Your Complete Guide to Cervical Checks During Pregnancy and Labor

This article may contain affiliate links. This means that if you make a purchase through these links, we may earn a small commission at no additional cost to you. Learn more about affiliate links.

Cervical checks are one of those pregnancy topics people feel VERY strongly about. Some people want to know their number at every appointment after 36 weeks. Others would rather not have anyone's fingers anywhere near their cervix until it's actually go time (fair). Both camps have a point, too. A cervical check can tell you something useful, but for a lot of people, knowing how dilated (or not dilated) they are does more harm than good.

I did a LOT of cervical checks during my 10 years working in labor & delivery, so I'm going to walk you through what's actually happening during one, what your provider is feeling for, whether a check can start labor, how to make it suck a little less, and when it's completely fine to say no thanks.

What is a cervical check?

A cervical check (also called a cervical exam or vaginal exam) is a quick manual exam where your provider uses a gloved hand to insert two fingers into your vagina and feel your cervix. Your cervix is the bottom part of your uterus, and it's the part that has to thin out and open up for your baby to come out.

If your cervix is open at all, your provider slips their fingertips into the opening and spreads them apart to estimate how dilated you are. Dilation is always measured in centimeters, from closed (they can't get a fingertip in) all the way to 10 cm, which is "complete." Once your provider can't feel any cervix left around baby's head, you're 10 cm, and that's usually (not always!) when it's time to push.

For a little perspective, 1 cm is less than half an inch, and 10 cm is almost 4 inches. Yep.

What your provider is checking: dilation, effacement and station

During a cervical check, your provider is mostly paying attention to three things:

• Dilation: how open your cervix is, from closed to 10 cm

• Effacement: how thin your cervix is, usually given as a percentage, from 0% (thick) to 100% (paper thin)

• Station: how far down baby's head has dropped into your pelvis. Zero station means baby's head has made it to about the middle of your pelvis. Negative numbers mean baby is still higher up, and positive numbers mean baby is moving down toward the exit.

They'll usually also notice the position of your cervix (tilted toward your back, in the middle, or toward the front) and whether it feels firm or soft. Those two matter most for the Bishop score, which I'll get to in a bit.

Before labor, it's really normal for your cervix to be closed, thick, firm, high and posterior. Posterior just means it's tilted back toward your spine, which makes it harder to reach (and is a big part of why early checks can be so uncomfortable). Once labor starts, your cervix typically softens, thins out, opens up and moves forward.

Who does cervical checks?

Cervical checks can be done by OBs, midwives, family medicine doctors and, in a lot of hospitals, labor & delivery nurses. During labor, your nurse is often the one checking your progress, depending on the hospital's policies and what your provider prefers.

How long does a cervical check take?

It's usually quick, often just a minute or so. A few things can make it take longer or feel more uncomfortable, though:

• Provider experience: someone who doesn't do many checks may need more time to figure out what they're feeling.

• Where your cervix is: a high, posterior cervix before labor is just plain harder to reach.

• Tension: if it's hard to stay still and relaxed (very understandable), the check can be harder and take longer.

One thing I want to be really clear about: your provider should always explain what they're about to do before doing a cervical exam, and answer any questions you have. They should get your verbal consent before starting, and they should stop promptly if you ask them to or if you aren't tolerating it.

Do cervical checks hurt?

That kind of depends on who you ask and how you define "painful." Nobody loves a cervical check, but some people tolerate them a lot better than others.

I know some of you are going to (strongly) disagree with me on this one, but for a lot of people, "uncomfortable" is a more accurate word than "painful." That said, your experience is your experience. A check can absolutely feel painful if your cervix is way back and hard to reach, if you're tense or anxious, or if pelvic exams are hard for you because of past trauma. If it hurts, you're allowed to say so, and you're allowed to ask your provider to slow down or stop.

Do cervical checks hurt less as you dilate?

A lot of the time, yes, they get easier. Before labor, that posterior cervix means your provider has to reach farther back. Once labor gets going and your cervix moves forward and softens, it's usually a lot easier to get to.

Easier is not the same thing as comfortable, though. Checks during labor can still be uncomfortable, especially during or right after a contraction. If you have an epidural, checks usually feel more like pressure than pain.

How to make cervical checks less painful

You always have the right to decline a cervical check (more on that below). But if you decide to have one and you're really struggling, try wiggling your toes during the exam. I know it sounds ridiculous, but it can distract you just enough to help the rest of you relax. And when you stay relaxed and keep your butt flat on the bed, the exam tends to go faster and feel less uncomfortable, so it's a win for everyone.

A few other things that can help:

• Taking slow, deep breaths during the exam

• Keeping your bottom flat on the bed instead of scooting up and away (super common reflex)

• Keeping the lower half of your body relaxed and staying in position. Your provider will probably have you bring the soles of your feet together and let your knees fall open like butterfly wings.

• Reminding yourself that it'll be over soon

• Asking your provider to talk you through it or pause when you need a second

When do cervical checks start in pregnancy?

A lot of providers offer a first routine cervical check around 36 or 37 weeks. But this varies a LOT. Some providers offer one at every visit after 36 weeks, some wait until around your due date, and some don't do routine checks before labor at all.

Outside of routine checks, a cervical check might actually be needed when the results could change your plan of care. For example:

• You're being induced

• You come in to the hospital thinking you might be in labor

• You're having contractions and you aren't full term yet

• Baby's heart rate is showing changes during labor

That's not every possible situation, but it shows how useful a check can be when there's a real reason behind it.

Are cervical checks necessary before labor?

Short answer: no. You don't actually need routine cervical checks at the end of pregnancy. "Routine" here means the check is being done just to see whether you're dilated or effaced, not because the answer would change anything about your care.

The main reason is that a cervical check before labor can't reliably tell you when labor is going to start. It's really common, especially with a first baby, to have little or no dilation before labor begins. And hearing "still closed!" at 39 weeks can be SO discouraging. It's easy to walk out of that appointment convinced your body is never, ever going to go into labor.

On the flip side, maybe you find out you're 2–3 cm at 37 weeks. Now you're convinced labor is happening any minute, when in reality you can hang out at that dilation for days or even weeks. Once labor actually gets going, your cervix can change quite a bit in a matter of hours. So if you do decide to get routine checks, try not to get too hung up on the number.

Now, if you're a naturally curious person like me, you might be like, "Why not, let's check!" There's nothing wrong with that. And if the thought of a cervical check makes you anxious or uncomfortable, it's completely fine to say, "Thanks, but no thanks."

Can I ask for a cervical check?

You can definitely ask your provider for a cervical check. They'll probably ask why, and depending on your reason, they may or may not think one is worth doing.

A good reason usually means signs that labor might be starting, like:

• Contractions

• Cramping or back pain

• Bloody show

If your provider doesn't offer a routine check around 36–37 weeks and you'd like one, it's worth asking. Just know they might say no. And if you're having contractions before 37 weeks, don't wait for your next appointment to bring it up. Call your provider.

What about asking for a cervical check during labor? That's a different story. Your birth team will usually be a lot more open to checks during labor, because that's one of the main ways they measure your progress. Most teams still try not to overdo them, though, and stick to that same "only if it's going to change the plan" approach.

During my years working in labor & delivery, I had patients ask for a check pretty often when they were trying to decide on their next step for pain management. If it had only been 10 or 15 minutes since their last check, I'd usually encourage them to wait a little longer. Otherwise, I was all about supporting my patients and doing whatever I could to help them have the birth experience they wanted.

So bottom line, yes, you can ask for a cervical check at any point in pregnancy or labor. It's just a good idea to have a reason behind the request.

Pros and cons of cervical checks before labor

Pros of cervical checks before labor

• They satisfy your curiosity. For me, knowing how dilated I was genuinely eased my mind, and I think that counts for something!

• They can give you a Bishop score, which helps your provider judge how ready your cervix is for labor.

• They can help with induction decisions, like whether you want to go ahead with an induction and which method makes the most sense.

Cons of cervical checks before labor

• They can be uncomfortable.

• They can cause unnecessary anxiety or discouragement, because the number doesn't predict when labor will start.

• They can cause some spotting or cramping afterward. This is usually harmless, but it can definitely freak you out if you aren't expecting it.

• There's a small chance your provider could accidentally break your water during the check.

Bishop score

The Bishop score goes hand in hand with cervical checks, so it's worth knowing what it is. Basically, it's a scoring system that rates how ready (or "favorable") your cervix is for labor.

Providers use it most often when they're planning an induction. It helps them estimate how likely an induction is to end in a vaginal birth, and whether your cervix needs some help softening and opening first (that's called cervical ripening). Generally, the higher the score, the more favorable your cervix. A score above 8 is considered favorable, meaning an induction is about as likely to end in a vaginal birth as spontaneous labor. But as with pretty much everything in birth, there are exceptions. I saw people with high scores end up with C-sections, and people with low scores deliver vaginally.

The score looks at five things from a cervical check and gives each one a number.

Bishop score categories

• Dilation

  • Closed = 0

  • 1–2 cm = 1

  • 3–4 cm = 2

  • 5 cm or more = 3

• Effacement

  • 0–30% = 0

  • 40–50% = 1

  • 60–70% = 2

  • 80% or more = 3

• Station

  • -3 = 0

  • -2 = 1

  • -1 or 0 = 2

  • +1 or +2 = 3

• Cervical consistency

  • Firm = 0

  • Medium = 1

  • Soft = 2

• Cervical position

  • Posterior = 0

  • Middle = 1

  • Anterior = 2

Add those up and you get a total somewhere between 0 and 13. A score of 5 or less is considered unfavorable, which usually means your provider will suggest cervical ripening as part of your induction.

Can a cervical check induce labor?

No. A cervical check isn't a way to induce labor. It's an assessment, meaning it's how your provider figures out your dilation, effacement and station. It isn't designed to start labor, and it doesn't open your cervix. It just measures how open it already is.

That said, it's really common to have some cramping, light spotting or a few irregular contractions in the hours after a check (more on what's normal below). That stuff usually settles down on its own and doesn't mean labor is starting. Your cervix has a ton of blood flow late in pregnancy, so it can be a little tender and bleed slightly after being poked at.

There's also a very small chance that whoever does the exam could accidentally break your water. If your water breaks, labor often follows, so call your provider if you notice fluid leaking after a check.

What's normal after a cervical check?

After a cervical check, it's common to have:

• Light spotting, often pink or brown, that tapers off

• Mild cramping or a dull lower backache

• A few irregular contractions that fade with rest

A really common question is how to tell spotting from a cervical check apart from bloody show. Spotting after a check usually starts pretty soon after the exam and stays light. Bloody show is mucus streaked with pink, red or brown blood, and it can happen when your cervix starts changing on its own. They can look really similar. Light spotting right after an exam can usually be watched at home, but in the last few months of pregnancy it's always okay (and recommended) to call if you aren't sure what you're seeing.

Call your provider or labor & delivery if you notice:

• Spotting that doesn't taper off, or any bleeding that's more than spotting (like a period or heavier, or with clots)

• Fluid leaking from your vagina

• Contractions that become regular and keep getting stronger and closer together

• Severe or constant belly pain

• Fever

• Your baby moving less than usual

Cervical check vs. membrane sweep

These two get mixed up ALL the time, but they're not the same thing.

During a sweep, your provider puts a gloved finger into the opening of your cervix and sweeps it in a circle to separate the thin membranes of the amniotic sac from the wall of your uterus. That separation can release prostaglandins, which are hormones that help the cervix ripen and may help get contractions going.

The big potential upside of a sweep is that it might help you go into labor on your own and skip a medical induction. The research suggests a modest benefit, though the quality of that evidence is fairly low. Some people go into labor in the days after a sweep, and plenty don't.

A membrane sweep also has some downsides:

• It's often more uncomfortable than a regular cervical check

• It can cause spotting or light bleeding

• It can cause painful, irregular contractions that don't actually turn into labor

• There's a small chance of breaking your water

• Your cervix needs to be open enough for your provider to get a finger in

The key difference is the purpose. A cervical check is an assessment. A membrane sweep is an attempt to get labor going. Sweeps are usually offered at or after about 39 weeks, and one should always be discussed with you first and done only with your consent. You should NEVER get a surprise sweep during what you thought was a routine check.

Cervical checks during labor

During labor, cervical checks get a lot more useful. They give you and your birth team real information that can help guide decisions and adjust the plan of care to fit what you need. If you want the bigger picture of what actually happens at each stage of labor (including when to head to the hospital and how inductions work), I walk through all of it in my online birth class, Birth It Up.

How often are cervical checks done in labor?

It depends on the hospital, the provider and what's happening with you. For low-risk labors, the World Health Organization recommends checks about every four hours during active labor. Your team might check more often if something changes, like if you're feeling the urge to push, you're making decisions about pain medication, or there are concerns about your baby's heart rate. They might check less often once your water has broken, to lower the risk of infection.

Pros of cervical checks during labor

Here's a really common situation I saw during my years in labor & delivery:

• A patient has been laboring for a looong time. She's exhausted, frustrated and starting to lose hope of reaching her goal of an unmedicated birth.

• Her provider or I (her L&D nurse) offer a cervical check to see where she is.

• We check, and she finds out she's 9 cm and almost ready to push. That gives her the push (sorry) she needs to get through those last contractions and reach her goal.

That's just one example of how knowing your dilation in labor can be exactly what you need to hear.

Cervical checks during labor can also help your team:

• Figure out whether you're in labor and whether you should be admitted

• Check baby's position, which matters for planning a safe vaginal birth. An ultrasound is often used to confirm it.

• See whether labor is progressing and whether the plan of care needs to change

Cons of cervical checks during labor

1. They can be subjective

This one is true of cervical checks in general, not just in labor. Results can vary depending on who's doing the check. Studies comparing two examiners have found they agree on the exact same number less than half the time, but they're within 1 cm of each other about 90% of the time.

One person might call you 4 cm, and the next person might call you 3 cm. That does NOT mean your cervix closed back up. It's pretty common when different people check you, and it just reflects how each of them reads your dilation. What isn't normal is for one person to call you 9 cm and someone else to call you 3 cm an hour later. In that case, it's safe to say one of them wasn't accurate.

2. They can be discouraging

Just like a check can be really encouraging (hi, 9 cm patient), it can also be really discouraging. I also saw patients labor for a looong time, get rechecked and find out they were still 4 cm. That is a HARD thing to hear.

3. They can be uncomfortable

Even once your cervix has moved forward and started dilating, checks can still be uncomfortable.

4. They can raise the risk of infection

More frequent vaginal exams, especially after your water has broken, are linked to a higher risk of infection. Infection from a cervical check isn't common, and gloves are used every single time to reduce that risk, but it's one of the reasons birth teams try not to do more checks than they need to.

Can you check your own cervix?

I get why people try this, especially around their due date when you're desperate for ANY sign of progress. But it isn't something I'd recommend. Your cervix can be really hard to reach, especially before labor, and without training it's very hard to tell what you're actually feeling. And since even a trained provider's check can't predict when labor will start, a self-check doesn't tell you much anyway.

There are also some real safety reasons to skip it:

• Don't put anything into your vagina if your water has broken, because it raises your risk of infection.

• Don't do it if you've been told you have placenta previa or a low-lying placenta, or if you're having unexplained bleeding.

If you're wondering whether you're making progress, call your provider. They can help you figure out whether a check actually makes sense.

Can you refuse a cervical check?

Yes. As a patient, you can decline anything. Let me say that again: you can decline ANYTHING. And yes, that includes cervical checks during pregnancy and during labor. Your provider should get your consent before every exam, and you can ask them to stop at any point. If you already know you'd like fewer checks in labor (or only the ones you ask for), put that in your birth plan so your team knows before you even walk in.

I'm all about patients having the tools to advocate for themselves. You are a key member of your care team. Only you know exactly how you're feeling, so take an active role in your care and speak up for yourself every step of the way.

Before you decline, it's worth asking your team what they'd learn from the check and how it might change your plan. Then weigh the pros and cons of what your provider is recommending, and go with your gut. Sometimes your gut is all you need to point you in the right direction.

Wrapping up

Cervical checks are a surprisingly controversial topic among medical professionals and patients alike, and sometimes they really do more harm than good. But they also have a real time and place, especially during labor and when you're making decisions about an induction. And if you'd rather listen than read, I talk through all of this (sweeps included) in my podcast episode Do You Have to Get Checked? Let's Talk Cervical Checks + Sweeps.

How much you want to know is up to you. If you do get checked, take the number with a grain of salt. It's one snapshot of a cervix that can change a LOT once labor actually starts.

~Liesel

Back to List Next Article