“How Do You Know If Your Cerclage Is Failing?” Signs of a Failing Stitch or an Incompetent Cervix, and When They’re Brushed Off
In this guide
If you have a cervical stitch, or have been told your cervix is short or “weak”, and something feels different, this guide is for you. It explains the signs that a stitch may be failing or a cervix opening, what is usually expected after a stitch, what should happen when you ring the hospital, and what you can do if you are brushed off. It also explains when being sent home may point to care that fell short.
Quick answer · updated November 2026
Many women feel very little. The signs to act on are pelvic pressure, a new backache, period-like cramps, a change in discharge, any bleeding, a trickle of fluid, or a fever. With a stitch in place, any of these should mean being seen and examined the same day, not reassured over the phone.
Living with a stitch, stage by stage
- 1The first daysSome spotting and discomfort are expected, and should settle.
- 2The watching weeksScans, and learning which changes matter.
- 3Something changesPressure, discharge, bleeding, cramps or fever.
- 4Being assessedSeen in person, examined, and usually scanned.
- 5If you’re not heardHow to escalate, and write it down.
At any stage: you are allowed to say, “I want to be seen.” You don’t need to be sure something is wrong to ask.
I was the one who rang. She was lying on the couch with a hot water bottle, the stitch in since fourteen weeks, twenty-three weeks along, and she said it felt like her period was coming. A heaviness, low down, that wouldn’t shift.
The birth unit put me on hold. I remember the music, some panpipe thing, looping. When the midwife came back she asked two questions. “Is she bleeding? Are her waters gone?” No and no. “Then it’s probably ligament pain, or a bit of thrush with all that discharge. The stitch is in. If it gets worse, ring back, otherwise she can mention it on Tuesday.”
I said thank you. I actually said thank you.
At six the next morning there was blood on the sheets. At the hospital the doctor looked with a speculum and went quiet, and then said the cervix had opened above the stitch and she could see the membranes. Our son was born that afternoon at twenty-three weeks and five days, and went straight up to the neonatal unit in a plastic bag to keep him warm.
I kept thinking about the panpipes, and about Tuesday.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
If you are reading this with a heaviness you can’t explain, I am glad you are looking. If you are reading it afterwards, wondering whether the signs were there and someone missed them, I am sorry, and I hope this helps you make sense of it.
This article is part of a series on failed cerclage and second-trimester loss. It covers the signs that a stitch may be failing or a cervix opening early, with or without a stitch; what is expected after a stitch and what isn’t; what should happen when you report symptoms; and what to do when you are told it’s nothing.
Why I can write this
I have been a medical negligence lawyer since 2013 and have worked on many hundreds of claims, a great many of them about pregnancy and birth. My doctorate looked at patterns of failure in medical negligence. I am not medically qualified. Clinical facts here are checked against named sources, including the RANZCOG statement on cervical length and King Edward Memorial Hospital’s cerclage information, and every source is listed at the end. If you have symptoms now, please contact your hospital rather than relying on this article.
Start with your question
- What are the signs of an incompetent cervix?
- What does a failing cerclage feel like?
- What’s normal after a stitch, and what isn’t?
- What does funnelling on a scan mean?
- What are the signs of infection after a cerclage?
- What should happen when I ring the hospital?
- What can I do if I’m not being listened to?
The signs of an incompetent cervix
Definition
Cervical insufficiency, still often called an incompetent cervix or weak cervix, is when the cervix shortens, softens and opens too early in pregnancy, usually without painful contractions, which can lead to a late miscarriage or a very early birth [1].
In plain terms: the neck of the womb starts to open months too soon, often quietly.
Many women dislike the word “incompetent”, and with reason; it can sound like blame. Nothing about it means your body, or you, did something wrong. I use it here only because it is the word people search for.
The hardest thing about cervical insufficiency is how little it can feel like. A medical guide notes that a weak cervix often causes few symptoms beyond the early labour itself [2]. The Mayo Clinic’s health library lists the signs to look out for [1]:
- a feeling of pelvic pressure;
- a new backache;
- mild stomach cramps;
- a change in vaginal discharge;
- light vaginal bleeding.
Each of these, on its own, is also something that happens in ordinary pregnancies. That is exactly why they get brushed off. The difference is context: if you have had a previous late loss, cervical treatment such as LLETZ, a short cervix on a scan, or a stitch, then these signs deserve to be checked, not explained away. RANZCOG lists previous preterm birth and cervical treatment among the risk factors that should prompt closer watching [3].
What does a failing cerclage feel like?
Women describe it in their own words, and I’ve heard many of them: “like the baby dropped overnight”, “a heaviness like my period was coming”, “more discharge than usual, sort of watery”, “a dull backache that wouldn’t go”, “pressure, like something was there”. Some notice nothing until bleeding or their waters break.
People also search whether a stitch can “tear” or “rip”. A stitch can cut through the cervix, especially if labour starts with it in place; that is why the stitch needs to come out promptly if contractions begin [4][5]. A UK hospital leaflet lists a tear in the cervix among the risks of a stitch, “especially if labour occurs with the stitch in place” [5]. Signs of that are usually bleeding and pain, and they need same-day assessment.
The underlying ways a stitch fails, such as the cervix funnelling above it, the waters breaking, infection or labour starting, are explained in the hub article “What Happens If a Cerclage Fails?”.
What’s normal after a stitch, and what isn’t
King Edward Memorial Hospital in Perth tells women that after a stitch some vaginal bleeding is expected, which should turn brown after a day or two, along with some lower tummy and vaginal discomfort [4]. It advises avoiding strenuous exercise, heavy lifting, swimming and sex for two weeks, and says the stitch is usually removed at about 36 to 37 weeks [4].
Usually expected in the first days
- Some bleeding that turns brown after a day or two
- Mild lower tummy discomfort
- Some vaginal discomfort
In plain terms: it should be settling, not building.
Get checked straight away
- Contractions or cramping
- Vaginal bleeding, or bleeding that isn’t settling
- Your waters breaking, or a trickle of fluid
- Smelly vaginal discharge
- A fever, high temperature or chills
- Pelvic pressure or a new backache, if you have a stitch or a short cervix
In plain terms: ring your birth unit and ask to be seen today.
Sources: King Edward Memorial Hospital cerclage information [4]; pressure and backache from the Mayo Clinic health library [1]. If you can’t reach your hospital, KEMH advises calling Healthdirect on 1800 022 222, contacting your doctor, or going to your nearest emergency department [4]. In an emergency, call 000.
Funnelling and a short cervix on the scan
Definition
Funnelling is effacement of the internal part of the cervix, seen on ultrasound [3]. Cervical length is the measured length of the cervical canal, most accurately measured with an internal (transvaginal) scan [3].
In plain terms: funnelling means the top of the cervix, inside, has started to open like a funnel, even though the outside may still be closed. A shorter cervix in mid-pregnancy means a higher chance of an early birth.
Sometimes the first sign isn’t a feeling at all; it’s a word on a scan report. RANZCOG notes that funnelling is associated with early birth, though it may add little to an accurate measurement of length on its own [3]. What matters is that a short cervix or funnelling, once seen, is acted on: a plan for progesterone, more scans, or a stitch, depending on your history. If you were told about funnelling and nothing followed, the series article “Do They Check Your Cervix at the 20-Week Scan?” explains what should have happened.
Infection: the cause that can be silent
Infection can weaken the membranes and start the cervix changing, and it can follow when the waters break. The signs KEMH lists after a stitch include smelly vaginal discharge and fever, high temperature or chills [4]. Some women simply feel generally unwell. Infection is often only confirmed afterwards, when the placenta is examined, which is why the placental pathology report matters so much later on.
If your waters have broken, or you are leaking fluid, the series article “My Water Broke at 20 Weeks” covers what happens next, including whether the stitch stays in.
What should happen when you ring the hospital
A phone call is a triage tool, not an assessment. With a stitch in place, or a known short cervix, the safe answer to symptoms like these is usually to bring you in, not to reassure you over the phone. The questions “Are you bleeding? Have your waters gone?” matter, but a “no” to both doesn’t rule out a cervix that is opening quietly.
You ring
Your symptoms, your stitch and your history are written down.
You’re seen
Observations, including temperature and pulse, and your baby’s heartbeat.
You’re examined
Often a speculum examination, and usually an internal scan to measure the cervix.
A plan
Explained to you, written down, with what to do if things change.
RANZCOG notes that an internal scan of the cervix is safe in pregnancy, even after the waters have broken, and can help define care for women with symptoms of early labour [3]. Exactly what is done depends on how many weeks pregnant you are and what is found. But being seen, examined and given a plan is the baseline.
Questions to ask
- “I have a stitch. Can I be seen today, rather than waiting?”
- “Can you check my cervix and do an internal scan?”
- “Is there any sign of infection? What were my temperature and pulse?”
- “What is the plan, and what should make me come straight back?”
- “Can you write that in my notes?”
When you’re brushed off
These are the phrases families tell me they heard: “It’s probably ligament pain.” “Sounds like Braxton Hicks.” “Discharge is normal in pregnancy.” “Could be a bit of thrush.” “The stitch is in, so you should be fine.” Each might be true in a different pregnancy. In yours, with a stitch or a short cervix, each deserves an examination before it is accepted.
If you are in a NSW public hospital and worried that you, or your partner, are getting worse and no one is responding, there is a statewide process called Raise It, previously known as REACH [6][7].
Talk
Tell a nurse, midwife, doctor or health worker what you’re worried about.
“I have a stitch and something has changed.”
Ask
If you’re still worried, ask the nurse or midwife in charge for a clinical review.
“I’d like a clinical review, please.”
Call
If you still have concerns, call the statewide number and a senior health worker will respond.
If you are at home, you can ring your birth unit back and say you want to come in, or call the Pregnancy, Birth and Baby helpline on 1800 882 436 to speak with a maternal child health nurse [8]. Two practical things help: have someone else on the call with you, and write down the time, who you spoke to and what they said. If you felt dismissed, you might also find this article on not being believed by a doctor helpful.
Our son came home at four months, on a little oxygen line that trailed behind us from room to room. Months later, we requested the records, mostly because she wanted to see his first hours.
My phone call was in there. Time, date, a midwife’s initials. “Partner calling. 23/40, cerclage in situ. Period-like pain, heaviness, increased discharge. No PV bleeding, SROM nil. Reassured, likely ligament pain. Advised review Tues.”
Reading it, I had two feelings at once. Relief, that I hadn’t imagined it, that I’d said all the right things. And something heavier, that I’d said all the right things and it still hadn’t been enough to get her seen.
When we met the specialist about any future pregnancy, I was the one who brought it up. She read the note and said, “With a stitch, that’s a come-in call.” Now I keep the Raise It number in my phone, and I don’t say thank you until someone has actually looked.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
What to look for in the records
| Record | Why it matters |
|---|---|
| Phone and triage notes | Shows what you reported, the time, who answered, and whether you were told to come in or wait. |
| Cerclage operation note | Shows the type of stitch, why it was placed, and the follow-up plan, including scans. |
| Antenatal card and clinic letters | Shows whether symptoms you mentioned at appointments were recorded and acted on. |
| Scan reports | Shows cervical length over time, funnelling, and any recommendation for review. |
| Assessment unit or emergency notes | Shows observations, examination findings, scan results, and the plan when you were sent home. |
| Observations and swab results | Temperature, pulse and swabs can show early signs of infection. |
| Stitch removal and birth notes | Shows when labour was recognised, when the stitch came out, and the timeline of birth. |
| Placental pathology | Often shows whether infection was present, which bears on what caused the early birth. |
| Escalation or incident records | Shows whether a clinical review was requested and what happened. |
My guide to getting and reading your birth records explains how to request them.
How the law looks at it
Being sent home is not, by itself, negligence. Symptoms are sometimes nothing, and clinicians make judgement calls with the information they have. The law asks whether the response fell below what was widely accepted as competent practice, under section 5O of the Civil Liability Act 2002 (NSW) [9]. With a stitch in place and symptoms like pressure, cramps or changed discharge, an expert would ask whether competent practice required an in-person assessment, and whether the phone advice reflected the woman’s history. Guidelines and hospital patient information are evidence of competent practice, not the law itself.
The law then asks whether better care would probably have changed the outcome. In Australia, losing only a chance of a better outcome isn’t enough: Tabet v Gett [2010] HCA 12 [10]. In plain terms, if you had been seen that evening, would your baby probably have been born later, or been born in better condition, for example because steroids or antibiotics could have been given in time? That is a question for independent obstetric opinion.
You are also entitled to be told the material risks of a stitch and what to watch for afterwards: Rogers v Whitaker [1992] HCA 58 [11]. Being sent home without clear warning signs is part of that picture.
Who can claim depends on what happened: the mother for her own injury; the family if a baby was born alive and died; or the child, if a baby survived with lasting injury from being born early. If your child was born early, their time limits don’t always wait until they turn 18, so please ask early. The series article “Can I Sue the Hospital for My Miscarriage or Stillbirth?” and my page on pregnancy loss and stillbirth claims explain who can claim and how time limits work, and my guide to time limits in NSW has more.
In my practice
The phone note is one of the most important pages in these files, and one of the shortest. I see the same pattern again and again: a woman with a stitch, or a known short cervix, reports pressure, cramps or discharge; the call is triaged on two questions, bleeding and waters; the answer is no; she is reassured. Her history is on another page, in another system, and doesn’t travel with the call. The chain that follows is short and fast: the cervix keeps opening overnight, labour starts, and by the time she is seen, the window for steroids, antibiotics or transfer to a hospital with a neonatal intensive care unit has narrowed. Not every one of these files shows negligence. Sometimes the cervix changed so fast that coming in earlier wouldn’t have changed anything. But the question is always worth asking.
Both can be true
The midwife who answered that phone may have been kind, busy, and doing what she was trained to do. And the advice may still have been wrong for a woman with a stitch. You can hold both. Asking what happened isn’t about blaming one person on one night; it is about whether the system made it easy for her to get it right, and whether the next caller will be told to come in.
The bigger picture
Not being listened to is one of the most common themes in birth trauma. The NSW Legislative Council’s Select Committee on Birth Trauma reported on 29 May 2024, after more than 4,000 submissions, with 43 recommendations [12]. NSW Health has supported patients and families to escalate concerns about deterioration since 2013, through REACH, now part of Raise It [6], and in March 2026 encouraged patients, families and carers to use it [13]. On the clinical side, RANZCOG’s cervical length statement, due for review this month, reflects how much more is now known about predicting early birth [3]. If you have concerns about an individual practitioner or service, the Health Care Complaints Commission can receive a complaint.
Support
These services are free.
- Pregnancy, Birth and Baby, a free call with a maternal child health nurse: 1800 882 436 [8]
- Miracle Babies Foundation NurtureLine, 24-hour support for families with a threatened pregnancy or a baby in NICU: 1300 622 243 [14]
- Red Nose Grief and Loss, 24/7 support after pregnancy loss, stillbirth or the death of a baby: 1300 308 307 [15]
- PANDA, the National Perinatal Mental Health Helpline: 1300 726 306 [16]
- Lifeline, if you are in crisis: 13 11 14
My guide to finding support after birth trauma in Australia has more.
The father in the stories still has the hold music in his head sometimes. But he has the number in his phone now, and a sentence ready: “She has a stitch. We’re coming in.”
With care,
Rosemary
Frequently asked questions
How do you know if your cerclage is failing?
Often there are few signs. Watch for pelvic pressure, a new backache, cramps, changed or watery discharge, bleeding, a trickle of fluid or fever, and get checked the same day if any appear.
What does a failed cerclage feel like?
Women describe heaviness “like my period was coming”, a feeling the baby has dropped, more discharge, or a dull backache. Some feel nothing until bleeding or their waters break.
What are the signs of an incompetent cervix?
A feeling of pelvic pressure, a new backache, mild cramps, a change in vaginal discharge and light bleeding, usually in the second trimester and often without painful contractions.
What are the signs of infection after a cerclage?
Smelly vaginal discharge, a fever, high temperature or chills, cramping, or feeling generally unwell. These need same-day assessment.
Can a cerclage tear?
Yes. A stitch can tear the cervix, especially if labour starts with it in place, which is why it is removed promptly once labour begins. Bleeding and pain need urgent assessment.
What should I do if the hospital tells me to wait?
Say you have a stitch and want to be seen today. In a NSW public hospital, you can ask for a clinical review and then call Raise It on 1800 777 333.
Questions about being sent home?
When you’re ready, and not before, I can go through what happened and your records with you, and tell you honestly whether there are questions worth asking.
When the Stitch Doesn’t Hold: the series
- “What Happens If a Cerclage Fails?” Failed Cerclage and Losing a Baby in the Second Trimester
- “Can I Sue the Hospital for My Miscarriage or Stillbirth?” Time Limits and Compensation After a Second-Trimester Loss
- “Do They Check Your Cervix at the 20-Week Scan?” Short Cervix, Funneling and Missed Risk Factors
- “How Do You Know If Your Cerclage Is Failing?” Signs of a Failing Stitch or an Incompetent Cervix, and When They’re Brushed Off (you are here)
- “Emergency Cerclage at 20 Weeks”: Rescue Stitches, Bulging Membranes, Risks and Success Rates
- “My Water Broke at 20 Weeks”: PPROM, Infection After Cerclage and What Happens Next
- “Baby Born at 22 Weeks”: Survival Rates, NICU and Comfort Care
- “Is 20 Weeks a Miscarriage or a Stillbirth?” Giving Birth, Funerals, Certificates, Leave and Payments
- “Why Am I So Angry After My Miscarriage?” Anger, Blame and “Is It My Fault?” After a Second-Trimester Loss
- “Transabdominal Cerclage in Australia”: Before Pregnancy, Success Rates and When It Fails
- “Pregnant Again After a Second-Trimester Loss”: How Long to Wait, a Preventative Stitch and Progesterone
More: Pregnancy loss and stillbirth claims · Birth trauma and obstetric negligence · Asking for a birth debrief · Complaining to a hospital · The birth injury map
References
- Mayo Clinic Health Library, via Altru Health System, Incompetent cervix.
- MSD Manual (consumer version), Cervical insufficiency, reviewed May 2023.
- RANZCOG, Measurement of cervical length for prediction of preterm birth (C-Obs 27), current November 2021, review due November 2026.
- Women and Newborn Health Service (King Edward Memorial Hospital, WA), Cervical cerclage: patient information, 2025.
- University Hospitals of Leicester NHS Trust, Having a cervical stitch (cerclage) in pregnancy, 2024.
- Clinical Excellence Commission, REACH and Raise It.
- NSW Health, Raise It.
- Pregnancy, Birth and Baby, Freecall numbers.
- Civil Liability Act 2002 (NSW), s 5O.
- Tabet v Gett [2010] HCA 12.
- Rogers v Whitaker [1992] HCA 58.
- NSW Legislative Council Select Committee on Birth Trauma, Birth trauma, Report 1, May 2024.
- NSW Health, Patients, families and carers encouraged to Raise It, March 2026.
- Miracle Babies Foundation, NurtureLine.
- Red Nose, Grief and Loss Support Services.
- PANDA, National Perinatal Mental Health Helpline.
The stories in this article are composites, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. They do not describe any individual client.
About the author
Dr Rosemary Listing, PhD (Law), specialises in medical negligence, has been in practice since 2013, and is Of Counsel at Peter Evans & Associates in Newcastle, NSW. Her doctorate looked at patterns of failure in medical negligence, and she teaches health law at the University of Newcastle. She is not medically qualified; clinical information in this article is checked against the sources listed.
Last updated: November 2026 · First published: November 2026 · Next review: May 2027
Cite this article: Rosemary Listing, ‘“How Do You Know If Your Cerclage Is Failing?” Signs of a Failing Stitch or an Incompetent Cervix, and When They’re Brushed Off’ (Reframe Legal, November 2026) <https://reframelegal.com/how-do-you-know-if-your-cerclage-is-failing/>.
This article is general information, not legal or medical advice. Every situation is different; please get advice about your own circumstances. If you have symptoms now, contact your hospital. If you or your baby need urgent help, call 000. If you are in crisis, call Lifeline on 13 11 14.
Legal services are provided by Peter Evans & Associates.
