August 19, 2020

Your Cervix Is Not A Crystal Ball

I got an email from a student who is 39 weeks & 1 day pregnant. She’s quite uncomfortable & distraught. 

She wrote to me having just come back from her weekly check up with her care provider. She was told that her baby is high & her cervix firm. According to her provider, she hadn’t made any changes since the prior week, as a result, her doctor offered to induce her. She declined – though said it was very tempting given how uncomfortable she is in this hot & humid weather, not to mention she’s chasing after her first child.

Discouraged, she wondered what my thoughts were on the situation 

Oh where to start?… is my first thought. 

Well, here’s where I’ll begin, Your cervix is not a crystal ball. Dilation can happen quickly. She could be in labor later tonight for all we know. 

I remember being 38 weeks pregnant, waddling into my OBs office, I asked if he was going to do a vaginal exam. I was prepared to clamp my legs together & refuse. 

To my great surprise, he answered “Nope. I don’t do vaginal exams prior to the onset of labor unless the patient wants me to.” 

I asked “Amazing! Why” 

And he said, “Because I am tired of just shrugging my shoulders and having no relevant information to share.” 

That’s when I knew – there was a reason I liked this guy & had chosen him to be a part of my birth team. 

When you decide to undergo any intervention- including what may seem like a benign vaginal exam, I recommend first thinking-What am I going to do with this information? Is this information necessary for the management of my care? If it’s not going to change the course of how things progress, do I need this intervention? 

This can allow you space to think. Is this intervention medically necessary for you or simply routine protocol?

Back to my student’s story, the information wasn’t medically necessary- whether she was still at 1cm or 3cm it was not going to change the next steps in her care. And I would argue -perhaps it was even harmful since it led to worry and anxiety over something she has no control over. 

If an intervention or procedure isn’t medically necessarily, give yourself some time to pause, weigh the risks, benefits & explore alternatives.



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