Navigating Cervical Exams in Pregnancy as an Abuse Survivor
Cervical Exams in Pregnancy
Cervical exams in pregnancy aren’t the most exciting thing, especially if you are a survivor of abuse or trauma. As Rebecca Dekker from Evidence Based Birth says, “The thing about cervical checks towards the end of pregnancy is that they can be uncomfortable physically and emotionally, especially for women who may have a history of past sexual trauma or abuse.” Before we dive into this topic and deciding if this is something you want to accept or decline, first let’s go over what it is we are talking about.
If you are worried about navigating cervical exams during pregnancy because you are a survivor of abuse, you need to read this! You have options that can help you feel safe. #pregnancy #survivor #abuse
What is a cervical exam?
Cervical exams, vaginal exams, pelvic exams, internal exams, etc. are all different names that in pregnancy are generally referring to the same thing. It’s an exam by a medical professional to look and feel inside the vaginal opening. These exams can determine dilation, effacement, and ripeness of the cervix and evaluate fetal positioning and station in the pelvis (how low or high baby’s head is in relation to the opening of your pelvis).
If it is a full pelvic exam for a pap smear, a speculum will likely be used to hold the vagina open. If it is only to check for dilation, it the exam is most likely just gloved fingers that are inserted.
If you are worried about navigating cervical exams during pregnancy because you are a survivor of abuse, you need to read this! You have options that can help you feel safe. #pregnancy #survivor #abuse
Abuse Survivor
As a survivor of abuse, you may have some additional hesitance when it comes to cervical exams. If you are a survivor of sexual abuse, having a provider insert their fingers into your vagina may cause you anxiety, discomfort, or even flash backs.
The important thing here is even in pregnancy, you retain autonomy over your body. You get to decide if and when someone is allowed to touch you, especially in intimate areas.
Just because something is “for the baby” or pregnancy related, doesn’t mean you suddenly are not allowed to say no. While there are different schools of thought about the importance and effectiveness of cervical exams in pregnancy, there are some cases where the benefits may outweigh the risks.
What are the benefits of cervical exams?
Cervical exams can tell us information about your cervix such as if you have started to dilate or efface. Effacement refers to the percentage your cervix has thinned and dilation refers to the number of centimeters your cervix has opened. 10 cm is considered fully dilated or complete and the point in labor where you start pushing.
The tricky thing here is deciding if this is medically necessary information in your case or not. Some people don’t dilate until they are in labor and others are walking around at 4 cm dilated for weeks before going into labor.
Your cervix is not a crystal ball and determining your effacement and dilation will not tell you when you will give birth.
If your provider is concerned about your baby and suggesting a medical induction, knowing if you are dilated or how dilated you are may influence the type of induction technique used and possibly give you an idea of if an induction at that point would be successful or not.
A cervical exam can also help a provider check for fetal positioning, though there are other alternative ways to accomplish this without any fingers entering your vagina.
If you are worried about navigating cervical exams during pregnancy because you are a survivor of abuse, you need to read this! You have options that can help you feel safe. #pregnancy #survivor #abuse
What are the risks of cervical exams?
Cervical exams carry the risk of infection as well as premature rupture of membranes (PROM). Any time something enters the vagina there is a risk of infection (even with sterile gloves). If your membranes are already ruptured or your “water broke”, you are at a higher risk of infection with a cervical exam.
If your water is not yet broken, the exam itself can in some cases cause your water to break. If you are not yet in labor when your water breaks (PROM), your provider may recommend medical induction if labor doesn’t start on it’s own within a certain time frame to prevent increased risks of infection.
Another possible risk is that some providers may do a membrane sweep without consent while doing a cervical exam. This can in some cases start labor, but can also be uncomfortable or even painful. A membrane sweep can also cause uncomfortable contractions that do not lead to labor starting. While a membrane sweep can be an effective option to induce labor without a medical induction, it should only be done with your full consent.
Deciding if a cervical exam is right for you
Ask your provider why they want to preform the exam. What is the information they hope to gain? What will that information be used for? Is there an alternative way to get the same information?
If you decide that a cervical exam is needed in your case, talk to your provider about any fears or anxiety you have. If they are aware of your abuse background, they may be more understanding about talking you through each step of the exam.
Perhaps requesting a juvenile sized speculum (if applicable) or requesting to insert it yourself may be helpful. A speculum is more commonly used in a pap smear than a cervical exam to check for effacement or dilation.
Talking to your provider and having the reassurance that they will stop if at any point you ask them to stop is also helpful.
You deserve to feel safe.
If you feel like you can't openly discuss your concerns or don't trust that your provider will respect your requests, those are good signs that you may need a new provider.
Community midwives typically offer well woman care and are usually more trauma informed than your average OB (this is absolutely a generalization and there are many fantastic OBs out there).
Even if you plan to deliver in a hospital with an OB, seeing a community midwife for a pelvic exam may be an option if you don't feel comfortable with your doctor and don't want to completely switch providers.
If the conversation about your abuse history is not something you are ready to do, perhaps a letter to your provider could be a nice alternative. I have a template letter you can use and personalize in my free resource library for this very reason!
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If you are worried about navigating cervical exams during pregnancy because you are a survivor of abuse, you need to read this! You have options that can help you feel safe. PLUS get a free template letter to your provider #pregnancy #survivor #abuse
Impact of Trauma
Trauma impacts many areas of our lives, many times in ways we don't even realize until we are confronted with something like a cervical exam that brings it all back up. It can be uncomfortable and distressing to be faced with memories and feelings that you have shelved for sometimes many years.
Don't forget that you are in control.
You make the decisions.
Your doctor or midwife is your hired medical expert giving you advice. Their job is to go over the risks and benefits of all of your options and give their recommendations. It's up to you to say yes or no.
You decide.
If your provider does not see their role that way, you may want to consider switching to a new provider.
If you are worried about navigating cervical exams during pregnancy because you are a survivor of abuse, you need to read this! You have options that can help you feel safe. #pregnancy #survivor #abuse
Coping with Discomfort
If you decide to get cervical exams in pregnancy, plan for ways to make it as easy as possible. Are you more comfortable with a friend or your partner being in the room with you? Have you taken a birth class?
During an exam is a great time to practice your relaxation and breathing skills that you have learned for labor!
Remember: You can do hard things!
