The Pre-labor Cervix is not a Magic 8 Ball
Each week, I get at least half-a-dozen searches to the blog related to pre-labor cervical dilatation.
Search terms/phrases like:
- dilated to a 4 and not in labor
- 0 cm 0 % effaced induction?
- 39 weeks and not dilated
- can you go into labor without your cervix being dilated?
- is it bad to have an “unfavorable cervix?”
- 37 weeks pregnant why aren’t I dilating?
And so on.
Whenever I read these phrases, I always feel a bit sad and mystified. Why are women so worried that their cervix isn’t dilating before labor? Who is making them feel as if their bodies are inadequate, or not cooperating, or unprepared for birth? Are they being misled by friends, family, popular culture, or even their care providers? How many of them even have a legitimate medical reason (such as threatened premature labor or impending medically-necessary induction) for their pre-labor vaginal exams?
Here’s the thing: your pre-labor cervical dilation is not a Magic 8 Ball. It cannot predict when you will go into labor.
Just ask around, and I’m sure you’ll find plenty of women (like myself before A’s birth, and like my mother before she gave birth to me) whose cervix was 0 centimeters dilated and 0% effaced less than 24 hours before their labors began.
I’m sure you’ll also find plenty of women (like my mother before my sister’s birth) whose cervix was 2, 3, 4, even 5 centimeters dilated for days, even weeks before their labors began.
And all of their pre-labor cervical dilatation (or lack thereof) was completely normal.
You might wonder, then, why care providers even perform vaginal exams prior to the onset of labor.
In some cases, there are legitimate reasons to evaluate cervical dilatation before labor. Some medical conditions (such as threatened premature labor and/or suspected “incompetent cervix”) might warrant a pre-labor vaginal exam. In addition, if a woman is planning an induction, it is crucial to know not only her cervical dilatation but also her cervical effacement, consistency, position, and the baby’s station so that her care provider can evaluate her Bishop’s Score. (The higher the Bishop’s Score, the greater chance of a successful induction–or one that ends with a vaginal birth. The lower the score, the greater the chance that the induction will end in a cesarean section, especially if this is the woman’s first birth.)
But other than these medical indications, most other pre-labor vaginal exams are performed either out of habit or to satisfy a woman’s curiosity–that is, without medical reason.
And in these cases, that “magic number” (only 1 cm? already 4 cm?) cannot predict when a woman will go into labor–no matter what your family, friends, or care provider tell you!
So for those people who have found my blog using the aforementioned (or similar search terms), and to all of my readers who wonder just what sort of fortune-telling powers your cervix has prior to labor, I want you to gather ’round.
Closer.
Closer.
It is completely normal for your cervix not to have dilated by 37 weeks, 38 weeks, 39 weeks, 40 weeks, and even after your estimated due date!!!
There. Is. Nothing. Wrong. With. Your. Body.
Allow me to say that one more time.
THERE IS NOTHING WRONG WITH YOUR BODY!!!
So in sum, if there is a medical indication for a pre-labor cervical check, then by all means, consult your care provider about your medical condition and determine the relative necessity of your exam.
And please, please learn your Bishop’s Score before an induction, especially if you are planning a non-medically necessary induction!
But if there is no medical indication for a pre-labor vaginal exam, then know that it is entirely within your right to refuse to have such an exam! (One of the best ways to refuse a pre-labor vaginal exam–besides politely telling your care provider that you do not want one–is to keep your clothes on in the exam room!)
And if you’d still prefer to have this exam–just to satisfy your curiosity (and trust me, I understand this curiosity completely)–then please remember that the number (or numbers) you hear at the end of the exam are not surefire predictors of when your labor will begin.
They’re not achievement awards or performance measures or signs on the Magic 8 Ball: they’re simply signals of the changes that your body is going through, or will go through soon.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did your cervix not dilate until you went into labor? Were you walking around for days or weeks with a cervix dilated to 2, 3, 4, 5…or even 8? Did you discuss your Bishop’s Score with your care provider before your induction? Do you wish you would have?
LOVE this post! Amen!
I bet I got them all beat- I was EIGHT cm dilated and still not in active labor when I finally let them ROM (after nearly 9 weeks of painless contractions and bedrest- all because my OB panicked that I was dilating).
And I wish I hadn’t, because while that did start “active” labor and it was a fine experience, I honestly think even at 8 cm my body- and my baby- weren’t as ready as they could have been. But walking around at 5, 6 and 7 cm dilated was scary- everyone acted like the baby would just fall out. It did make it difficult to know when to the hospital, and I expect a similar experience with my current pregnancy- I can only hope for a SROM to make things more clearcut. Of course, this time it’s a homebirth, so no worrying about getting to the hospital:)
Jenn´s last blog ..Running a marathon
8 cm?! WOW! Thanks for sharing, Jenn! I’m sorry you feel as if you were forced into an induction with your last birth, though. How wonderful that you have a different/better support system this time around!
I don’t know if I was necessarily pressured so much as “encouraged to be impatient”. The bedrest and panic and inability to know when I was REALLY in labor played a big factor in just wanting to be done- not because I was “done” with pregnancy – I was fairly content as a heavily pregnant woman- but because I hated feeling in “limbo labor” all the time.
See, women in my family labor oddly. We have relatively painless but constant contractions from about week 30 and dilate about a centimeter a week. I was already a 6.5 at week 35 (and my doc panicked and wanted to break my water THEN at only 35 weeks- I finally gave in just under two weeks later), my sister Lori was 4 cm from week 34 and didn’t SROM until week 39, and sister Becky has never “started” labor less than 5 cm dilated. None of our 6 babies have hung around past 39 weeks.
Fortunately, my labor experience that started with the doctor breaking my water at 8 cm went well- no drugs, and a healthy nearly-8-pound “premie”. But I will always have to wonder- if my labor was that great without the baby sending his signals he was ready, how much better could it have been if I had let HIM decide when to come?
Jenn´s last blog ..Running a marathon
Oops, sorry if I assumed that you were pressured into an induction! (Sadly, it’s all too common…) Not that “encouraging a mom to be impatient” is a much better alternative, but it’s different than some of the pressure that some moms face.
That’s so interesting (though not all that surprising) that the women in your family have similar labor experiences! It certainly makes sense, though. I’ve even heard, anecdotally, that sisters’ labors (or at least the unique “quirks” in their labors) are often very similar.
This is awesome – one of your best posts ever. And I LOVE the comment above about being 8 cm dilated and still not in labor. It says a LOT! I’m off to post this on my FB wall to see how many other stories of pre-labor cervical dilation we can get!
TheFeministBreeder´s last blog ..This Is No Way to Convert Me to Christianity
LOVE this! Re-posting!
I was 4cm dilated a week before labor and I still had a 22 hour induction that I now regret because its obvious that my body wasn’t ready despite being past the 40 week mark.
Thanks! And that’s such a great point–even a “higher” Bishop’s Score does not *guarantee* that one’s body is ready for labor to begin.
I’ve never dialated or effaced before labor. When I had my fifth baby I allowed my midwife to check at 41 weeks and 3 days. I was told, “Oh, I won’t be seeing you for a while.” My cervix was high and closed. I went into labor on the car ride home. I’ve gotten a similar response with all my babies…minus the last who was born unassisted.
I succumbed to the curiosity and got checked.
36 weeks: 0/0 (dilation/effacement)
37 weeks: /50%
38 weeks: 1/75%
39 weeks: 3/75%
and I went into labor spontaneously at 39 weeks 2 days.
I think that’s the classic pattern that people expect but I was one of those people who, honestly, was expecting to go 40+ weeks.
My sister, on the other hand, had an OB appointment on her due date at 8 a.m. and was 0/0 and had my niece at 7 a.m. the next day — all natural.
I had a check on a Monday because I thought my water had broken and my midwife told me I was closed up tight; not dilated at all. Even though I knew it didn’t mean anything, I couldn’t help but feel a little down, like nothing was ever going to happen. The following Thursday morning after laboring at home for quite a while, I came in at 3 cm and 100% effaced. Baby was born that afternoon.
Love this! Cervix dilation really is not an indicator as to when labor will begin. I was 0 centimeters dilated and 50% effaced at my 39 week checkup. My water broke the following night and I was almost immediately in active labor. I checked into my room at the hospital about 2 hours after my water broke, and was 7 centimeters and completely effaced. Dilated to 10 and had my VBAC birth about 2 hours after checking into my room.
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I was minimally effaced/softened before each labour. Labours were 16, 12 and 46 hours long by MY experience and every time I did not go further than 2 or 4 cms until mere moments before baby crowned. So, if you have to be 4 cms to be in “active labour” all of my labours were 30 minutes or less. \
I was less than 1 cm dilated, not effaced at all and had a floating baby when I went into spontaneous labor at 41 weeks and had a vaginal delivery.
went in for an appt. w/ my CNM, she checked me to feel me at 4-5 cm and said I was in active labor at 40w6d… didn’t have trouble talking, walking, or even climbing flights of stairs til after ROM at 8 cm.
With my 1st, I was 3cm dilated for 2 weeks…ended up with a heavily augmented labor – I was not educated or informed enough 11 years ago. When I hit 4cm and was not in labor, I allowed an induction.
With my 2nd, I was 5cm for 3 weeks before I was having progressive labor.
With my 3rd, I was 5cm at 39 weeks, 6cm at 40 weeks with mild continuous contractions. With both my 2nd and 3rd, I did go in for inductions because of bleeding, but the bishop’s scores were good, I was contracting (just not very strongly) and I had my water broken at 40/41 weeks (no drugs). With both, delivered just a few hours later.
Karen´s last blog ..Partners in Perinatal Health Conference, May 2010
I was 0/0% at my last check. Contractions started on Monday, finally called the midwife Wednesday night, she got to my house about 8pm and we all went to bed. I did a self-check the following afternoon and *everything* in there had moved. What a weird feeling! The midwife checked around 6pm and I was at 6cm. At that I was really disappointed and just hearing I was only at 6cm (which sounded like halfway to my ears) was discouraging. Then my daughter was born two hours later.
Definitely not having any checks next time–I don’t care what the number is!
I don’t remember what my dilation was before labor started with my first two, and I didn’t even get checked before the last two. But with my third, I went to bed one night 42 weeks and 2 days pregnant, barely 1cm dilated, with no contractions. The next morning I woke up when my water broke, and my daughter was born 45 minutes later.
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I was 1-2 cm dilated and 90% effaced for WEEKS before real labor. With my next pregnancy, I will not be checked until I am laboring.
My best friend was 4cm dilated for nearly 2 months on bed rest, and she STILL didn’t go into labor until her membranes ruptured.
5 cm dilated at 35 weeks and delivered at 40 weeks + 1 day!!
Precipitous labor and healthy baby!
Oh and BTW, with my first baby, my Bishop’s Score was 1 before induction. They told me that it would probably end in a c-section. 72 hours of ruptured membranes and no contractions later, I decided that it was probably a good plan to get it started.
4 hours later….healthy baby, no tears, no drugs (other than Synto)!
That’s so wonderful, Candace! You know, I *think* the modified Bishop’s Score calculator (that accounts for things like pre-eclampsia, ruptured membranes, etc.) adds a point for ruptured membranes. Not that 2 would have given you a much better score though.
I love how you write that YOU decided “it was probably a good plan to get it started.” So many women never get the chance to make (or at least feel as if they are making) these decisions on their own, let alone be “allowed” to go more than 12 or so hours (or even less) after AROM without an induction! Good for you!
I was at 4 a week before the baby was born, at 5 when they sent me home from triage 3 days later (and they assured me I would be back within 48 hours), and 6 when I finally went to the hospital. When I was still at 6 a couple of hours later, the doctor started threatening Pitocin within an hour if I didn’t progress. Luckily an hour later I had made significant “progress” and I was able to continue birthing naturally.
Really, all the nonsense about dilation just ended up being an excuse to ignore what I was experiencing — which was a lot of strong contractions, even when I supposedly “wasn’t progressing.” I think I could have foregone the exams altogether, although at the time I agreed to them because I was desperate for some kind of prediction about how things would go. Turns out they don’t predict the future after all.
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I was 4 cm. dilated for about a couple days before I went into labor. For weeks I had been at 2 cm. and then I dilated a little more. By the time I got to the hospital I was in active labor and 8 cm. The triage nurse just about fell over when she discovered that I was at an 8 and still “walking around”. The bag of waters was bulging and my son was just kind of floating. I delivered him about an hour later, naturally.
I was dilated at 3cm for over a week before labor started. I went into labor immediately after my water broke, and who knows, I could have been 4cm before active labor actually started because I never had an exam until I was already at the birth center and was 7 cm. I even remember my midwife saying “any day now” when she discovered I was at 3cm, I guess she really meant “any WEEK now”! Ha.
I always love to tell the story about my boss who left her manager job at 36 weeks pregnant because she was 4 cm dilated and they INSISTED she would be in labor any minute. She had planned to work until her due date, but they convinced her that there’s no way she’d make it another day.
She sailed a week past her due date before labor finally started. That means she was dilated to 4 for FIVE WEEKS. (That’s five weeks of her maternity leave that she lost too, sitting at home driving herself crazy.)
I, however, was barely dilated at all when I lost my mucous plug at work the week of my due date, and went immediately into hard labor.
I’m going to compile all of these stories and use them to teach moms in my class about the utter uselessness of cervical checking in determining the “time.”
TheFeministBreeder´s last blog ..This Is No Way to Convert Me to Christianity
Oh man, what a story–and how horrible that she lost all those weeks of maternity leave!
I’m thrilled you’ll be using these stories in your childbirth ed class!
My mom was one of those who was very effaced (not sure–maybe even 100%) and at 4 cm dilated for weeks. Her doctor thought my brother would be 2 weeks early–but he was 3 weeks late. (My mom often complains about what a hippy this doctor was and how he refused to induce since her non-stress tests and how awful it was to go 3 weeks past her due date–I secretly think it was pretty awesome. Way to go, 1980′s.) As for me, I was probably only ever 1 cm and some tiny amount effaced dilated at the exams before I went into labor. The number didn’t matter to me–I wish I’d known that there was NO good reason to let such an uncomfortable exam take place week after week.
In three pregnancies I’ve never had a pre-labour VE.
During three labours that averaged about 30hrs, I’ve had on average 3 VEs.
I don’t think that prelabour VE should be done, and I think that during labour they should be VERY limited.
I say, just leave us the hell alone and we’ll be fine, thank you very much.
I have no idea whether I was dilated before or even during most of active labor. I never met my midwife without pants on and she showed up for my birth just before transition. At that first check, I was 8 cm — an hour later, I was fully dilated and pushing. I loved it that way.
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I’m going to explain it the way I see it. I’m not anti pre labor VE. I get them done simply because I like to have some sort of reassurance that any of the contractions I have are actually doing something. To me its sort of like a way for me to keep my head up despite the random aches and pains.
I completely understand! Not every woman will want this, but some do appreciate this reassurance. And it’s always important to remember that even if the pre-labor contractions/prodromal labor/etc. have not resulted in any cervical dilation, they may still be helping with cervical effacement, position, consistency, or even helping the baby to rotate into a good position for birth!
I was checking myself (I wouldn’t let the doctors touch me!) and I know that I was 0CM and pretty well effaced the morning I went into labor. That’s right, 0 CM just hours before I went into labor. I didn’t check myself at onset of contractions, but I suspect I was probably STILL 0CM! I had my baby 8 hours later. I was pretty proud that my first official check was at 10 CM. LOL I’m hoping that with the next one I can have a homebirth and NEVER be checked by anyone other than myself – how cool would that be?!
With my first daughter i got told by the doctor, there is nothing going to be happening the next two weeks, becasue everything was closed snuck and immature like she said, one week later i went into labor and my daughter was born after only 6 1/2 hours.
I have a good one! I was checked (medically necessary) at 37 weeks with my twins and was a whopping 1cm and 50% effaced! I gave birth 10 days later, and after laboring all day and having tons of show was only 4cm when my MW arrived. Now, my twins weren’t huge but they were good sized at 6 pounds 6 ounces and 7 pounds 6 ounces. So all in all, I had what we approximate to be about 20 POUNDS of baby, fluid, and placenta sitting on said cervix. Which, I might add, was so posterior that she had to hurt me to get to it to check! It helps that my presenting baby was floating breech but still….
Chantel´s last blog ..Catching Up! | Dallas Maternity, Birth, Baby, Newborn, and Family Photographer
I guess my OB is in the minority here, but he doesn’t start offering cervical exams until 40 weeks. He will give them if wanted, but otherwise, doesn’t bring it up. Got my first CE of the pregnancy in triage while in labor. Was at 3cm and baby way born 5 hours labor. With my first, the CE started at 36 weeks, of course I was with a different doc who thought the exams did tell you something. Unless I have a reason, I will not ever allow someone to check me that early again.
I have absolutely no idea! We never checked!
I’m 40 +5 days and I just know I’m not in labor right now
“…I just know that I’m not in labor right now.”
Too funny, Hillary.
I’m excited to hear when (or at least after) you HAVE found out that you are in labor, though! Best wishes to you and your little one on that day!
The baby comes when he or she wants to come *shrug*. My due date was November 19th and I had an appointment on the 18th where I was 3-4 CM dilated. I was back the next week and about 25% effaced. I let my doctor strip my membranes, but guess what, I was back for my 42nd week appointment, 5 CM dilated. I went into labor on my own a couple of days later. When I got to the hospital I was about 6 cm dilated. So I effectively walked around for 2-3 weeks at 3 CM dilated. Every woman and pregnancy is so unique, I don’t understand why doctors won’t let moms just relax and go with the flow. I also never lost my mucous plug or had any bloody show before I went into labor. I’m glad I wasn’t stressed about it and was able to take it in stride (although by week 42 I was ready for it to be over and wanted my baby and the swelling in my poor feet to go down!)
I completely agree with you–babies generally come when they’re ready, and women’s bodies generally start labor when they are supposed to. And a little (or a lot of) dilation before labor–or none at all–is entirely on the spectrum of a normal, healthy end-of-pregnancy! I so wish that care providers would reinforce this so that no woman ever had to worry about her body being inadequate or uncooperative at the end of her pregnancy.
I must add, however–although going to 42 weeks is also completely normal, I do reserve some extra admiration for those women who have gone to that 42-week mark.
Thanks for this post!
My story? I had one internal exam during my pregnancy – at the first doctor’s appointment at 12 weeks. I then switched to a midwife around 20 weeks and didn’t have any more internal exam until labor, where I had two. Those two exams were completely non-violating. My midwife waited until I was finished with a contraction and waited for permission. I cannot say that I have ever had a better internal exam, if there is such a thing as a nice one, lol.
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Thank you! Thank you! Thank you! Absotely awesome post! I 4cm dilated for at least a couple days with baby #2 and 2+cm with baby #3 days (a week or more?) with baby #3. I am a doula so I know all about this, but it is disheartening to have to tell women over and over and over again that there is nothing wrong with their bodies if they aren’t dilated before labor begins.
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I got barked at by a lady (“Sue”) who was 38 weeks and 1/25% when I told her sister (“Hattie”) not to worry about making Hattie’s flight in time to meet her new nephew. I was reassuring Hattie that cent dialated isn’t necessarily indictative of imminent labor and many women can go from zero to baby in hours or hang out for weeks dialated 2 or more. Sue got so mad at me and insisted I was wrongety wrong wrong, and how dare I say anything like that because I am not a doctor. Ok, Sue, that is ok to think your doc is always right, but I was trying to reassure Hattie that she’d make in time for the birth. Sue was induced at 41 weeks, and Hattie got to be by her sister’s side.
I am 36+4 by my ovulation, or by my LMP (inaccurate for a long non-28 cycler like me) 37+5. Last doc appt, the nurse started getting things set up for a VE, & I politely asked why. “You been having B-H contrax, she’s going to want to do a cervical exam today.” I politely said “no thank you. I decline” and she looked at me like I grew 2 heads. It goes to show that routine VE’s are just that, routine. No one seems to question or decline them.
In fact friends are starting to ask about the state of my cervix! Uh, that is supremely personal, and I think that the only thing that should be going near my cervix belongs to my husband
Good for you for refusing the exam, Karin! I think it’s perfectly fine if a woman does want a non-indicated pre-labor vaginal exam (so long as she’s been informed that it’s not a magic predictor), but I am not fine at all with routine pre-labor VE’s–especially ones where women feel pressured to have them.
And that last comment? HILARIOUS!
i had my second daughter on the same day you posted this :O) i had been 1cm for a few weeks and 3cm for at least a few days before i went into labor (at 39+6). i expected to go overdue, but i was happy to get checked because i am one of those woman who contracts endlessly for the last several weeks of labor.
actually, i thought i would go overdue because my cervix was completely posterior still. that was an issue with my first delivery.
i had so much water that even after a spontaneous rupture and a break from the mw 14hrs later, my daughter was still floating at 6cm, a few hours before she was born. at 9cm (a half hour before birth) my cervix was still facing my sacrum.
guess you never really know the tricks your body has in store :O)
Congratulations, Shawna!! You’re right–we never really know what tricks our body has in store (love it)! None of us are textbooks, after all.
With my oldest, I wasn’t dilated until I went into labor. I got to the hospital 0cm dilated. My entire labor with her 9 hours.
With my son, I was dilated to 2 centimeters for almost 2 weeks. I got to the hospital at 4cm dilated. I was in labor for 15 hours. My dilated cervix did nothing to start nor speed up the process.
With my daughter I was seeing an OB who did perform routine VEs after a certain number of weeks. (Not only was I not informed enough to know I could turn them down, I’m the curious type and likely wouldn’t have turned them down anyway.) At my weekly appointment when I was 38w5d, I was 1.5 cm dilated. At the following week’s appointment (at 39w5d) I was still 1.5 cm dilated. I went into labor that night and was checked just before midnight at L&D and I was 10cm dilated. So I went from 1.5 to 10 cm sometime within a 9 or so hour span!
This pregnancy I am checked weekly (since 29 weeks) due to pre-term labor. I am holding strong at 1.5 cm (currently 32w3d), which is great news — bedrest and/or the tocolytics are working. The memory of how quickly I moved to 10 cm last time is what makes me be such a compliant bedrester.
Wow, it sounds like you had an extremely fast labor with your first baby! And my thoughts are definitely with you now that you are on bedrest. I know from experience with my second pregnancy that bedrest is not as easy as it looks to those who haven’t done it before! (FWIW, if you haven’t checked it out yet, http://www.mamasonbedrest.com is a great site.)
I love this! I had early labor for three days before my 1st was born at 41w3d. DD was malpositioned and had not dropped into the birth canal at all so while I was having contractions, my cervix was not moving. I was 0cm/0% and DD was not engaged at 10 days past my EDD. An hour and a half after my DD fell into place, my water broke which prompted active labor and DD was born 6 hours after SROM. Thank goodness my midwife and I were on the same page and recognized that induction would have done no good and we just had to wait for DD to get into a good position.
And I love stories like yours! I wish that more maternity care providers would pay attention to what your midwife did–namely, that your labor probably wasn’t starting because your baby was malpositioned, not because there was anything wrong with your body!!!