Cervical checks are one of the mainstays of obstetric care.  It is not unusual to get checked around 38 weeks even though labor has not begun.  Then you get checked at the hospital while they are admitting you when you are in labor.  You might get checked more than a few times during labor.  Why all these checks? Do they tell how much longer you will be in labor? Are they risk free? Do you do cervical checks in your midwifery practice?

Let's start with the last question first.  I do not do cervical checks as part of routine care in my midwifery practice.  If a client asks me to do a check, we will discuss the risks and benefits of checking before I actually do a cervical check.  In all honesty, I prefer not to check.  I use external cues to assess how well labor is progressing, and those cues have served me well during my midwifery career.

What are the reasons for cervical checks anyway? Before labor begins, a provider may use a cervical check to assess how likely it is a pitocin induction will work.  Sometimes providers want to know if dilation has started before labor has begun.  A check when you are admitted to the hospital is done to confirm dilation is happening during labor and can also be to show insurance enough progress has occured to justify admitting you.  During labor, many providers have an assumption of how quickly you should be dilating, so they check to see if your body is conforming to their assumption.

Cervical checks do not tell you how much longer until your baby is born.  They tell the provider how dilated your cervix is in the moment, and potentially how your baby's head is positioned in your pelvis.  A cervix can be at 4 cm dilation, and baby could be born in the next 30 minutes or less, or a cervix can be dilated to 9 cm and labor may last another 6 or more hours.  Honestly, I think medical providers feel the need to check dilation because they are not staying with you in the hospital as labor progresses, so they don't have the opportunity for assessing progress by external cues.

Cervical checks do have risks.  Cervical exams increase bacterial levels in the vaginal canal which might lead  infection, especially after the membranes have ruptured.  Even with the most scrupulous hygiene, and wearing sterile gloves for each check, that risk does not go away.  There is a risk they may unintentionally rupture the amniotic sac.  Cervical checks are uncomfortable and may cause stress or anxiety, which can slow your labor.  Cervical checks are subjective, dilation is estimated because we can't use a measuring tape to get a precise number, and the estimation may vary between providers.  I have seen this personally when the nurse estimates dilation at 7 cm, and the doctor checks within 10 minutes and estimates dilation at 5 cm.  Hearing that you have gone backward after hours of labor can be disheartening to put it mildly, and can cause unneeded stress.

I like to watch and wait for the body to let my clients know when dilation is complete.  Because cervical checks are uncomfortable, intrusive, have risks and don't give me big picture info, I rarely use them.  As a midwife, I understand each birth has its own unique pace and rhythm and my job is to support and nurture that, not try to manage it.
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During my prenatal visits, and at the home visit, I ask my clients who is catching baby.  See, I do not have to catch baby.  I don't own that as a midwife, and I love providing guidance for another agreed upon person to catch baby.  I have helped Moms, Dads and Grandmas catch babies.

Once I know who is catching baby, we discuss what that will look like. I explain to them that I will be there right next to them talking them through everything if they want. I also let them know that if I see anything concerning, I will tell them  and I might need to step in.  I talk to them about what I do if the cord is wrapped around a neck or shoulder and that I will let tell them if I see signs of the cord being wrapped.  If I do see cord wrapping, I help whomever is catching baby navigate that, or if it is a really tight cord or a complicated wrapping, I will jump in to help with navigating that.

I love being able to guide Mom or Dad in catching their own baby.  I honestly think it is wonderful that the first hands to touch baby are Mom or Dad's and not mine. If there is a reason for me to help, I do so as quickly as possible and then get baby into Mom or Dad's hands right away. 

We have all seen the pictures of a provider who has just caught a baby holding baby up like a trophy for everyone to see.  Everytime I see a picture like that I cringe.  Baby should not be put on display even for one second, your baby should be in your arms as soon as they are born with no delays.  

In my practice, I fully support my clients who desire to have someone else catch the baby and I do everything in my power to let that happen.  It is so satisfying to me as a midwife to enable and support that choice for clients.

I am a firm believer that there is no such thing as "one size fits all". I can assure you "one size fits all" does not apply to gloves or pajamas and it certainly doesn't apply to midwives.  

We are all individuals with unique personalities, needs and desires. We all have unique backgrounds, upbringing, family history, and so on.  This is part of what makes life interesting.  Being unique means that what works for one person may or may not work for someone else.  Being unique also means we may connect more with one person, and not connect as well with someone else.  I feel this is normal, and perfectly ok.  

As a midwife, I want to connect with my clients and I want them to connect with me.  A huge factor in the safety of home birth is trust.  Trust in the birth process, and trust in mom's body is important.  Even more important, in my opinion, is trust in your birth team, especially your midwife.  As I attend more births, that need for trust in the birth team has become more and more evident to me.  The births where there is a lack of trust just don't seem to work as well as births where trust is overflowing.  

Before I agree to serve a client, I need to meet them in person.  This is the chance for the client to interview me and for me to interview them as well.  During the interview I am looking for a connection, understanding and respect.  With those things in place, trust can be nurtured. If they are not there, I am not the midwife for that client. I want the very best outcomes for my clients and families, so there are times I have to turn down someone who wants to hire me. Likewise, I have interviewed with prospective clients who decided to hire a different midwife. I'm thankful those Moms recognized they connected better with a different midwife. I want potential clients to know if they have any doubts, or do not feel a connection, they should continue looking for a midwife to find the one they connect well with.  Knowing I am not the midwife for everyone who is pregnant makes me a better midwife for everyone.

I've been asked during interviews with prospective clients, and also by complete strangers who just learned I'm a midwife about the risks of having a home birth.  It's a good question that needs a straight answer.  However to understand the risks of home birth, you need to understand that birth in and of itself has an element of risk.  There are "low risk"  births but there is no such thing as a "zero risk" birth.  

What are the risks of birth?  There is a risk of baby being breech.  There is a risk of Mom tearing.  There is a risk Mom may have a hemorrhage.  There is a risk of shoulder dystocia. There is a risk baby may be in a posterior or other less than optimal position.  There is a risk baby may pass meconium before or during labor.  My list of risks is not complete, I decided to list the ones I have seen. These risks can be factors regardless of where birth happens.  I've seen shoulder dystocias in the hospital and in home births.  I've seen hemorrhages at the hospital and at home.  Births are not risk free.  Risks can be minimized or managed and for the majority of births, the risks are minimal.

Sometimes birth can be high risk.  For instance, a mother with a placenta covering all or part of the cervix is certainly dealing with more risk than a mother who does not have that issue.  A mother with high blood pressure has higher risks than someone who doesn't.  As a home birth midwife, I recognize I am not equipped or prepared to handle higher risk birth, so I monitor carefully to make sure pregnancy and birth remains normal to keep risk low.  I am particular about taking clients have low risk, healthy pregnancies.

The risks of home birth are exactly the same as at the hospital.  The biggest difference is that if there's a problem, care may be delayed due to needing to travel to the hospital.  In my midwifery practice, we discuss the risks and also have a plan if there is a need to get more help than I can provide.  During the birth I am constantly monitoring to ensure baby and mother are navigating labor well and that everything stays within the range of normal. Situations requiring immediate emergency care are thankfully uncommon. Usually we have time to arrange for a calm, orderly transfer of care.  I keep my training in emergency skills current and I practice them with my assistant on a regular basis so if there is ever a need to use them, we are ready.  I can't promise a risk free birth. I can promise that I will use my intuition, knowledge, and skills to the best of my ability to provide the best possible care and outcomes for my clients.