Cervical Dilation & Effacement with a Fruity Theme
What is the Cervix?
Cervix in Latin means neck (English Dictionary, 2008). Anatomically, picture the cervix being the neck of the uterus. You can also think of the cervix as the protection gate that keeps your baby inside the uterus until ready for birth.
Where is the Cervix?
A woman’s cervix lies between the uterus and the vagina. The side inside the uterus is called the internal os, the side at the top of the vagina is called the external os.
What is Cervical Ripening?
Your cervix starts out like a green tomato, firm and strong. Towards the end of pregnancy your cervix will ripen like a tomato becoming soft and squishy. This cervical ripening is essential as it assists the cervix to efface and dilate.
What is Effacement?
Effacement is when the cervix becomes thinner. The average cervix size is between 3-5cm thick (Jordan, 2013). Effacement is measured in percentages. Your provider or nurse might say, “Your 25% effaced”. What in the world does this mean? It means your cervix has decreased in thickness by 25%. The average person’s cervix will start at 0% (4cm) to 25% (3cm) to 50% (2cm) to 75% (1cm) to 100% just paper-thin and very close to delivery!
What causes your cervix to efface?
As you progress closer to labor or as you go into labor, contractions will put pressure on your cervix. If we go back to the analogy of your cervix being like a protection gate for your baby to the outside world, picture your baby pushing on those gates and with every strong contraction those gates are becoming thinner and wider!
What is Dilation?
Dilation is when the cervix becomes wider. A score of 0 is when a woman’s cervix is completely closed and most likely has never been through vaginal birth before. A score of ten is what the Nurse or Physician calls “complete” meaning it may be time for the mother to start pushing! A women’s cervix must be dilated to a 10 before delivering a full term baby. The cervical dilation is demonstrated in the picture above. I’ll admit I gave a little chuckle when I thought how fitting a papaya for 10cm because PAPAYA just seems something appropriate to scream at that time in point. Haha.. too cheesy? But in all seriousness, how incredible is it that your body was made to do this!
“How long will it take me to dilate from 1cm to 10cm?”
This question is one of the most common questions I get from my patients. The answer is… drum roll… Everyone is different! The rate of how quickly you dilate is influenced by many factors and is difficult to predict. Research done by Dr. Friedman has been previously accepted to suggest that the average labor progresses by 1.2cm/hr in active labor. A more recent study in 2010 showed 80-90% first time moms that go into labor (without being induced) dilate at least .5cm/hr when in active labor. This recent study suggests that Friedman’s expectation of 1.2cm/hr may be unrealistically fast (Neal, Lowe, Patrick, Cabbage, & Corwin, 2010). Another recent study also concluded that Friedman’s curve should not serve as the regular standard but more as the ideal (Shang, Troendle, & Yancey, 2002).
*Take home message… be as patient as you can with yourself 🙂
During your labor, with your consent, the Nurse or Physician will be checking your cervix regularly to assess the progression of labor. We do this by doing Sterile Vaginal Exams (SVE) also called a Cervical Exam. These exams give important information to the Provider such as cervical effacement, cervical dilation, if the baby’s head is down, how far down the baby is, and the status of your membranes (if your bag of waters “amniotic fluid” has broken). This information is important because it helps the health care team make key decisions to manage your labor.
How is a Cervical/Vaginal Exam Done?
The nurse will ask you to lie flat in the bed and bring your feet together and knees wide (like a frog… ribbit!). A TIP... To make these vaginal checks less uncomfortable for you (especially if you have been told you have a posterior cervix) make your hands into fists and place them right under your sit bones. This maneuver helps to tilt your pelvis up towards the ceiling making the cervix more accessible. The Provider or Nurse will then check you with a sterile glove and a little K-Y jelly. Try to relax, this will help the check be over faster for you!
A little something you should know about Vaginal Exams: It is normal to bleed a little after a cervical exam as the cervix is a very vascular tissue. Cervical exams may also stimulate your uterus causing a couple of small contractions.
And that’s what the Mommy To Be should know about cervical dilation and effacement! It’s a voyage from a blue berry to a papaya! You can do it!
Jordan, Elizabeth T., (February 27th, 2013). Moms-To-Be: What You Should Know About Cervical Length. National Healthy Mothers, Healthy Babies Coalition. Retrieved from http://www.hmhb.org/2013/02/moms-to-be-cervical-length
English Dictionary (2008). Latin Dictionary. Retrieved from Latin-Dictionary.org
Neal, J. L., Lowe, N. K., Patrick, T. E., Cabbage, L. A., & Corwin, E. J. (2010). What is the slowest-yet-normal cervical dilation rate among nulliparous women with spontaneous labor onset? Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN / NAACOG, 39(4), 361–369. doi:10.1111/j.1552-6909.2010.01154.x
Zhang J, Troendle J, Yancey M. Transactions of The Twenty-Second Annual Meeting of The Society for Maternal-Fetal Medicine: Reassessing the labor curve in nulliparous women. American Journal Of Obstetrics And Gynecology [serial online]. October 1, 2002;187:824-828. Available from: ScienceDirect, Ipswich, MA. Accessed January 15, 2015.