Cervical checks or vaginal exams can be painful and sometimes unnecessary. Today I want to talk about if you can refuse them and the consequences that might happen.
First off — who am I and why do I know this? Hi, I’m Hilary — The Pregnancy Nurse 👩⚕️. I have been a nurse since 1997 and I have 20 years of L&D nursing experience, I am also the curly head behind Pulling Curls and The Online Prenatal Class for Couples. 🩺 After helping tens of thousands of women in labor I can really speak to this (as well as having 3 of my own kids).
I just did a whole podcast on refusing vaginal exams:
I also have a youtube video all about this:
What are Cervical Checks For?
Before we get into if you can refuse them, let’s talk about what cervical checks are for.
They’re mainly to see what stage of labor you are at.
Now, you’d think that as professionals we’d just know. And frankly, as a nurse you tend to eye a patient as they are wheeled into a room and assess them for yourself to know what you bring in. That being said — often we’re wrong. Sometimes people look very comfortable but have a cervix that shows they are definitely in active labor.
And very often the opposite is true that a patient thinks they are in active labor and appear to be by how they are handling the pain — and then we check their cervix only to find it closed.
Of course, in the second scenario it is also very possible that the pain is something else — possibly a bladder infection or ligament pain. If we just assumed it was labor we would be doing them a dis-service.
By the way — if you appreciate this type of information about you and your labor — I would totally recommend a prenatal class. Knowing what to expect in advance can help you feel SO much more prepared! This one can be done entirely on your own schedule in just 3 hours time. And it’s guaranteed to get you prepped.
Can You Refuse Cervical Checks in Labor?
Yes, you can always 100% refuse cervical checks. You can refuse ANYTHING in labor and delivery.
In this instance you could:
- Just refuse it and say you won’t have any.
- Ask them to wait until you’re between contractions or can get in a spot you can handle the exam.
That being said — all of our choices have consequences.
Consequences of Refusing Cervical Checks
There are a few things that could happen:
You provider may not admit you
Admission orders are given by a doctor or midwife to labor and delivery. If you refuse being checked and the baby/you seem stable the care provider may send you home.
Now, I wouldn’t feel very comfortable doing this, as a nurse — but the choice isn’t up to me.
However, it could also be a poor use of our health care dollars to admit you when we aren’t sure how long it will be until you have your baby.
Of course, before sending you home we would watch for contractions and make sure the baby’s heart rate is ok.
PRO TIP: If cervical exams are something you’d prefer to avoid I would have a talk with your provider WELL in advance of your delivery date. Come up with a plan between you and them to decide what to do. Keep in mind that if you go to a hospital your provider doesn’t go to, or if they aren’t on — a different provider may make a different choice.
We may not get give you the best of care:
When we don’t know how far in labor you are, it can be difficult to help with interventions. Meaning IV pain medication, possible epidural administration, things like that.
We would want to be sure you are in active labor before an epidural, and we can’t give IV pain medication if the baby is close to coming out — so we would want to be sure you’re not too advanced in your cervical dilation.
I would feel very uncomfortable doing either of those. As a licensed professional, there are certain things I just can’t do.
I would also not administer an induction without SOME provider knowing your cervical dilation.
I just don’t have the knowledge I need to give good care in any of those cases.
On the flip side of not admitting you, we may keep you when in reality you’d be safer/better off at home if we’re unable to assess your cervix.
The reality is that we can totally MINIMIZE checks, but if you want to ELIMINATE checks you need to talk with your provider at length.
But also, there are emergency times that a cervical exam is emergently necessary:
- The baby’s heart rate shows the cord may have come out (called a prolapse, which can be fatal for the baby)
- Unexplained cervical/vaginal bleeding
- Laboring for a long time with a lack of progress (could be that baby isn’t positioned well, and knowing HOW they are positioned can help)
It is also important that we know that your cervix has “disappeared” so you are safe to start pushing (otherwise you can make your cervix swell).
Why Some Refuse Cervical Checks
Most women don’t enjoy cervical checks. They are painful and can bring up a lot of feelings about sexual assault or other issues women may have had.
If that is something you experience I would totally recommend talking to your provider about it. We want to be very understanding of you and your needs, while also keeping you as safe as possible.
When we know your background it helps us know more about where you are coming from. It just makes sense to us vs just refusing them or acting wildly when we say they are necessary. That’s confusing to us and we’re not sure how to help.
Why Providers Need Vaginal Exams?
I would agree that many vaginal exams are not necessary. In fact, most of them at prenatal appointments (unless you think you’re in preterm labor) are pretty useless. That’s not what prenatal checks are for, for the most part.
However, many women like to know what their cervix is and to know if it’s opening at all, or if they are having contractions.
However, once you think you are in labor it is important that we assess how soon we think the baby will come. As an experienced provider I can tell a lot from a vaginal exam. It’s not just the numbers that we tell you. The feeling of the cervix, if you’re dilated, where the head in the pelvis is and how it is applied to the cerivx… it’s one of the most important things we can do when you’re in labor.
It’s easy to think that it’s just about the centimeters we tell you, but it’s more than that.
Vaginal exams are one of our most important assessment tools in labor. If you eliminate that tool from our toolbox, it makes us much less helpful. Most women are coming to the hospital for a safety net and it is much harder to build that safety net when we’re not sure if/how far you are in labor.
As I said above it seems like it’s easy to tell if someone is in labor, but I have 100% thought someone was in labor and then found out it was a kidney infection that needed a whole other treatment.
When I realized her cervix was closed but she was in so much pain we planned other lab work to see what else it could be.
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What to Do if Cervical Exams Bother You:
Talk with your provider
Make a plan to eliminate them where possible. Realistically talk with them about the ones you WILL need to have a safe labor.
In most cases, it is not realistic to plan to decline all of them at the hospital — although in some circumstances it could be possible.
Learn Coping Techniques
The tricky part of exams is that the more you stress or tighten your pelvic floor, the more painful they are. If you can get yourself into a zone of relaxation it will really help you get through the exams. I would recommend some natural pain management techniques (there are some taught in here) — and if you have a lot of anxiety about the entire birthing process you might want to try something like Hypnobabies + a prenatal class.
There will be a lot of pain in that area involved in labor and you will not be able to refuse those pains — so learning coping techniques in advance will be so helpful to you.
I would also consider some therapy about whatever it is that triggers you about the exams. There is a lot that our mind can process with help.
Some things you can do to help with exams:
- Practice breathing through it in advance (as I mentioned).
- Waiting to do exams between contractions
- Putting something under your bottom to tilt your uterus and make them easier.
- Choosing who does the exam (maybe your known provider does them vs a new nurse).
- Being able to guide the exam — the provider only does things when you give the OK (keeping in mind your provider may have other patients they also need to attend to).
I do think a lot of women think in advance it will be horrible, but with proper communication with your health care team and a supportive partner (possibly including a doula) they find that the minimal ones that are really necessary aren’t so bad once they are in labor.
I actually find this for a lot of the labor process. People are often SO worried about eating, exams, who will be in the room, etc. And when labor actually comes, little of it actually matters.
Just remember you came to the hospital for a safe place and there are things and tests we need to do to make sure it’s safe for you. We truly are there to help.
If you’re looking for more honest information like this to get you prepared for the hospital I’d recommend taking this prenatal class.
If you’re not sure you’re ready for the full class yet, check out my free beginning prenatal class:
- About the Author
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A nurse since 1997, she has worked in various fields including pediatrics, geriatrics & hospice.
She has 20 years of labor and delivery experience in the San Jose, CA and Phoenix, AZ areas.
She is also the curly head behind the website Pulling Curls and is the creator of The Online Prenatal Class for Couples — the #1 hospital-based prenatal class on the internet.
If you read this article just beware of what she is saying might not be true. Real labor contractions that are going to continue and not stop, feel like a hardening of your stomach and electricity flowing through your uterus. I have had these types of contractions and have been completely closed but it progressed to labor. Kidney pain is nothing like labor pain so I find it incredibly hard to believe that someone would just be in pain in general, be pregnant and then go to labor and delivery. Labor and delivery always asks you to call firsts and they would also hook you up to a machine that detects baby’s heart rate and contractions. So if someone is there with kidney pain, the first sign would be that they would not be having contractions as kidney pain is not waning if it is serious as a contraction would be as they come and go and start and stop. Now cervical checks in hospitals are necessary, not that uncomfortable depends on the woman (I have been through it many times through my five soon to be sixth ordeals in pregnancy) and they are necessary but not because it could be some other pain you are experiencing (which is ridiculous) but for the hospital to admit you. Cervical checks do not tell you how long someone will be in labor, but the hospitals need to know this so they can have an idea of whether you are in active labor or not.
Hilary Erickson, BSN RN
I very much agree that kidney pain is most often different, but not always. It’s complicated, very complicated.