Do I Need to Have Cervical Exams in Late Pregnancy?

So, you really hate the cervical exams during pregnancy. What happens if you just say, “no?” In most cases, the short answer is nothing. Keep reading to learn more about what cervical checks are, when cervix checks start during pregnancy, and if you really need them.

What Is a Cervical Check?

A cervical check or exam is typically one part of a pelvic exam done by a medical professional to check the health of your reproductive parts. But during pregnancy, it can help the doctor check for cervical effacement (thinning) and dilation (opening) as well.

According to the American College of Obstetricians and Gynecologists (ACOG), a doctor will examine the internal organs, including the cervix, by inserting two lubricated, gloved fingers into the vagina and pressing up toward the cervix. They can feel the cervix and determine what stage of effacement or dilation it is in and whether or not interventions are needed in instances when the cervix is dilating too early.

Are Cervical Checks Necessary?

As long as you’re not having complications that suggest premature labor, infection, premature rupture of membranes (PROM), heavy bleeding, or some other issue, you can skip the uncomfortable exam.

Internal exams aren’t absolutely necessary, says Catherine Harth, MD, an OB-GYN and associate professor of Obstetrics and Gynecology at the University of Chicago. Often, they don’t tell us all that much—and they don't indicate when labor is going to start. They’re usually just a progress report of what the cervix has done so far, and they do come with some small risks. That said, sometimes they're helpful, she says.

When Do Cervix Checks Start During Pregnancy?

If your medical provider performs them as part of routine prenatal care, cervical checks can start at your first prenatal visit, but most commonly, they occur throughout pregnancy and postpartum to monitor the health of your pregnancy and your reproductive parts. Here are three times during late pregnancy when you can expect to have cervical checks:

• Late pregnancy: Cervical checks around week 36 will look for group B strep (GBS), which can be a serious infection if passed to a newborn during birth.
• During labor: During the first stage of labor, cervical checks can happen as often as once every two to three hours to check dilation progress.
• 6-week postpartum: Your doctor will perform a pelvic exam that includes a Pap test and cervix check during your 6-week postpartum visit, even if you've had a Cesarean section.

When Are Cervical Checks Recommended in Late Pregnancy?

There are some situations where it’s useful to know if a patient’s cervix is getting ready for labor, says Dr. Harth. One situation when a check might be helpful: When a pregnant person's water breaks, but they're not having contractions and their group B strep test was positive.

We'll want to know what the cervix was like at their last doctor’s visit, Dr. Harth explains. "If [the] cervix was already dilating, we might want [them] to come into the hospital for antibiotics sooner than later. If it was still closed, we might not need to rush,” she adds.

In general, however, expert opinion is mixed on whether or not these exams are needed. “There’s been some debate in the medical literature though about the utility of doing cervical checks in the last weeks of pregnancy. If the patient is healthy, we know the baby’s head is cephalic [presenting head first in the birth canal], and it’s not going to change how we manage care, it’s not absolutely necessary,” says Dr. Harth.

What Are the Risks?

Cervical exams are generally safe when performed by a medical professional. But even the safest exams are not without risk. Studies have shown that cervical exams during pregnancy can introduce the risk of chorioamnionitis, which is an infection of the placenta and the amniotic fluid. The risk increases as the number of exams increases. Pregnant people who underwent eight or more cervical checks were 1.7% more likely to develop an infection than those who had one to three exams.

Doctors and researchers have long known the potential consequences of chorioamnionitis, which can lead to complications including premature birth, meningitis, pneumonia, brain damage, and death, making excessive cervical checks not worth the risk.

Should I Decline a Cervical Check?

Some pregnant people don’t mind the internal exam and may even like the updates. These people might hear that their cervix is softening and dilating and feel hopeful that the end is in sight. Or it might help them to feel like their body is doing what it’s "supposed" to.

Unfortunately, the news isn’t always encouraging. You might feel discouraged and anxious if you’re a week overdue and your cervix is tightly closed and showing no signs of opening soon. So, if you're not a fan of cervical checks, tell your provider. If they insist, ask why they want the information and how it might (or might not) change your care.

If you choose to decline a cervical check—or any medical procedure, for that matter—it is wise to ask your doctor about the benefits and risks of the procedure you are declining and to discuss alternative options available to you.