Cervical Dilation and Effacement
November 19th, 2009
“Cervical dilation” and “effacement” are terms that you will hear your care provider talk about toward the end of your pregnancy and throughout your labor. These terms refer to the opening and thinning of the cervix. Dilation is measured in centimeters, from 0-10cm, and being at 10 cm means that you are fully dilated and can start push when you feel the urge to do so. Effacement is the thinning and shorting of the cervix measured in percentages, from 0-100%, and being at 100% means your cervix is paper-thin.
It is not uncommon for me to hear students come in and proclaim that they are 1cm dilated and expect labor to start any moment. Realistically, that is probably not going to happen. You can walk around dilated for several weeks before the onset of labor. As a labor support doula, I am more interested in how effaced a client is than how dilated. If the cervix is not shortening and thinning it doesn’t really matter much that it is has opened a bit. The cervix will not open significantly if it is not effaced very much. Once the cervix is on its way to fully becoming effaced, change in dilation will often happen.
What can you do to help effacement? The cervix becomes soft or effaced by the secretion or application of prostaglandins. “Prostaglandins are produced by the mother’s body as well as by the fetus and placenta.” (Holistic Midwifery pg 190) However, there are some other nonpharmaceutical ways to help ripen the cervix. Since semen contains prostaglandins, sexual intercouse is one of the best, natural ways to apply prostaglandins directly to the cervix. I know that toward the end of pregnancy, that may not seem all that appealing, so you can also insert evening primrose oil directly into the vagina. Please note: THIS IS NOT TO BE DONE IF YOUR MEMBRANES HAVE BROKEN! The recommended dosage is 2,500mg capsules a day. This can also be done by taking the oil capsules orally if you are not comfortable with inserting it vaginally.
Another natural method is called “stripping the membranes,” but again, note: THIS PROCEDURE NEEDS TO BE PERFORMED BY A MIDWIFE OR DOCTOR! It is done by the doctor or midwife inserting two fingers inside the cervix and separating the amniotic sac from the cervix. This may stimulate the body’s natural production of prostaglandin. “In two studies, sweeping the membranes successfully induced labor in half the cases attempted.” (Ina May’s Guide to Childbirth. Pg 216.)
If your cervix is not ripening on its own and, for a medically sound reason, your care provider is advising you to be induced, you will receive a vaginal suppository of either cervidil or cytotec. These both contain prostaglandins to help soften the cervix and make it favorable for dilation.
Take a look at the picture below to get an idea of how the cervix shortens and thins out.
Before moving on to discussing dilation, I also want to take a moment to mention the mucus plug. This is just an accumulation of secretions that forms a seal in the cervical canal. Its main function is to create a barrier for infection. As the cervix starts to change, the mother will notice the passing of the mucus plug. Some women describe it as clumpy mucus others experience the release as more of a stringy mucus discharge. The color can be anywhere from pinkish to slightly brownish. The passing of the mucus plug does not guarantee the rapid onset of labor, just an indication that some change is starting to happen.
Cervical dilation can best be described as the baby’s head pushing through a turtleneck sweater. It is the downward pressure applied directly to the cervix that causes the cervix to open. A well-applied head is regarded as being more efficient at dilating the cervix during labor. This pressure is made possible by the uterus contracting around the baby and pushing it downward. Gravity also helps apply pressure to the cervix, which is why squatting can be so beneficial and productive. If you are either stalled in labor or hit a plateau in dilation, it could be a result of poor fetal positioning. Read “Explanation of Fetal Of Position” for more details.
Although this is not to scale, you can get an idea of how the cervix widens and thins until there is no cervix left, at which point full dilation (10 cm) has been reached.
Also keep in mind that second or third time, mothers tend to dilate more, up to 3 or 4 cm before labor even starts. Some mothers may experience this kind of dilation for several weeks before the onset of labor.
The whole reason I was prompted to write this blog was the many questions and concerns that have come up in class. One mother was particularly concerned about doing yoga at 37 weeks pregnant, being 1cm dilated. I always refer to the care provider should there be a medical reason I am unaware of, but for most women, it is fine to continue your yoga practice right up until labor, dilated or not. I wish I could say yoga will help further efface or dilate the mother’s cervix and start labor. The best I can offer is that the yoga practitioner walks (or waddles) out of class more relaxed which is good for the hormonal cocktail that supports labor. But as far as I know, it can not jump start your labor.
Entry Filed under: Cervical Dilation and Effacement
17 Comments Add your own
1. Rinko | January 2nd, 2010 at 1:23 pm
Dear Deb, A Happy New Year to you! I read your blog and always admire how you explain not so easy medical terms and subjects well so that we can all understand and have a clear picture/image of it.
Regarding the last paragraph in this blog, as one of the regular students at PYC, I am just curious if you have already thought of doing some kind of survey to see what are the positive effects yoga practices may bring in terms of birth and pregnancy outcome. Of course, it would be very difficult to attribute the effect only to yoga as there are so many confounding factors around the birth/pregnancy outcomes, but something you may be interested in.
Wishing you and the center a productive and successful year 2010.
Rinko
2. Deb | January 8th, 2010 at 10:12 am
Hi Rinko
Thank you so much for your comment. I am very glad that you are enjoying the blogs and your classes at the Prenatal Yoga Center.
I have never conducted a survey among the students as to how yoga attributed to their birth outcome. I am happy to boast that we receive countless emails and letters from mothers that have recently given birth and explained how their yoga practice helped many. Many women talk about how the breath work helped keep them calm and confident. Mantras and self affirmations are also commonly used. For example- “i can do anything for a minute”, “take it one contraction at a time”, “my body was made to do this”, “i can open up and let me baby out” Some mothers also say that feeling part of a community of other strong women gave them courage and confidence.
On a more scientific level, there is a study “Prenatal Yoga May Result in Less Labor Pain, Shorter Labor” which is published on Deb’s blog that explains why prenatal yoga is beneficial during labor. I invite you to take a look at that article.
Thank you again for reading my blog and being part of the Prenatal Yoga Center community.
I hope you have a wonderful 2010 full of happiness, health, laughter and joy!
Deb
3. Beverly | January 29th, 2010 at 3:31 pm
You explained this very well, keep up the good work!
4. I.N. | March 23rd, 2010 at 8:12 pm
One of the first signs of labor is the cervical dilation. It can ocurr as early as two weeks before the actual labor process starts, but this initial dilation will not be a threat to pregnancy if it keeps a low dimension (one to two centimeters).
5. Lynn | June 13th, 2010 at 7:38 am
Hi. I’m 37weeks and have dialated 3 to 4 centimeters. but my cervix isn’t thin enough and I have lots of contractions but they want to send me home what should I di beg the doctor to go head let me have this healthy baby what should I do?
6. Deb | June 15th, 2010 at 7:06 am
Hi Lynn
While I don’t want to tell you how to proceed with your birth since I am not a medical doctor. I will just offer the advice I would give one of my doula clients. First - make sure that you are well hydrated. If you are experiencing contractions but the doctors do not believe you are in labor yet, hydration can help stop or slow down the contractions caused by dehydration.
Secondly- I love the fact that your care providers are sending you home instead of inducing labor. Try to rest and relax and allow your body to naturally go into labor as time goes on. The good news is that you are already 3-4 cm dilated. So something is going on that is moving in the right direction.
If you really want to get things moving and softening in your body, Try acupuncture and evening primrose oil (the latter suggestion ONLY if your water is still intact) and also check w your provider to make sure they are on board with these suggestions.
I bet it is only a matter of days until your little one is snuggled happily in your arms!
Take care
Deb
7. CINDY | January 9th, 2011 at 6:10 pm
MY DAUGHTER -IN-LAW WAS VERY LAZY DURING HER PREGNACY, FROM THE COUCH TO THE CHAIR AND BACK AND FORTH. SHE DID EAT WELL AND GAINED 65 POUNDS DURING HER PREGNACY. SHE DRANK ALOT OF MILK AND WATER, BUT COME TIME TO DELIVER SHE HAD A VERY HARD TIME. 12 HOURS LATER AFTER BEING 4CM THAT LONG, THE DOCTOR TOLD HER SHE WAS STILL NOT EFFACED ENOUGH AND HAD TO DO A C-SECTION. wHAT WOULD CAUSE HER NOT TO EFFACE?
8. Deb | January 10th, 2011 at 2:44 pm
Hi Cindy,
Thank you for sharing the story of your daughter-in-law. The cervix effaces by the release of the hormone prostoglandin. Before the onset of labor, a woman can help efface the cervix by inserting Evening Primrose oil into the vagina or having sex (semen contains prostoglandin) or the care provider can strip the membranes which stimulates the release of prostoglandin.
Other then that, I can not explain why her cervix did not efface. There may have been some other underlying reasons why after only 12 hours of labor the doctor decided to do a c-section.
Also- the rate of which your daughter in law progressed has very little to do with her exercise habits during pregnancy. Exercise is recommended during pregnancy to help the mother be stronger and more comfortable while dealing with the aches and pains of the changing pregnant body and can also help with stamina and endurance. But it does not predict how long or how quickly labor will be. I have attended a lot of long births from very active women.
The good news is, if your daughter in law decides to have another baby and a VBAC (vaginal birth after cesarean), second births tend to be quicker!
Hope this answers your question.
Sincerely,
Deb
9. Chanda | July 29th, 2011 at 12:19 am
Thank u so much for your clear and concise explanation on effacement and dilation. The best part is the pictures of the different
ratios of effacement. They really helped me put it altogether, now I am
clear as to what’s going on. Thank you.
10. marcy | October 25th, 2011 at 5:02 pm
i am 38 weeks 3 cm and 50 %i inserted 3 caps through out today of epo and i was wondering if i will dialate tonight and go into labor
11. Deb | October 26th, 2011 at 11:37 am
Hi Marcy,
Evening Primrose Oil helps more with effacement then dilation. I would be doubtful that the EPO will put you into labor. However, it is good that you are being proactive.
Also keep in mind that you are only 38 weeks pregnant. ACOG (American College of Obstetrics and Gynecology) is recommending waiting until 39 weeks for induction. So I would recommend hold off on heavily trying to self induce.
I wish you a happy and healthy birth when the time comes!
Best,
Deb
12. Jennifer | October 29th, 2011 at 6:46 pm
Hi Deb,
First off, I love your blog. Can you send me a direct link to it so I can know how to follow you? I’m on my iPhone right now and I’m not 100% sure I will be able to find you after I leave this page lol. My question is.. How soon should one start using the Primrose Oil? I am 32 weeks.. My dr will be inducing at 38weeks due to the babys size. This is my 4th child. I have never tried using the Primrose, but I definitely will be!!
of course I do not want to go into labor now, just was curious on when do I start taking them? And also are they just as effective when taken orally? Do you prefer a certain brand?
Jennifer
13. Dee James | February 24th, 2012 at 3:31 pm
I now understand fully what I am going through. I was not sure what to ask, and I was trying to break down the terms the doctor was using during my visit–just got a little confused. This is my second pregancy (two weeks to go), and I was wondering why I was dialating already… I thought maybe I heard something wrong during my doctor’s visit, but now I have a better understanding. Thanks again for this useful information!
14. Mom | March 9th, 2012 at 10:51 am
Dear Deb,
I so appreciate your explanation of cervical effacement and dilation. As I am currently pregnany with my first child, it’s important for me to be able to understand what the heck is going on with my body! One thing you mentioned however concerns me,
“If your cervix is not ripening on its own and, for a medically sound reason, your care provider is advising you to be induced, you will receive a vaginal suppository of either cervidil or cytotec. These both contain prostaglandins to help soften the cervix and make it favorable for dilation.”
Cytotec is actually not FDA approved for use in inducing labor. In 2000, the FDA and Cytotec’s manufacturer both issued statements that the only approved use for this drug is the prevention of stomach ulcers. Just wanted to pass along what I have learned! Thanks again for the helpful information!
15. Tatiany | March 12th, 2012 at 9:12 pm
This post helped me so much! I am a second time around mom to be and I am 37 weeks. I found out I am 4 cm dilated and not effaced. Thanks for the explanation, since with my first pregnancy, it all happened during labor and in less than 24 hours I had my baby boy in my arm! Good luck to all the mom’s to be!!
16. Melissa | May 15th, 2012 at 1:57 pm
Hi Deb,
This has been some of the most helpful information I have come across yet, thank you! I am not sure if you are still responding to posts but I figure I will give this a shot. I am 35 weeks with my second pregnancy. My first I was induced at 41 weeks because I was showing not very many signs of labor. I didn’t thin until about 39 and a half weeks and wasn’t dilated at all at 40. When they induced I was in labor for 12 hours and stopped dilating at about 5 or 6 centimeters so they decided to do a c-section. My doctor said it was my body’s way of saying ‘no’ to a vaginal delivery because my baby girl was 9lb 2oz. So now, almost 7 years later I am having my second child. I have been having Bradton Hicks contractions for almost a week now and passed my mucous plug 2 days ago. The baby also dropped significantly over night. Still getting my kick counts, just not as active, but i understand there is less room. Today I was 20% effaced. I never experienced any of this with my first pregnancy. I know in subsequent pregnancies things tend to go faster, would that still be the case for me even though they induced and I didn’t have a successful vaginal delivery last time? If I am starting to efface now should I prepare for labor at anytime from now until my due date?
Hope to hear from you!
17. Deb | May 16th, 2012 at 4:25 pm
Hi Melissa,
Congratulations on baby number two! So, let’s take a moment to look at your first birth. Most first time mothers do not go into labor or even show signs of progress before there due date. In fact, on average, a first time mother goes into labor spontaneously at 41 weeks and 1 day. So the fact that after only 12 hours of laboring there was augmentation seems a little premature. Keep in mind- I am just going on what you relayed, I don’t know if there was any other medical indication to why your provider chose to move labor along. It is also not unusual for a labor to move slowly and methodically along- especially with a bigger baby. Your baby and body may need time to negotiate space as to how to move your baby along.
All that said, I have not been able to find studies that show a second labor after a c-section is shorter then a first. But since you did have a chance to labor and your body to respond and dilate- at least to 6 cm., that is promising! If your doctor is open to you going for a vaginal birth after cesarean- VBAC- then, yes- I would be preparing for labor at this point.
I would also encourage you to see if your doctor will allow you to go past your due date before scheduling another c-sections. Concluding a due date is not an exact science, there are variables involved.
I hope you have a wonderful birth and thank you for posting your questions.
All the best,
Deb
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