Cervical exams are often treated like a routine part of late pregnancy care, but they are completely optional. You always have a say in what happens to your body.

Let’s talk honestly about what they are, the pros and cons, how to advocate for yourself, and how to handle situations where a check is offered.

What is a “Cervical Exam?”

A cervical exam is a manual (gloved) internal check where your provider feels your cervix to assess how your body might be preparing for labor. It’s most often offered in the last few weeks of pregnancy or during labor.

Here’s what they’re checking and what it means:

1. Dilation: How open is the cervix?

This measures how wide your cervix has opened, from 0 to 10 centimeters.

• 0 cm = completely closed
• 10 cm = fully open (ready for baby to come through)

Imagine the opening of a balloon. When it’s unstretched, it’s tight and closed. As you pull it open, the opening widens—that’s dilation.

You can be 3–4 cm dilated for weeks before labor starts…or not dilated at all and go into labor within hours. It’s just one data point.

2. Effacement: How thin is the cervix?

Effacement refers to how thinned out your cervix is, measured in percentages.

• 0% = thick and long (not yet softened)
• 100% = completely thinned

Before a balloon is inflated, the neck is thick and firm. As you stretch it and prepare to blow it up, that neck becomes softer and thinner. That’s kinda what effacement is like: your cervix is preparing by becoming soft and shortening so it can open more easily.

Effacement often happens before or alongside dilation, but again…t’s not a timeline, just a snapshot.

3. Station: How low is baby in the pelvis?

This shows how far down the baby is, measured in relation to the bones in your pelvis (called the ischial spines).

• 0 (Zero) station: The baby’s head is aligned with the ischial spines. This means the head is “engaged” and has entered the pelvis.
• Negative numbers (-5 to -1): The baby’s head is still above the ischial spines and not yet engaged in the pelvis. The higher the negative number, the higher the baby is in the birth canal.
• Positive numbers (+1 to +5): The baby has descended past the ischial spines and is moving closer to delivery. A reading of +4 or +5 means the baby is crowning. 

This is not always checked for prenatally. The provider may just say something like “your baby is still really high.”

4. Cervical Position & Consistency: Is the cervix soft, and where is it?

• Position: Is your cervix tucked toward your back (posterior) or coming forward (anterior)? A cervix that moves forward is usually considered more “ready.”
• Consistency: How soft or firm your cervix feels.
  • Firm = like the tip of your nose
  • Soft = like your lips

A Note On Baby’s Positioning:

While you might hear your provider talk about baby being “head down” or “still breech,” this positioning can be assessed by feeling your belly externally, not during a cervical check. A cervical exam is not required just to find out your baby’s position. If there’s any uncertainty, providers can also use ultrasound to confirm.

A Reminder: Cervical Exams Are Not a Crystal Ball

Cervical checks don’t predict when labor will start.

You can walk around 3–4 cm dilated for weeks, or go from 0 cm to active labor in hours. These numbers are not timelines, they are simply snapshots.

Warning: They Can Be Uncomfortable…and Sometimes More

Let’s be real:

• Cervical exams can feel invasive
• They may cause cramping or spotting
• They are often uncomfortable or painful
• Some providers have performed membrane sweeps during exams without consent.

Yes.. that last one has happened to a client of mine. She thought she was getting a standard exam and only later realized a sweep had been done.

When Cervical Exams Can Be Helpful

There are valid clinical reasons to consider one:

• If you’re planning an induction, your Bishop Score helps determine the most effective method.
• During labor, cervical exams can help assess progress (if desired or necessary).
• Some people like knowing what their body is doing, because it can feel empowering or encouraging.

You get to decide if this info is relevant or helpful to you.

How to Decline a Cervical Exam (Without the Awkwardness)

It’s much easier to give (or decline) consent when your clothes are still on.

At your appointment, if the nurse hands you a sheet on the way out of the room and says something like, “Go ahead and undress from the waist down”,

You can say decline by saying:

“Oh, no thank you. I’m going to decline the cervical check today.”
“Thank you, but I’m going to stay dressed. I don’t consent to a check today.”

No drama. No big conversation. Just a clear boundary. You can also restate when the doctor comes in the room.

Keeping your clothes on is a great way to stay in control of the situation until you’ve been fully informed and given explicit, enthusiastic consent.

Special Note: The 36–37 Week Appointment (GBS Swab)

This is a key time to advocate for yourself.

During this appointment, providers typically perform a Group B Strep (GBS) swab (a quick vaginal and rectal swab to test for bacteria.)

Some providers use this moment to “just do a quick check” or even a membrane sweep.

Ways to communicate if you do not wish to have a cervical exam or membrane sweep:

“I’m comfortable with the GBS swab, but I do not consent to a cervical exam.”
“Please don’t perform a membrane sweep or cervical exam. I do not want that today.”

You have the right to informed refusal.

Want to Dive Deeper?

Here are a few trusted sources that break this all down:

• Birth Kweens: Ep 62: At Your Cervix
• Evidence on Cervical Checks at the End Of Pregnancy

Final Thoughts

You don’t have to just go along with what’s “routine.” You can:

• Ask questions
• Set boundaries
• Stay dressed until you’re ready
• Give or withhold consent at any point

Whether you want a cervical exam or decline every single one, that choice is yours. 💗

⚠️ Disclaimer:
The information shared in this blog is for educational purposes only and should not be interpreted as medical advice or a substitute for care from a licensed healthcare provider. I am a doula, not a medical professional. My goal is to provide general information about birth and support you in advocating for your wishes. Always consult with your care provider for medical guidance specific to your pregnancy and health.