Cervical Checks During Pregnancy: Is it worse than labor?

If you’ve had a cervical check by your provider and you found it extremely painful you are not in the minority.  Lots of people find cervix checks painful and wonder if they will be able to tolerate labor of the check alone was that bad.  Today we’re going to talk bout the pain of cervical checks, and how it differs from the pain of labor!

Before we get started on this tricky subject, let me introduce myself! Hello, I’m Hilary — The Pregnancy Nurse® — where we aim to prepare you from bump to bassinet! I’ve been a nurse since 1997, and I have 20 years of labor and delivery experience. I’ve checked THOUSANDS of cervixes and I am a great resource for you on this one.

Oh, and I’ve had 3 kids of my own, and I HATED exams early on, so I have some great tips for you!

Are cervical checks more painful than labor?

For a variety of reasons, early cervical checks can hurt quite a lot.  However, the pain is very different than labor pains.  Most (but not all) would say that labor is more intense, and painful than a cervical exam.

Let’s talk more about why it hurts so much and how the pain compares with labor….

Why do cervix checks hurt so bad?

Early cervical checks can be quite painful.  As an educated guess — here is why:

• Doctors tend to be less gentle than nurses or midwives (could be biased here, but I don’t think so)
• Sometimes they strip your membranes (but don’t tell you they’re going to)
• Your cervix may be posterior where they have to reach further back
• Lack of lube (in labor you’ll produce more of your own)

I also find that you may be hopeful that labor will be soon, only to find out that your cervix is closed and not ready for labor at all.  Those first cervix checks can be disappointing if you are hoping labor will start soon.

A lot of cervical checks hurting is the unknown, and fear.  So I really recommend getting educated and prepared about pregnancy and birth so you remove the unknown from the picture.

I have a whole post on if you can refuse cervical exams, but you really only need to get a cervical check if you find it will be worth while and may change your plan of care (or are curious, and that’s fine too). Also, sometimes people find that they are still in pain after the cervical exam (and I explain why in that post).

But, here’s the real good news:

Later Cervical Checks Don’t Hurt As Much

This is again, for a variety of reasons — but the main one is that most often your cervix moves more forward as baby progresses into the birth canal and you dilate.  Meaning that cervical checks during labor aren’t as painful.

Labor nurses are often more gentle with exams and explain things better (you may also feel more comfortable with them as they are a younger woman who maybe spend more time with you and educate you more than a doctor).

Also, once you’re into labor you’ll find that the pain of the contractions (your labor pain) outweighs what you feel going on in your cervix.

For all these reasons (and likely other reasons) people find them less painful (I’ve had many patients express this to me).

Are cervical checks the same as painful labor?

No.  Cervical checks tend to be a sharper, shorter pains (although you may cramp afterwards).  Labor is a cramping, more generalized-pain (that may include areas of your whole body) that is long-lasting and does not go away until baby is born.

While some people say that those early cervical exams were worse than labor, they are talking about that short sharp pain that happens with the exam.  However, most people don’t find this to be true.

How do they check your cervix?

Your provider will wear a sterile glove (I have heard some providers just use a clean glove outside the hospital, which is fine as the vaginal area isn’t sterile), will put some lube on their fingertips and then insert them into your vagina.  At that point they are feeling for your cervix, so they can measure it and assess it with their fingers.

Most often this procedure is done on your back as your provider is best able to assess all the things while you are in that position.  However, as you get into labor and pushing they can do it in a variety of birthing positions.

Why do they do cervical exams?

Great question.  Most often they do a cervical exam to check for dilation (measured in centimeters), effacement (given as a percentage) and how far the baby is into the birth canal.  They may also be able to assess the position of the baby. I have a whole post on the signs of dilation.

Pro tip: Your provider may do vaginal and speculum exams for other things like STD testing or pap smears. While they may feel similar, they are different and for different purposes.

Sometimes these exams are done routinely (aka, one at your 36 week check-up) that aren’t really necessary, but the doctor has just gotten into a pattern of doing them at that point, or the hospital expects providers to check a cervix every couple hours or so.

I do find that these “routine cervical exams” are fading away as people state that they’d prefer not to have them.  Just remember that some patients want to know what their cervix is and do not find them that painful, so always be sure to communicate with your health care team clearly so they can help you have the best birth for you (because everyone is different).

During labor we need to figure out how far along you are, check your labor progress, see if you’re in active labor (where your cervix is actively dilating) to prepare for delivery or alert your provider. 

There can also be issues with the baby’s heart rate that should initiate a cervical exam to make sure the cord hasn’t fallen out or that there are other issues.

If you are planning on an induction of labor, your health care provider will need to check your cervix to use the right medication for where your body is at then.

A cervical exam by a trained provider can tell you a lot about labor’s progress, or lack of progress. They are an extremely valuable tool in your provider’s toolbelt of getting you the best birth possible.  In their assessment, they’re looking for:

• Cervical Dilation: How open the bottom of the uterus (called the cervix) is as the baby is pushed out of the uterus
• Effacement: To efface means to thin out, so this measures how thick or thin the cervix is.
• Station: How high or low the baby is in the birth canal (measured against your sit bones)
• Consistancy: How soft or firm your cervix is
• Placement: Is the cervix in the back or the front of the birth canal
• Baby’s position: Is baby head down, and if so which way are they facing (this can only be done if the cervix is either very thin or opened enough for the provider to feel baby’s head)

I talk about it more on my post on vaginal exams.

Is there a downside to cervical checks?

Well, as we’ve stated — many people find them quite painful.  Your experience with a medical procedure is a big part of why we don’t do them as much.  Things like IV’s, NG tubes are often not placed because we know they are painful to patients.  So, this should not be ignored.

Pro Tip: If you find cervical exams very painful please do talk with your provider.  In some cases that can be a sign of an issue, and at the very least they can help you tolerate them better (or do less of them).

There is also a risk of infection with a cervical exam.  You are pushing the bacteria in the birth canal up towards the cervix.

How do you relax when getting your cervix checked?

I have written a full post on painful cervical exams, and I have gotten a lot of great answers in that article.  My top three are:

Relax:  This is so much easier said (or typed) than done.  It is really hard to relax an area that is experiencing more pressure and pain than it has previously.  But, the more you can relax, and not tense up the better off you are.

This is NOT the time to do a Kegal!  Many prenatal classes (including my own) encourage people to practice NOT tensing up their pelvic floor to aid in a great delivery and I would encourage you to do that as well.

Hips Down: When you lift your hips up it gets harder for the provider (and tenses your pelvic floor).  I would encourage you to keep your hips on the table.

Pro Tip:  If your provider is having a hard time reaching your cervix you can place your fists under your bum to raise your pelvis up a bit (while keeping your pelvic floor relaxed).  In the hospital I often put people on a bedpan if their cervix is very far back.

Wiggle your toes:  Go ahead wiggle your toes right now.  It’s almost impossible to tense up your pelvic floor while you’re wiggling your toes.  Many people in the comments on that post said they were concentrating so much on wiggling their toes it made the exam so much faster, so it’s a great tip!

One other way that a LOT of patients use is to get an epidural.  Many people feel great relief over the fact that they can not tolerate cervical exams with ease.  If you find a cervical exam very painful you may want to consider getting an epidural.  You can use IV pain medications, but they only take the edge off.  I’m not saying you’ll NEED to get an epidural, but it is something to consider (and likely learn about so you’re not afraid of the epidural also).

Learning to manage pain both with exams, and during labor can be a huge asset to your toolbelt during labor. I include lots of tips and techniques in the natural pain management bonus video in here.

If there is ANYTHING your labor and delivery nurse can do to make exams more painful I can guarantee they are interested in helping you feel the best that you can, so just be sure to talk with them about what helps you during a vaginal exam.

If you’re reading this article you may be very interested in what labor is going to feel like. We talk all about what to expect and what you’ll feel in The Online Prenatal Class for Couples — plus, will give you lots of great coping techniques to handle it all. Come join me!

Or, if you’re not quite ready for the full class, check out my free prenatal class — It’s your first step towards being your own birth boss.