven't had the time to have this conversation with every single patient and many patients, especially [00:04:00] if they're there with their moms. 

Back in the pre covid days when moms used to come in for a lot of the visits, the moms would say, you mean you're not gonna check me every week? You're not gonna check my daughter every week. And I would always kind of retort, well, tell me what happened when you got checked. 99% of the time the moms would say, you know, you're right. 

They checked me that. And said I was closed and I went into labor that day, or they checked me and said I was three centimeters dilated, but I walked around that way for four weeks. So again, there is no value in the absence of labor or bleeding or some other reason that we need to check you. There's no value in just routine cervical checks prior to you actually needing them when you're in labor because it doesn't help predict. 

Now, what about your. Didn't they used to do assessments of the pelvis to see if someone could deliver a baby? Well, yes. They used to actually do clinical PVI imagery, which is where they would have different ways of measuring, or X-ray pvi imagery where they would actually x-ray a woman's pelvis to do these measurements to try to predict if the head was gonna come out. 

As you might guess, it wasn't found to be so accurate. [00:05:00] I've definitely had times, not frequently where I'll check someone's pelvis. , ain't no baby coming outta that pelvis lo to hold two days later. That woman is pushing out a kid, right? On the other hand, I would say most of us clinicians who've been in practice long enough can generally assess like, what do we think is gonna happen? 

We're not always right, but we're probably close to right? If we feel a very kind of contracted pelvis with a certain shape, um, or if the baby's head is incredibly high up and not even close to the. Yet we've all seen that dirty labor things can change because of the effect of the hormones on all the ligaments. 

So again, do you need a cervical exam? In my humble opinion, prior to being in labor, no, you don't save four. If you'd like to know, save four. If you have bleeding or we think you're in early labor, or if we're trying to predict what medications we might use when you are going to be induced, then it might be valuable to do before you actually go to the hospital for the in. 

Those are the times I would say you need it now, do you have the right to decline? Of course. I mean, you always have the right to decline [00:06:00] though. I guess I would offer like think about why you're declining. Meaning are you, is your doctor saying, I really think I need to check you because you've had X, Y, Z symptoms, in which case you're kind of asserting your right as the patient to decline. 

I would personally say maybe that's not wise. Now, if you feel that your doctor's being aggressive and just doing something for no. Then forget declining. That is a reason to go see a different doctor. That's a completely different story, but yes, the answer is you always have the right to decline. It is your body, and you get to choose what you need. 

Now, what you need is not something you always know. So appreciate the fact that you should have a collaborative relationship with your doctor before you just kind of decline, right? If you have that type of relationship where you feel like you have to assert your need to decline, then I would suggest finding a different practitioner. 

More than continuously thinking about your ability to assert the declination. Does that make sense? Okay. What would be another time to check? Let's say you're close to the end, like you're 39 weeks and you would like to have your membranes stripped. . That is something, some people [00:07:00] call it membrane sweeping. 

Membrane scraping, which I hate the word or membrane stripped, which just basically means if the cervix is a little bit open, the doctor over nurse or mid midwife can put her finger inside. On the other side of that cervix is the membrane, the amniotic membrane, the balloon in, the baby's in, and we can push our finger there and this gently kind of push away and essentially detach where the balloon, the. 

Is attached to the inside of the uterine wall, and by gently separating that just a couple of, you know, millimeters or a centimeter or. L like in that circumference around there, you're not particularly stretching the cervix out. You're pushing away the membranes and detaching them from where they are attached to the uterus that releases prostaglandin. 

And prostaglandin is the hormone that can help put you into labor and stimulate your cervix to thin out. So that can be one form, just like nipple stimulation or bowel stimulation of actually getting you into labor. Okay, I hope that helps. Happy Sunday.