Can You Refuse Cervical Exams with Nurse Chantel — Episode 139

Can or should you refuse cervical exams in labor. What can you do to communicate your needs, but also do the things your body needs to have your baby.

Today’s guest is my friend Chantel. She’s been an OB nurse for 5 years, and is one of the kindest nurses I know. 🙂

This episode was inspired by my post on refusing exams.

Big thanks to our sponsor The Online Prenatal Class for Couples — if you’re looking for someone to help you simplify labor, this is the class for you, and it can be done in just three hours!

In this episode

Why you might want to refuse exams.

Why we need to check your cervix

Things that influence how often we check

What to do when you’re not wanting exams

Times you really need to be checked.

Other things that might interest you

Understanding exams in labor

True Labor Contractions

Painful Cervical Exams

What you can refuse during labor

Refusing cervical exams in pregnancy

Refusing routine things in labor podcast episode.

Producer: Drew Erickson

Check out my other pregnancy podcasts:

Transcript

[00:00:00.130] – Hilary Erickson

Hey, guys, welcome to the Pulling Curls Podcast. Today on episode 139, we’re talking about a hot topic on The Tikkity-Tok. We’re talking about if you can refuse cervical exams, let’s untangle it.

[00:00:22.230] – Hilary Erickson

Hi, I’m Hilary Erickson, the curly head behind the Pulling Curls Podcast where we untangle pregnancy, parenting, home, and even travel. We know there’s no right answer for every family, but hopefully we can spark some ideas that will work for yours. Life tangled just like my hair.

[00:00:44.350] – Hilary Erickson

Okay, before we get started, leave a review. I am giving you the actual information, not like all the controversy on TikTok, so just leave a review in support of actual information. Thank you.

[00:00:55.710] – Hilary Erickson

Today’s guest is my friend Chantel. We used to work together at the same hospital. She is an excellent nurse and honestly one of the kindest nurses that I’ve ever seen practicing. So I thought she was a great choice for this episode because she will bend over backwards to give you the labor that you want. I’ve seen it time and time again.

[00:01:16.250] – Hilary Erickson

Do you feel prepared for your delivery? In just three short hours, you can be prepared for the confident, collaborative delivery you want. You’ll know what to expect and how to talk with your health care team. And there are no boring lessons in this class. I’ll use humor, stories from my 20 years in the delivery room to engage both of you. I love how Alyssa told me that she found herself laughing at things that used to sound scary. Most of all, you guys are going to be on the same page from Bump to Bassinet. Join the online prenatal class for couples today. You can save 15% with coupon code UNTANGLED. You can find the link in the show notes.

[00:01:51.630] – Hilary Erickson

Hey, Chantel, welcome back to the podcast.

[00:01:54.060] – Chantel

Hey, Hilary, how are you?

[00:01:55.580] – Hilary Erickson

I’m so good.

[00:01:56.660] – Chantel

Good.

[00:01:57.100] – Hilary Erickson

This is such a hot topic on The Tikkity tok.

[00:02:00.020] – Chantel

It really is.

[00:02:01.080] – Hilary Erickson

Which is funny because it was not a hot topic as a laborer nurse.

[00:02:04.830] – Chantel

No. I mean, I know no one likes to have their cervix checked, but I’m surprised it’s gone this far on TikTok.

[00:02:12.460] – Hilary Erickson

Yeah. So everyone that’s listening, you need to take a step back and realize that Tik Tok is not real life, isn’t it? I thought it was the things that people go crazy about on there. I’m just like, I don’t get it. I do not get it. But whatever.

[00:02:30.610] – Chantel

No, really, I do agree. It’s funny how much gets out there on certain topics. And I’m like, that’s not the most important thing to worry about.

[00:02:38.940] – Hilary Erickson

Right. And before we get started, I want to say that Chantel and I 100% understand that this could be a huge issue for people. And we’re not saying that we’re not, like, minimizing you or that you don’t want to have a vaginal exam or you’ve had a history of abuse or anything like that. We’re just saying what’s most practical and safest for you. In the hospital. That’s what we’re talking about today, right? Correct.

[00:03:00.410] – Chantel

Yes. Always about safety. And we’re very understanding people. We get it. There are going to be circumstances where you don’t need to be checked.

[00:03:08.650] – Hilary Erickson

Yeah.

[00:03:09.030] – Chantel

And there are going to be somewhere you do need to be checked.

[00:03:12.200] – Hilary Erickson

And I’ve had patients that have asked me every hour, can you check me again? Can you check me again before your water is working? I’m like, fine, whatever. But after your water is broken, we don’t want to check you that frequently. And I’d be like, can we go 2 hours maybe?

[00:03:25.930] – Chantel

Yeah, that or until you start having more pain or your baby is showing me signs on the strip that something’s changing, those sort of things. Yeah.

[00:03:35.690] – Hilary Erickson

It definitely goes all different ways. Some people want to be checked frequently, some people don’t, which is fine. That’s how it works, correct? Yeah. Okay, so cervical exam, let’s say, what is it for? Because I think a lot of people probably have no idea. We’re just like sticking our hand up there and into a nebulous spot for them because probably other people haven’t stuck their hand in that spot themselves or if they did, it really is a nebulous spot.

[00:03:59.010] – Chantel

Yeah. It can be very hard to find sometimes. I’m always impressed when people try to say it. I think I was this. I don’t know. Have you ever had anyone try to check their own cervix before they’ve come in?

[00:04:07.360] – Hilary Erickson

No. You weren’t checking cervixes when you had your last baby?

[00:04:10.830] – Chantel

No, I didn’t check my own either.

[00:04:12.780] – Hilary Erickson

I didn’t check mine. It’s so hard because you can’t bend over that baby like you could normally. I will say that I have an IUD now, and I do make sure that it’s in place.

[00:04:22.660] – Chantel

No more babies for Hilary.

[00:04:24.220] – Hilary Erickson

No.

[00:04:25.110] – Chantel

Yeah. That’s a good thing to make sure it’s in place. But no, I’ve had patients come in and say they’ve tried to check themselves and tell me what they are. And I’m like, wow, it’s impressive.

[00:04:34.590] – Hilary Erickson

It is one of the main skills for a new labor nurse. It’s very difficult, first off, to even find the cervix in a lot of patients and then to figure out what number each one is. And then I will say that it just becomes ingrained like you’re just like, that’s a five.

[00:04:51.130] – Chantel

Yes, it does. Yes.

[00:04:53.590] – Hilary Erickson

And if I think if somebody asked me to put my fingers at like, what a five is, I’d kind of be like, I don’t know. But I know it when I’m in there.

[00:05:00.620] – Chantel

Yeah. It is true. Sometimes we have little circles at work that we can show the patient, well, it’s this. And when I put my fingers there, I’m like, yeah, that’s exactly what it is. So it definitely gets ingrained in you. But it’s a hard skill to pick up when you are learning.

[00:05:14.680] – Hilary Erickson

And other nurses do not have a skill, so don’t go to your bed surge nurse friend down the street and ask them to check your cervix. They’ll just get wide eyed and be like, no, it’s just a hot mess down there.

[00:05:25.080] – Chantel

That’s what it is.

[00:05:26.120] – Hilary Erickson

They don’t want down there.

[00:05:27.320] – Chantel

No. Okay.

[00:05:28.290] – Hilary Erickson

So it can tell you, like, how dilated you are. I mean, that’s what most people think of is how open their cervix is. But there’s more that it’s telling us beyond just that. And I think a lot of people think it’s just a number. But as a really educated, good provider, you learn so much from a vaginal exam beyond just that number. And you can’t really say it all at the nurses station. We’ll kind of be like, I don’t know, it just felt really wonky in there. Yes.

[00:05:53.320] – Chantel

And by wonky like soft, hard, how thick the cervix was. All those things make a big difference in how your labor can progress or what we’re going to do to help the patient, to help you have your baby.

[00:06:06.400] – Hilary Erickson

Yeah. So there’s a lot that we learn from an exam that you guys we don’t really verbalize or talk about it beyond just the number that you guys are all just looking for a number.

[00:06:17.070] – Chantel

Right, right. Lots of things we’re looking for.

[00:06:20.410] – Hilary Erickson

And a big thing is how it changes, correct?

[00:06:23.150] – Chantel

Yes. That’s the most important thing. Is it changing our intervention’s working.

[00:06:28.510] – Hilary Erickson

Yes. And a lot of times, even if we’re changing shifts, I’ll have the previous nurse check the cervix because sometimes there are really subtle differences that you can only tell if you were the person who checked last, if that makes sense.

[00:06:41.360] – Chantel

Yeah, it makes total sense. I mean, even the station of the baby. I know for you, like you said, I’ll have a nurse come check after me or have that same nurse that’s leaving check, because sometimes just a little change in the baby’s head coming down can be a change that we want to know about.

[00:06:58.600] – Hilary Erickson

Yes. And the station is how high or low the baby is in the pelvis. And again, we just give a number. But that number really differs, I feel like, in a lot of people. And so it’s really nice to have that nurse be like, no, that baby really came down. And when we say really came down, we really are talking like a centimeter. But we’re like, yeah, it came down.

[00:07:20.610] – Chantel

Yes, it is. We celebrate very small changes in labor. It’s awesome.

[00:07:25.600] – Hilary Erickson

The other thing it can tell us is the baby’s presenting part.

[00:07:28.660] – Chantel

Right.

[00:07:29.070] – Hilary Erickson

If it’s a head, if it’s a hand, if it’s a cord, different kinds of things. Because as nurses, we are not well, some nurses are, but most nurses are not trained to do an ultrasound. So officially, the only way we can say that it’s ahead is either get an ultrasound by a doctor or an ultrasound tech or check and be like, well, that’s not a bottom that’s ahead.

[00:07:49.940] – Chantel

Yeah. That’s a nice hard head. That’s what we’re looking for. Yeah.

[00:07:53.180] – Hilary Erickson

So just so you guys know, there’s so much that we’re learning from this. It’s not just one thing. Correct.

[00:07:58.010] – Chantel

There’s a lot of reasons that we are checking that cervix.

[00:08:01.240] – Hilary Erickson

Yeah. But there are a lot of times that you can say no happy care cervix checked. I would say some hospitals want to check people every hour, which, like our hospital doesn’t want us to check every hour. Like they didn’t care. Some doctors did. But some hospitals, that’s their routine policy. And if it’s just a policy rather than something they’re seeing on the baby, you can 100% be like, no, it is true.

[00:08:23.460] – Chantel

Yeah. I would say overall, most of us nurses where I work, they’re really reducing the amount that they’re checking. But there are certain times that you just have to check more often than not. It’s hard to explain to people. There’s a lot of things influencing how often or how little we check.

[00:08:41.090] – Hilary Erickson

Yeah. And so definitely what you want to do is, first off, if you really want to limit the exam, especially if you have a reason that you’re willing to share, share that with your hospital team. Because if somebody came to me and was like, I have a history of sexual abuse, I really do not want to be checked frequently. I’m 100% going to take that into consideration every time I check. And I’m going to tell the next nurse that and report, I’m going to be like, let’s be really cautious of this.

[00:09:04.490] – Chantel

Yes, definitely. And I know we’ve had a couple of circumstances where that’s happened. And really, I remember the doctor only came in and checked just to limit the amount of times we were checking. So we can make changes to the plan based off of what the patient tells us. And we definitely need them to tell us what’s going on or why they don’t want exams.

[00:09:24.590] – Hilary Erickson

Yes. Whereas if you came in and you were just like I saw in TikTok, I won’t need any exams. Yes.

[00:09:30.930] – Chantel

Then we’re like, well.

[00:09:32.330] – Hilary Erickson

You’Re misinformed, then we’re just going to have an eye roll as we’re doing our 7 hours of charting. And we want to know your actual reasons for things.

[00:09:42.000] – Chantel

Yes. I think we’re very understanding for the most part, and we want to be there and we want you to have the labor that you want. But we kind of need to know your reasons, just like we explain our reasons for what we do to the patient as well, if that makes sense.

[00:09:56.510] – Hilary Erickson

Yeah, that does make sense. Okay. So the main time I really don’t think you can avoid it is if you’re just coming in and you think you’re in labor. Really? I think maybe if you had pre prepared it with your doctor and you had a history and everybody was on board and they had it on your prenatal, which would be a lot of rigor moral, we could probably avoid it, but otherwise we really just need to see if your cervix is opening, correct?

[00:10:18.120] – Chantel

Yes. If you’re walking in telling us you’re in labor, we’ve got to start with some sort of a baseline. Unless your baby’s head is right there, then we know. Yeah.

[00:10:26.170] – Hilary Erickson

If we can see the scalp, we’re good to go. Yeah. So things you can do is try and labor longer at home so you know you’re in labor. If we check you and you’re like four or five, we’re not going to have to check you again. Whereas if we check you in year one, we probably are going to send you on a little walk and then check you again in a little bit to see if your cervix is opening. Yes, correct.

[00:10:45.890] – Chantel

That’s how it rolls when you come in.

[00:10:48.520] – Hilary Erickson

And so that’s the main time that I’m like, oh, that would be really difficult to avoid. Also, we don’t want you to push until your cervix is completely gone. So usually somebody’s just going to make sure because everyone says on TikTok that you’ll know, because you’ll have the urge to push. But there’s lots of patients who have the urge to push at 8 CM. That would not be awesome if they did start pushing.

[00:11:07.990] – Chantel

No, I’d say unless you have an epidural when you’re seven, eight, 9 CM, you want to push and it’s hard not to. But yeah, like I said, really bad if you start pushing against a cervix.

[00:11:19.600] – Hilary Erickson

Yeah. Just so you guys know, you can skip this if you don’t want to hear about it, but you can tear your cervix if you push. You can also make it swell. And then that would delay even your labor. Like there’s a reason that we want to make sure it’s out of the way before you start pushing.

[00:11:32.010] – Chantel

Yes. Especially with your first baby.

[00:11:33.630] – Hilary Erickson

Yeah. Other times I think you might need it is if you’re getting an induction. Like if you’re asking for an induction or they think you need an induction, they might check you in the office because we need to know what your cervix is to pick which medication we need to induce you with.

[00:11:45.030] – Chantel

Yes, I agree. I will say I think people could probably skip that 36 week. I talked to a few of the doctors at work and they said they’re starting to get away from that 1st 36 week cervical exam. So that would be one that I could totally support skipping. But if your plans and induction, your doctor kind of needs to check you in the office before they send you straight to us. So we know what we’re starting out with.

[00:12:09.290] – Hilary Erickson

Yeah. Although a lot of people really like to know at 36 weeks and they’re like, my pants are already off because you have to get the GPS swap. Although I’ve heard some doctors just handing patients to swab and tell them to go do it in the bathroom so that’s kind of cool. Although I don’t know that you’d get it in the right spot.

[00:12:23.770] – Chantel

Yeah. I don’t know. I don’t know if I would want to do my own trying to picture that. No, thanks.

[00:12:29.150] – Hilary Erickson

Yeah. That’s what I’m paying you for, doctor.

[00:12:31.990] – Chantel

Exactly. But you are right. I think most people just want to know. We’re kind of tired of being pregnant at that point. And it’s like, am I getting anywhere? Most people do want to know. But for those that don’t, I could totally see skipping that exam.

[00:12:43.900] – Hilary Erickson

Honestly, any exams, because really, it doesn’t tell you anything. Even if you’re 2 CM at 36 weeks, you could still be 2 CM at 41 weeks.

[00:12:52.630] – Chantel

Yes. Sadly, can walk around with that for a long time.

[00:12:55.700] – Hilary Erickson

Yeah. And then the other time I think it’s necessary is sometimes we see things on the fetal heart rate strip that make us want to check the cervix just to make sure there isn’t something in the way or the head is not right there. Or there’s just things that we need to do.

[00:13:09.000] – Chantel

Yes, there are things we need to do based off of what the baby’s telling us.

[00:13:12.920] – Hilary Erickson

Yeah, it’s just hard. Okay, so Chantel and I have been talking about this line that they talk about that goes up between your bum cheeks that supposedly is supposed to tell you if you’re dilated. And I was like, Chantel, ask everybody at work, has anybody heard of it or ever even seen it?

[00:13:27.830] – Chantel

So one person was like, yeah, that doesn’t work. No one hears about that thing because it does not work. And so, yeah, everyone thought I was crazy at first. Like, what purple line are you talking about? And I’m like, when I’m reading off TikTok, they can say that there’s a purple line, that it goes away as you dilate. And no, it’s definitely not something that has been taught to us at work, and it’s not something that we use. And the study is trying to say it’s very unreliable.

[00:13:57.770] – Hilary Erickson

Yeah, it might work in a couple of people, but how do you know that it’s actually working if it’s not working in a good percentage of the population? Really? Well, I was trying to decide if I would rather have them check between my bum cheeks or just check my cervix.

[00:14:12.930] – Chantel

I know. I think it was you I joked with. It takes on spreading the cheeks, gives it a whole new meaning. No, thank you. Yeah.

[00:14:20.380] – Hilary Erickson

And obviously, if you’re a woman of color, then it would be even more difficult to see. Yeah.

[00:14:25.320] – Chantel

I mean, you’d need a very bright light to see that. So it’s just putting a spotlight in an area that I don’t want a spotlight showing down there on me.

[00:14:33.260] – Hilary Erickson

Yeah. I’ve seen other people say, oh, you can just check the baby’s engagement with Leopold’s maneuvers. But, I mean, some people really start with that baby low. Some people it’s hard to check. Liam pulled maneuvers if you’re overweight like me. Yeah. I don’t think it’s a great indicator of how far along or if you’re in active labor, all those kind of different things.

[00:14:51.660] – Chantel

Yeah, I know.

[00:14:52.560] – Hilary Erickson

I would get it wrong.

[00:14:53.490] – Chantel

If I was to rely on that, I would be wrong.

[00:14:56.210] – Hilary Erickson

Yeah. And it’s just not how we’re trained because essentially they find that a cervical exam is the best way to know. It’d be like walking into the Er and just saying, I think my bone is broken, but I will not have an X ray.

[00:15:07.230] – Chantel

Yeah, exactly. It’s a very good analogy.

[00:15:09.440] – Hilary Erickson

And then we’re kind of like you can feel the bone, but you just can’t know. And you don’t really know how to fix it until you have an X ray.

[00:15:17.090] – Chantel

It’s true. Yeah. Plus it’s really offset. But then again, that would be comparable to, oh, your baby’s head is coming out. I think you’re complete.

[00:15:24.580] – Hilary Erickson

Right. I should call your doctor.

[00:15:26.380] – Chantel

Yeah.

[00:15:27.490] – Hilary Erickson

And put some gloves on.

[00:15:28.830] – Chantel

Yes, definitely.

[00:15:29.840] – Hilary Erickson

Yeah. Chantel, do you have any good tips on? Because nobody thinks they’re fun. But I will say that after my first baby, they got much more tolerable. Do you have any tips for people who can’t stand exams?

[00:15:40.290] – Chantel

No. My advice, I know it’s always lame, but I do think the more you try to just relax, the easier it is on you. The first thing we all want to do is tense up. But really, if you relax, it’s better tell your provider you’re going too fast, slow down and tell the person checking you to be very open, like, hey, I’m going to start now, or I’ve almost got it. Or it’s kind of high. Tricks that the patient can know as well are what we use. Sometimes a bedpan sitting on a bedpan can help. And so you can tell the nurse or the doctor is having a hard time, ask them for that. Or ask them if you can put your hand underneath your bum to raise that pelvis so that it’s easier for them.

[00:16:24.830] – Hilary Erickson

Yeah, that’s the trick. And I don’t know what they do in the doctor’s office because I didn’t know that trick before. I already had a second baby and it was easier to check. But you can always just make this put them under your bum and kind of raise your pelvis up that way. And it can make your cervix easier for them to find. And I totally agree that relaxing makes all the difference. I know that the first hospital I worked at, they called it the Chandelier reflex because people’s pelvis would go up in the air when they were trying to get an exam, which makes it even worse because then you’re contracting all those muscles.

[00:16:55.030] – Chantel

I know it’s hard and definitely it’s not fun, but that’s my best advice. Try to relax, put some music in your ears or have your partner distract you.

[00:17:05.360] – Hilary Erickson

Yes.

[00:17:05.930] – Chantel

Squeeze their hand back.

[00:17:07.160] – Hilary Erickson

And I really Like The Advice To Talk To The Provider And Be Like, What Is It That Bothers You? Is It The Cold Jelly? Tell them to let you know before they touch or exactly what’s going to go on. People are more than happy to do that. But Honestly, if we did that with every single patient, every time, a lot of them would just roll their eyes at us. So we kind of need to know what you want so that we can cater to you.

[00:17:27.960] – Chantel

Sure.

[00:17:28.350] – Hilary Erickson

Yes.

[00:17:28.710] – Chantel

There’s a lot of eye rolling that does go on with some people when you offer too much advice or ask too many questions. So it is a little easier the more open you are with your provider.

[00:17:38.130] – Hilary Erickson

About what you want. Yup.

[00:17:39.370] – Chantel

Yeah, about what you want.

[00:17:40.260] – Hilary Erickson

We can learn about this one because you have to remember, the hospital sees literally everyone nationalities, cultures, ages.

[00:17:49.330] – Chantel

We do see it all, and we don’t know… we know how we want things, but it doesn’t always mean that’s how you want it. And it just makes your provider’s life a lot easier when you’re just open and honest. Just tell us.

[00:18:01.550] – Hilary Erickson

Yeah. And nothing you’re going to say is going to shock us.

[00:18:04.260] – Chantel

No, we’ve heard it before.

[00:18:06.360] – Hilary Erickson

Yeah.

[00:18:06.860] – Chantel

Guarantee it. Whatever you say, we’ve heard it before.

[00:18:09.410] – Hilary Erickson

Yeah. Amen. I mean, that’s what we should end it on. Whatever you tell us, we’ve heard it before.

[00:18:14.350] – Chantel

Exactly. It’s true.

[00:18:16.050] – Hilary Erickson

All right, Chantel. Thanks so much for coming on.

[00:18:17.970] – Chantel

All right. Thanks, Hilary.

[00:18:19.250] – Hilary Erickson

I hope you guys enjoyed that episode. Like I said in the beginning, don’t give in to all the controversy. So many people are like, “My nurse forced me to give birth on my back,” or “I had to have cervical exams in labor” or “I don’t want any cervical exams in labor.” And when you get to the edges, like, all-the-time or none-of-the- time, it usually just doesn’t serve you very well. So hopefully this advice really helped you guys out.

[00:18:43.520] – Hilary Erickson

Be sure to stay tuned for next week’s episode. We are talking about making summer fun for mom. I think often we make summer fun for kids, but let’s make it fun for the mom. And if you’re interested in more pregnancy information, I have my friend Crystal coming on to talk more about how she got her confident birth in two weeks.

[00:19:00.080] – Hilary Erickson

Thanks so much for joining us on today’s episode. We know you have lots of options for your ears, and we are glad that you chose us. We drop episodes weekly and until next time, we hope you have a tangle free day.