Your cervix is located inside your vagina and is the “neck” or entrance to your uterus. It is made up of complex connective tissues including collagen, elastin and smooth muscle. It is believed to be a sphincter muscle. A sphincter muscle is shaped like a ring and is able to open and close a passage. Did you know that there are over 60 sphincter muscles in the human body?!
Your Cervix & Pregnancy
Your cervix in pregnancy does the important job of staying closed and holding the weight of your baby, placenta and keeping amniotic fluid in. It is long, closed, firm, high, and pointing posteriorly (towards your tailbone).
As you approach your baby’s birth day your cervix begins to go through some important physical changes: it softens, starts to move anteriorly (pointing toward the opening of your vagina), and it may even start to efface (shorten) and dilate (open). These changes are known as “cervical ripening”. Basically (well actually, quite complicatedly), this happens because the composition of your cervix changes (like an increase of water in the tissue) and hormonal changes occur including increases in oxytocin and prostaglandins which also help to ripen the cervix. However, most studies of cervical ripening have been done on rodents and human bodies are different, so scientists are still researching to learn more about how and why the cervix changes.
Did you know that the cervix can take hours, days, weeks, even months (for those who start prematurely) to dilate fully but will close almost instantly after the baby and placenta are born?
What the heck is an “incompetent cervix”?!
“Cervical insufficiency” or “weakened cervix” occurs in about 1-2% of pregnancies. It is a condition in which a pregnant person’s cervix starts to ripen (dilate, efface, soften, etc.) before 37 weeks. This can lead to premature birth or miscarriage if it occurs before 20 weeks. Cervical insufficiency is also known as an “incompetent cervix” – what a cringeworthy name! I find most people who have experienced this condition dislike this terminology, as it can often trigger more feelings of body shame and guilt, especially if it leads to health complications for their premature baby, infant death or miscarriage.
Scientists are working hard to determine why these cervical changes occur too early and how to prevent it. In some cases, it could be due to physical attributes or higher risk pregnancies such as carrying twins, triplets or higher order multiples, but it also happens to pregnant people carrying one baby at a time.
Sometimes cervical insufficiency can be treated by taking the hormone progesterone or by suturing the cervix closed (know as cerclage) and then removing the sutures when you are full term.
The Cervix at Full Term
Typically for most people, their cervix doesn’t start to change until they are full term (37 – 42 weeks). For some birthing people, cervical ripening doesn’t start at all until they are experiencing early labour contractions. For others their cervix does little to no changing and induction methods may be necessary to bring their baby earth side. Every birth is different, even for people who have had multiple babies!
When you start to get close to your estimate due date your health care provider will likely do cervical exams to get an idea of what changes have occurred to your cervix, if any. They will track those changes using a scoring system called the Bishop Score.
What’s the score?
The Bishop Score is used to determine if you are a good candidate for induction (using medications to start your labour) or if induction is more likely to fail leading to a caesarean birth.
The higher your score, the more likely intravenous synthetic oxytocin (ex: Pitocin) would be one of the first steps used to help trigger contractions.
A lower score (6 and below) means that your healthcare provider will likely use a cervical ripening technique before starting synthetic oxytocin. These techniques can include applying medications directly onto your cervix, such a gels made with prostaglandins or using a foley catheter to mechanically open your cervix. A higher Bishop Score also means that you’re more likely to go into labour on your own.
Therefore, it is important when considering induction that you understand the reason why it is being recommended and what your Bishop Score is so that you can confidently make a plan with your healthcare provider.
Natural Options for labour induction
There are also natural techniques that can help ripen your cervix and trigger labour. Some of the most successful techniques include:
- Eating dates daily starting at about 36 weeks gestation – note that this is NOT recommended for those with diabetes
- Taking Evening Primrose Oil orally or vaginally – note that this one is not recommended for anyone with blood clotting disorders or a history of hemorrhages
Remember though that “natural” does not always mean “safe”. ALWAYS consult your healthcare provider before trying any technique.
This Doula’s Two Cents
The cervix isn’t a crystal ball!
Measuring the changes of a cervix during pregnancy or labour cannot predict when you will go into labour or how long you labour will last. It is just one piece of information in a huge million-piece puzzle that is your body in pregnancy and birth.
It is however information worth collecting when you are considering induction or other interventions. However, even the most experienced OBGYNs, midwives and doulas cannot make accurate predictions based on it (otherwise we would have a pretty successful gambling ring going on!).
What you can do:
- Have patience with yourself. Babies do not care about due dates and your body has to do a lot of complicated work to make changes to your cervix. Your cervix could be completely closed during the day but that night you go into labour…. Or your cervix could slowly change over weeks before your labour starts. EveryBODY is different and it’s ALL normal – no one is pregnant forever!
- Talk to your healthcare provider about their induction philosophy. Do they routinely induce all of their patients at a certain time in their pregnancy or only if there is a true medical/health concern? If you are facing an induction be sure to inquire about what techniques they would use to help your cervix ripen and dilate?
- When you are in labour don’t fixate on just dilation – ask about all the changes happening in your body so you don’t get discouraged at cervical exams. Find out your cervical dilation, effacement (the process of thinning), the cervical position, how soft is your cervix is and your baby’s station/position in your pelvis. Remember, there are other ways to measure labour progression besides cervical exams, these include your contraction pattern and intensity, where and how you are feeling contractions, body temperature changes, increased nausea and lack of appetite, mood changes, and more!
The cervix is an incredible and important part of your body. It does so much work in pregnancy and labour. Think about your cervix and what you can do to help it prepare for labour, it is the key and doorway to bringing your baby to you.
Sarah Baker is a the co-owner of Lifetime of Love Doula Services. She has been supporting families for almost a decade as a birth doula, postpartum & infant care doula and childbirth educator. She is mom to three boys, twins and a singleton.