Ways to Assess Labor Progress without Checking the Cervix
Cervical exams, or checks, give us three major pieces of information: how dilated the cervix is, how low the baby is, and how much the cervix has shortened. It can also help with knowing baby’s position and whether the bag of water has broken or not, among other things.
Reasons to limit a cervical check include: increased risk of infection by putting a hand in the vagina, discomfort, disruption to the labor progress, and frustration when not much progress has been made. We know that one in three women have experienced sexual abuse or sexual assault, and vaginal exams for those people can be re-traumatizing and stall labor or make the experience of labor harder. For us, that is sufficient reason to be mindful of limiting exams when possible. As home birth midwives, we value physiologic birth and the goal of our management is to keep labor and birth as low-intervention and the birthing person wants and safety allows. Cervical checks can provide valuable information and they absolutely have a role to play; however, there are other ways to assess labor progress and we like to use all of our senses to determine progress- not just our hands.
Let’s walk together through a labor where no vaginal exams are performed to check progress. Every labor is different- not everyone does these things, and some people like having the information a cervical check provides- but here’s an idea of what it might look like without an exam.
Imagine at 8:00pm a laboring person is talking in complete sentences between contractions. They might be finding humor in things, feel excited, and stay aware of what’s going on in the room. It’s not uncommon at this stage to hear a birthing person say something like, “Take the lasagna out of the freezer that I made for the after the birth!” They are focused when the contraction comes, and take a moment to quietly ride the wave, but in between they are more or less themselves. Each time they go to the bathroom, they have a small amount of “bloody show” on their toilet paper, which looks like red mucous when they wipe. They are able to eat and drink a small amount.
At 4:00am this same person is laying on their side on the bed with one leg hiked up supported by pillows. They are not interested in talking, and when they want a sip of water, they simply say, “Water.” They might be a irritated by certain kinds of touch but really want counter-pressure on their sacrum or another part of their pelvis. When a contraction comes, they moan powerfully and completely inwardly focused, unable to do anything else but ride the wave. They are so challenged by the physical task that they are no longer interested in engaging with the room. When they go to the bathroom, there is more bloody show on the toilet paper and in the toilet bowl. They may have begun to have a purple, red, or brown line on their bum that is visible to those behind them. They might have small bites of food and sips of water, but nothing more.
At 11:00 am, this person is shaking and saying, “I can’t do this. I really can’t do this.” They are starry-eyed and wild, behave somewhat like someone who is using hallucinogenic drugs. Contractions continue to come every 3 minutes or so, and they last a long time. During the contraction, they moan powerfully, focusing hard to keep from crying out. Often, they need to squint their face or bare their teeth to powerfully force out sound that matches the intensity of the contraction they are feeling. The purple line, if they have one, is now visible on their back. They may vomit and have trouble drinking more than small sips of water. Soon, they will start to introduce a grunt to the noise they make during the contraction involuntarily. They share that they have a feeling of immense pressure in their bottom- like they need to have a bowel movement immediately. This is the urge to push, and it means that their baby’s head is very low and likely the cervix is completely dilated or almost dilated. Soon, they will be ready to start pushing and their baby will be born.
Every body is different, and every baby is different. Therefore, every labor is different. We can’t always rely on these signs to assess progress, and sometimes cervical checks are necessary because they help the client make informed decisions about what they want to do and help the midwife suggest interventions might be helpful or necessary. That said, they are NOT required in many labors. We hope this has been educational and, if you are planning a pregnancy or are having a baby soon, we hope this helps you advocate for what the kind of birth you want.
Charli & Sarah
Photo credit: BonJu Fotografia