When your due date is rapidly approaching, and medical appointments are as frequent as once a week, a cervical exam is considered a routine medical procedure, but is it really? A cervical exam, also known as a vaginal exam or cervical check, is the insertion of fingers into the cervix in an effort to estimate a patient’s effacement and dilatation. This intervention will occur multiple times throughout your labor, and many women request them, believing that they are an accurate measure of her progress. We are in a climate in which data determines the direction and progress is the goal. But your dilation can’t be Googled. We want to know, “Am I progressing?”
A harmless procedure and valuable data? No and No.
Fact: Measuring the dilation of a cervix is a very poor indicator of birth progress. (Downe et al.)
Cervical exams are frequently performed during labor item to verify a woman is not laboring abnormally slowly, which may lead to neurological problems in the baby. (Downe et al.) The periodic exam has a direct impact on the patient by interrupting the physiological process of birth, can be sometimes painful, and triggers a hormonal release of adrenaline. Adrenaline directly interferes with the release of oxytocin, the hormone necessary for contractions. The expected mammalian response to this distress is for labor to stall or stop completely (Ashworth). The laboring woman is then labeled as having “failed to progress,” and begins the “Cascade of Intervention”: Pitocin, epidural, forceps or vacuum delivery, and cesarean section birth.
A specific and problematic aspect of Cervical Exams is that it is uncommon for any provider to ask for consent prior to these checks, and the procedure is not required. Many women find them to be uncomfortable, intrusive, even painful, and for victims of abuse, the exam triggers a traumatic response. (Sobel et al.)
Cervical exams have an inherent risk of bacterial infection, as well as infection to the reproductive tract (“childbed fever”) (Maharaj, WHO). These postpartum infections are among the leading causes of maternal mortality rates worldwide, accounting for 10% of maternal deaths (Say et al.). Given the fact that maternal death is on the rise in the United States with the HIGHEST maternal mortality rate in the entire developed world (Kassebaum et al.), there is a strong correlation that frequent vaginal exams are a direct cause of maternal deaths. Additionally, newborns are 4.5x more likely to contract neonatal sepsis when 7 or more vaginal exams are performed on the mother. (Sebitloane et al.)
Informed Consent means you are made aware of the risks before a procedure, and it is not performed unless you consent to it first.
Were you informed of the risks prior to being examined during your birth? Tell me in the comments below.
“If a vaginal examination is not a good measure of progress, there is an urgent need to identify and evaluate an alternative measure to ensure the best outcome for mothers and babies.”
(Downe et al).
REFERENCES
Downe, S, et al. Routine Vaginal Examinations in Labour. www.cochrane.org/CD010088/routine-vaginal-examinations-in-labour.
Ashworth, Emma. “Vaginal Examinations in Labour.” AIMS, 2017, www.aims.org.uk/information/item/vaginal-examinations-in-labour.
Maharaj, D. “Puerperal Pyrexia: a Review. Part I.” Obstetrical & Gynecological Survey, U.S. National Library of Medicine, 2007, pubmed.ncbi.nlm.nih.gov/17511893/.
WHO Recommendations for Prevention and Treatment of Maternal Peripartum Infections. Human Reproduction Programme, World Health Organization, 2015.
Sebitloane, HM, et al. “Prophylactic Antibiotics for the Prevention of Postpartum Infectious Morbidity in Women Infected with Human Immunodeficiency Virus: a Randomized Controlled Trial.” American Journal of Obstetrics and Gynecology, U.S. National Library of Medicine, 2007, pubmed.ncbi.nlm.nih.gov/17997391/.
Kassebaum, N, et al. “Www.thelancet.comVol 388 October 8, 2016 1775ArticlesGlobal, Regional, and National Levels of Maternal Mortality, 1990–2015: a Systematic Analysis for the Global Burden of Disease Study 2015.” The Lancet, 2016, www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)31470-2.pdf.
Bell, S, et al. “Pregnancy and Childbirth After Sexual Trauma: Patient Perspectives and Care Preferences.” Obstetrics and Gynecology, U.S. National Library of Medicine, 2018, pubmed.ncbi.nlm.nih.gov/30399100/.
