Description and Official Rationale
Both nurses and physicians insert gloved hands into laboring women's vaginas to find out how many centimeters the cervix has dilated, how far it has effaced (thinned out), and whether or not the membranes are intact, as well as to check on the insertion of the internal monitor and to measure fetal descent during second stage. Under the technocratic model, cervical checks are very important and must be performed at regular intervals, as a woman has only so many hours available to her for labor; if her progress along Friedman's curve is not steady, interventions must be instituted.
Cervical exams are often quite painful. The pain they cause is increased when the exam is performed during the height of a contraction--as is often the case because more information can thus be obtained. These exams are most likely to be performed by the attending nurses or physician, but, in teaching hospitals, any resident in need of practice is likely to pop in without introduction. Each exam performed increases the possibility of infection of the mother, especially if her membranes have been ruptured. Heightened maternal tension and anxiety can result from the disruption of her breathing exercises and of the natural rhythmicity of her labor, as well as from the psychological stress produced when the mother is told that she is not progressing well--as in Patricia's following response.
They would do exams every once in a while. I got some real conflicting reports on them....They really didn't bother me. It was exciting to find out how far along I was. But the strange thing is, the doctor and the nurse were doing them at different times. It was going along--I was 8 and then I was 9 and then I was 7--you know, that began to disturb me and that was kind of a problem.... Supposedly you don't go backwards. That would get discouraging when I was finding out I was 9. I thought I was really close and then to go back and I was 7, and it was still going to be a long time.
-Patricia Hellman [After taking the Demerol] I would doze between contractions and] wake up to this blinding, overwhelming pain. But then Stan would grab me and we'd look at each other, and I'd do the breathing, and you know, we were maintaining well. But then every hour they would come and do a cervical exam, you know? God, that was painful. That was the worst part of all of it, when they stuck their fingers up in there. After I had the baby, about six weeks later when I went back for my checkup the doctor said, "You know, it's a wonder you didn't get an infection with all those people sticking their hands up inside of you."
-Lisa Smith The routine cervical checks they did every hour really bothered me, because they threw off my breathing.
-Terry Lutzer
Any strategies, from ambulation to breathing to taking showers, that the mother has developed for coping with her labor in her own way can be disrupted by the frequent performance of vaginal exams "for her own good." Brigitte Jordan (personal communication) points out that such exams are only necessary under the technocratic model which so drastically attempts to minimize production time. In no other culture have such invasive, disruptive, and painful procedures been performed with such frequency and regularity as in the American hospital. In Holland, a country whose infant mortality and Cesarean rates are considerably lower than our own, such exams are considered necessary much less often than in the U.S.--women are encouraged to push when they experience the urge to push, not when and only when their cervix has reached the arbitrary standard of 10 centimeters dilation. These frequent production control checks are necessitated by the standardization of American birth, not by the physiological needs of the birthing woman and her child.
Frequent cervical checks drive home to the laboring woman the physical significance of the messages about time, about the suspected defectiveness of her own body, and about her lack of status and power relative to the hospital staff (the institution's representatives) and the institution (society's representative). When they are painful, cervical checks also function as part of the impersonal hazing of the initiate, the ritual process she must undergo to ensure the complete breakdown of her category system so that she will be as psychologically open to the reception of the messages imparted by her birth experience as possible. Cervical checks powerfully intensify the process of symbolic inversion begun with the "prep"--to have a series of strangers sticking their hands through her vagina and deep into her cervix approaches the extreme of opposition to a woman's usual ideas of appropriate relations between herself and society--an extreme that will ultimately be reached on the delivery table with the lithotomy position.
