” I’m 39 weeks pregnant and my doctor says my cervix is still closed. What’s wrong with me, why aren’t I dilating?”
Well the clue is in the first few words. You’re only 39 weeks pregnant, you’re not in labour and in fact your baby could still be a couple of weeks away from being born so why should your cervix be dilating?
For some reason, there is a huge obsession with how dilated or effaced a cervix is before labour. In fact so much so that I get questions every week from women worrying about why their cervix is STILL closed, hard and not starting to efface (thin out)
Heres the thing; Some womens cervix’s will start to ripen and even slightly dilate days or weeks before labour but the majority don’t. Put it this way, your cervix could be closed, 3cm long and hard one day. The following day you could go into labour. Similarly, your cervix could be starting to efface and a cm or 2 dilated with you walking around like that for a week. The current state of your cervix doesn’t really have any bearing on when you will give birth and in fact when we obsess over cervical dilatation, all it does is cause women to become more uptight and stressed because they feel their body is not doing ‘what it’s supposed to’. Remember your baby is more likely to make an entrance into the world when you are relaxed and in a state of calm. If you are stressed, you release hormones that can inhibit the birth process.
So why the cervical obsession?
In some countries, some obstetricians will routinely offer a cervical examination late in pregnancy. It doesn’t really tell much apart from the current state of the cervix at that time. If you go in for an examination at 36, 37, 38, 39 or even 40 weeks and have a closed cervix, it does not mean that you are weeks away from labour. It just means that nothing is happening at that moment. It’s actually pretty pointless medically and just increases the risk of infection.
In the UK there are no routine cervical examinations in pregnancy at all. When a woman reaches 40/41 weeks, her midwife may offer a membrane sweep (I will cover in another post) which involves her sweeping her fingers around the base of the cervix to try and separate the membranes and hopefully get the labour going naturally. Another time a cervical examination might be done is prior to an induction of labour. The cervix is assessed using something called a Bishops score which helps health professionals decide the best form of induction.
Second and subsequent pregnancies
If you have had a baby vaginally before (or you’ve dilated significantly prior to a c-section), your cervix will most likely never closed fully again. We call it a ‘multips os’, multip meaning multiparous (more than one birth) and os meaning cervical opening. So if you have already had a baby and you are examined before you go into labour, don’t be surprised to hear you are 1 or 2 cm dilated.
If you have already had a baby and you are being induced, sometimes it’s possible to start the process by just having your waters broken if the cervix is open enough to allow for that. If your cervix is closed, a prostaglandin gel/pessary will be offered first to help soften and dilate the cervix before waters can be broken.
So remember, try not to worry about the state or your cervix pre labour. When the time comes, it will start to ripen and this could be on the day you give birth!