Does It Hurt When They Check For Dilation

Cervical Evaluation: From Ancient Medicine to Precision Medicine

Helen Feltovich

Maternal Fetal Medicine, Intermountain Healthcare, Utah Valley Hospital, 1034 N 500 W, Provo UT 84604 & Associate Scientist, Department of Medical Physics, University of Wisconsin-Madison, Madison WI 53705Since ancient times, cervical assessment for predicting timing of delivery has relied primarily on digital (subjective) assessment of dilatation, softening and length. To date, transvaginal ultrasound cervical length is the only one of these parameters that meets criteria for a biomarker; no objective, quantitative measure of cervical dilatation or softening has gained clinical acceptance. This review discusses how the cervix has been assessed from ancient times to the present day, and how a precision medicine approach could improve understanding of not only the cervix, but also parturition in general.

Dilatation

Soranus taught that a midwife should do frequent intrapartum examinations to monitor progress of labor. Similarly, the Friedman labor curves were based on digital appreciation of dilatation, although Dr. Friedman himself was keen to find something more objective and quantitative than the practitioner’s finger. Toward this end, he and others developed cervimeters. These were instruments based on electrical, mechanical, magnetic, or ultrasonic principles, which used calipers, strings, electromagnetic coils, or ultrasound transducer crystals affixed to the cervix and coupled to some means, outside the vagina, of recording dilatation. An example is Friedman’s 1956 device: proximally, bulldog clips affixed the calipers to the cervix while the handles on the distal end were connected to a centimeter rule that depicted cervical diameter (Figure 2). Electromagnetic cervimeters used induction coils attached to opposite sides of the cervix to create a magnetic field that allowed calculation of the distance between them, and an ultrasonic device was based on the same principle but instead used two tiny ultrasound transducers. The problem with these devices was that they easily fell off the cervix. Even when they remained affixed, they demonstrated no advantage over digital evaluation and so they disappeared by the 1980s, leaving practitioners with nothing but their fingers to measure dilatation.

Softness

Clinical assessment of softness is perhaps the best example of imprecision with respect to cervical evaluation. The first published use of elastography in the pregnant cervix, in 2007, used manual (extrinsic) compression for tissue deformation. Similar to the device of the 1960s. marked measurement variability was noted, attributed in large part to an inability to standardize the…

FAQ: Does it hurt when they check for dilation?

Does it hurt when they check for dilation?
The process of checking cervical dilation during labor can be uncomfortable, but it is generally not considered extremely painful. Here are some key points about the discomfort associated with cervical checks:

• Cervical checks involve the healthcare provider inserting one or two gloved fingers into the vagina to assess the cervix and determine how dilated it is. This can cause a sensation of pressure or stretching.
• The level of discomfort can vary depending on factors like the stage of labor, the provider’s technique, and the individual woman’s pain tolerance. Checks tend to be more uncomfortable as labor progresses and the cervix becomes more effaced and dilated.
• Many women describe the sensation as similar to a strong menstrual cramp or a “tugging” feeling. The discomfort is usually brief, lasting only 30 seconds to a minute.
• Techniques like slow, gentle insertion of the fingers and providing counterpressure can help minimize discomfort during cervical checks.
• Pain management options like epidurals, nitrous oxide, or other medications can also help reduce discomfort from cervical exams, especially during active labor.
• Communicating with the provider about any pain or discomfort is important, as they can adjust their approach to make the process more comfortable.

Overall, while cervical checks are not entirely painless, the discomfort is generally manageable for most women. The provider’s skill and the woman’s pain tolerance are key factors in determining the level of discomfort experienced.

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