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Cervical ripening, a critical phase in preparing for childbirth and a phase that many women are often unfamiliar with. The process of cervical ripening can begin weeks to days prior to the start of labour and continue during the initial phases of labour. Most times expectant mothers are unaware it is happening within their cervix. This is a natural process that allows the body to begin preparing for labour and childbirth. Understanding the process and learning a bit more about times when assisted intervention might be needed is essential for expectant mothers. Let's delve deeper into what cervical ripening entails, including its key components: softening, dilation and effacement.
What is cervical ripening?
Cervical ripening is the natural preparation of the cervix which can begin before labour and delivery and continue during the initial phases of labour. This process involves several changes:
- Softening: The cervix undergoes a transition from being firm, similar to the tip of your nose, to a softer, more pliable state. This softening is crucial for enabling the cervix to stretch and dilate during labour. It is driven by hormonal changes as your body prepares for natural birth. Cervical softening is one of the most important aspects of labour because a soft cervix is easier to open up further.
- Shortening and effacement: During cervical ripening the cervix becomes shorter in length. The cervix is about 2-3 cm long. However as labour approaches, it gradually begins to thin out. This is also known as effacement. As the cervix ripens and softens it transitions from being thick to becoming as thin as a piece of paper. This process is measured in percentages, it is not uncommon that 100% effacement (paper-thin) occurring during the active labour stage. Overall, this thinning process is necessary for the cervix to stretch and open wide enough for the baby to pass through.
- Dilation: Dilation is the opening of the cervix. The cervix is usually closed and as it begins to open it is measured in centimetres from 0 (completely closed) to 10 (fully open, ready for the baby to pass through). Some women may experience some cervical dilation prior to labour, however the majority of dilation takes place during the phases of labour. Dilating to 10 cm (fully dilated) is necessary for a vaginal birth. The other stages of cervical ripening are crucial to allow the cervix to be flexible and stretchable enough to allow the baby to pass through the cervix and into the birth canal.
When is cervix ready?
Clinicians usually use the Bishop score system to evaluate the readiness of the cervix for labour. It assesses five factors, including those mentioned above - softening / cervical consistency, dilation and effacement. A higher score suggests that the cervix is ripe and more likely to respond favourably to labour induction if necessary.
What is difference between natural and assisted cervical ripening?
Near the end of the third trimester, the cervix should start to soften in order to begin preparation of your body for your birth. Hormones like prostaglandins and estrogen are naturally released in the body, these are key in softening the cervical tissue and increasing its elasticity. They facilitate the changes in the cervical collagen structure, preparing it for the significant stretching during labour.
This typically occurs naturally however some circumstances require medical assistance. Do not worry, today, about 1 in 3 of expectant mums are induced to stimulate their labour and lead to a natural vaginal birth. It is very common that the majority of mums need assistance with cervical ripening before the start of the induction. In these cases, methods like DILAPAN-S, a small cervical dilator made from hygroscopic gel, are used to aid the process.
Which methods can be used for assisted cervical ripening?
There are several methods available to promote cervical ripening and these can be divided into two basic categories:
- Mechanical methods, including DILAPAN-S or balloons.
- Pharmacological methods, which involve the administration of artificial hormones to stimulate changes to the cervix.
Interestingly, as data show, the effectiveness of both methods are similar. While pharmacological methods still dominate worldwide, there has been a shift toward mechanical methods due to their gentleness and safety profile.
Note: This article is designed for informational purposes, incorporating key aspects of cervical ripening. Always consult your clinician for advice tailored to your unique pregnancy and labour journey.
Why is cervical ripening so important?
Effective cervical ripening plays a pivotal role in ensuring a successful natural vaginal birth for several reasons:
- Essential for smooth labour: A ripe cervix is fundamental process for a smooth and efficient labour. As the cervix ripens, the tissue becomes softer and more flexible, which are both necessary for dilation.
- Minimising the need for medical interventions: Adequate cervical preparation, either naturally or with minimal assistance, greatly decreases the necessity for medical interventions during labour, facilitating a more natural birth process.
- Enhancing success rates in induced labour: in cases where labour is induced, a well-ripened cervix is crucial for increasing the probability of a successful, streamlined labour experience.
Cervical ripening is a fascinating and vital part of the journey towards childbirth. Understanding its stages and importance empowers expectant mothers with knowledge about their bodies and the birthing process. In cases where nature needs a nudge, methods like DILAPAN-S offer a gentle, predictable, and controlled approach, working in harmony with your body's natural labour preparation.
Monica Myron
certified registered nurse
Disclaimer: This blog post is for informational purposes only and should not be considered medical advice. Always consult with your healthcare provider to address your individual needs and concerns.
