Ways to Assess Labor Progress without Checking the Cervix

Childbirth

Cervical exams, or checks, provide valuable information about labor. They tell us about dilation, how low the baby has descended, and how much the cervix has shortened. They can also help us determine the baby’s position and if the water has broken, among other things. That being said, cervical exams are not the only way to assess labor progress and there are alternatives to cervical exams during labor.

Why limit cervical checks during labor?

While cervical exams are an important tool, there are valid reasons when we might limit their use. These include:

• Increase risk of infection: Each vaginal exam introduces a hand into the vaginal canal which has the potential to increase the chance of infection.

• Discomfort and disruption: Many birthing people find cervical checks uncomfortable or even painful, and they can be frustrating when not much progress has been made. 

• Emotional impact: We know that one in three women have experienced sexual abuse or sexual assault. For survivors of sexual trauma, a vaginal examination 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 prioritize physiological birth. The goal of our management is to keep labor and birth as low intervention as possible, while respecting the birthing person's comfort and safety. 

Cervical checks can provide valuable information and they absolutely have a role to play, but there are other ways to assess labor progress. We like to use all of our senses, and not just our hands, to monitor labor without looking at the cervix.

How to Assess Labor Progress With Other Monitoring Tools

Let’s explore some of the ways to monitor the stages of labor, from early labor to active labor, without cervical exams. These methods use physical signs of labor and other tools to assess how labor is unfolding. 

It’s important to note, however, that 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 how to monitor labor naturally.

1. Contraction Patterns

As labor progresses, contractions generally become longer, stronger, and closer together. Monitoring the frequency, duration, and intensity of contractions are important signs of labor progress.

2. Behavioral Changes

Early labor is often marked by a laboring person who can talk between contractions, engage with their surroundings, and even find humor in the moment. As labor intensifies, they may become more inwardly focused and less communicative.

3. Sounds During Labor

Listening to the sounds a laboring person makes can reveal where they are in labor. Early on, they may speak or breathe through contractions. Later, sounds often shift to moans or guttural tones as they work through each wave.

4. Physical Positioning

Changes in how the laboring person positions their body can signal progress. For example, they may instinctively adopt positions that help open the pelvis, such as lying on their side with one leg elevated or hands-and-knees positions.

5. Appearance of the Purple Line

A purple, red, or brown line often appears along the crease of the buttocks as the baby descends into the birth canal. This line can serve as a visual marker of labor progress.

6. Bloody Show

The presence of red or pink mucus, known as “bloody show,” often increases as labor progresses and the cervix dilates. 

7. Urge to Push

The sensation of intense pressure in the rectum, accompanied by involuntary grunting, is a sign that the baby’s head is very low and the birthing person may be entering the pushing stage.

8. Emotional and Mental State

Birthing people often have feelings of self-doubt during transition – the final phase of active labor. Statements like “I can’t do this,” can indicate that the birth is near. 

A Glimpse Into Labor Without Cervical Exams

Now that we’ve covered our midwife tips for how to assess contractions and labor progress, here’s an example of what this might look like during labor.

8:00 PM: The laboring person is cheerful and talking in complete sentences between contractions. They might laugh, make lighthearted remarks, and even give instructions like, “Take the lasagna out of the freezer that I made for after the birth!” 

Contractions require some focus, but they’re manageable. When they go to the bathroom, blood begins to appear on their toilet paper when they wipe. They’re able to eat and drink a small amount. 

4:00 AM: The birthing person is now laying on their side with one leg hiked up, supported by pillows. They’re not interested in talking, and when they want a sip of water, they simply say, “Water.” They might be 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 are completely inwardly focused, unable to do anything else but ride the wave. Bloody show has increased, and the purple line may be visible on their bum. They might have small bites of food and sips of water, but nothing more.

11:00 AM: They’re shaking, possibly vomiting, and saying things like, “I can’t do this. I really can’t do this.” They may appear wild-eyed and completely absorbed in the intensity of the contractions. They often need to squint their face or bare their teeth to powerfully force out sound that matches the intensity of the contraction they’re feeling. 

The purple line, if they have one, is now visible on their back, and they may have trouble drinking more than small sips of water. Soon, they’ll 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’ll be ready to start pushing and their baby will be born. 

Balancing Natural Signs with Medical Tools

Every labor is unique, and while natural signs can provide significant insights, there are times when cervical checks or other tools may be necessary while assessing labor progress with a midwife. These decisions ultimately depend on the birthing person’s preferences and the midwife’s assessment of safety and potential complications. By understanding the alternatives to cervical exams, you can better advocate for the labor experience you want.

Related: Fetoscope Tool

Embracing Empowered Birth with Hearth & Home

We hope this guide has offered helpful insights into the various ways to assess labor progress naturally. Whether you’re planning a pregnancy or preparing for birth, knowing your options empowers you to create a birth plan that aligns with your values. 

Remember, labor is a journey, and every step is as unique as the person experiencing it. Trust your body, trust your midwife, and know you have the tools and support to navigate this transformative journey. Contact us to schedule a consultation.