I’m Dilated to a Four, Yet Not in Labor
DISCLAIMER: *This article is not written as medical professional advice or suggestions. It does not take place of provider recommendations. Please follow the advice and suggestions from your medical provider or make decisions about your own healthcare via your own research outside of this article.
As a labor and delivery nurse, I have performed many cervical checks. I have also given advice based on the knowledge and experience I have about what those cervical checks really mean. However, one of the most frequent things I find myself saying to my pregnant patients regarding what their dilation means in relation to when they will go into labor is, “I honestly don’t know.”
I’m sure these patients hate hearing this, because now that I myself am sitting at 39 weeks pregnant, dilated to a 4, I really would love to know when I can expect to go into labor. So although my official cervical check is dilation of 4, effacement of 90% and station of -1, what does that really mean? And does it actually have any correlation to when I will go into labor?
Let’s start with dilation. This is the one that is easiest for people who are not in the medical field to understand. A cervix in nonpregnant and pregnant non-term women is generally what we consider “closed.” Meaning that there is no opening through the cervix into the uterus. In pregnant women who are within the last few weeks of their pregnancy, this changes as the cervix prepares for labor, progressing from 1 centimeter dilated and eventually to the standard “10 centimeters” or “complete” dilation during labor in order to give birth. In women who are not pregnant, the cervix can open slightly during menstruation, or can be manually dilated during procedures, such as IUD placement.
To go along with dilation, you have what is called effacement. Effacement is a fancy word for thinning. The cervix is generally thick. Meaning that from the beginning of the opening to the inside of the uterus, the cervix is about the length of your pinky or pointer finger. As the uterus contracts, it puts pressure on the cervix and pulls the side walls up, stretching and thinning the cervix. Eventually it reaches 100% effaced, which is about the thickness of a sheet of cardstock paper. Very thin and stretchy to stretch over the fetal head and slip behind it all together.
The last portion of a cervical exam is the station of the fetus. This just indicates how close the top of the baby’s head is to the outside of the vagina. The further away the baby is, or the more “floaty” or “ballotable” the baby’s head is, the more negative the number. The closer the baby is to “crowning,” the more positive the number. Therefore, a -3 means that your baby is not engaged in the pelvis at all and is floating high up freely. While a +2 and +3 means that baby is well seated in the vaginal birth canal and is beginning to crown, such as during pushing and actively delivering.
Having a cervical exam at my 38 week and 5 day appointment and being told that I was dilated to a 4, about 90% effaced, and my baby was decently low at -1 but not engaged, simply means that I am at a good spot for labor. This check does not mean that I will go into labor that night, or that week even. But that when I do go into labor, my cervix is well prepared and will probably take labor progression well. Which is both nice but also sounds like a crock of shit, considering my cervix has pretty much done half the work! So why doesn’t this mean I can expect labor within the next handful of hours?
Dilation never fully equates to a labor timeline. This is because everyone is different, and everyone’s body reacts to labor differently. Most often, you see a cervical check like mine in women who have had multiple babies. These cervixes have done the job multiple times and are a little quick and eager to start again, even though the rest of the body is not ready to start with labor. And labor could still be hours to days to even weeks away. Often, first time mom’s take a little longer reaching that “favorable” cervical check prior to being in labor. For the opposite reason of course, that the body is making these changes for the first time and is just figuring it out. This is why first time moms are most often coming into labor starting with a less than favorable cervix or only dilated to a 1 or 2 and still decently thick.
However, being that this is my first full term pregnancy, with my only other pregnancy being a miscarriage at 5 weeks, the big question is: How did my cervix become so favorable so early?
There are a few theories I have for this that I am going to share in the event that those reading this may wish to prepare their cervix prior to labor to help encourage an easy and smooth labor progression. But, PLEASE, PLEASE, PLEASE, do not take me saying any of the things that I did as full permission to do them in your pregnancy and that they are fully safe for your pregnancy. Please consult your provider. Every pregnancy is different and some are even higher risk, therefore, your provider may discourage these things. However, these are the things that I did during my low risk pregnancy that my provider was okay with.
THEORY NUMBER 1: I had a recent miscarriage. This is obviously not something that one can or wants to predict and plan for. But it has crossed my mind that having a recent miscarriage may have allowed my cervix to kind of “practice” the dilation process. Now, considering I was only 5 weeks along, it would not have had to dilate much. But maybe it was enough for my body to recognize the process come the end of this pregnancy when I have had Braxton hicks and therefore my cervix had an easier time dilating early.
THEORY NUMBER 2: I have stayed relatively active during this pregnancy. Having the job I do, I am not always confined to a desk chair for hours and hours of the day. When days are busy at work, I am often up and down, lots of walking, squatting to help patients, and overall, doing lots of daily moving. I take the stairs every shift, multiple times a day, and up and down, when going to get meals from the cafeteria. When I am home, I am doing plenty of walking, cleaning house, doing chores. Movement is almost always your best friend during pregnancy and labor.
THEORY NUMBER 3: Stretching! Somewhere between early and mid-pregnancy, I started doing daily, or every other day, stretching. Sometimes this was just sitting on the floor with my legs in a V, stretching one side and then the next. Stretching my back, doing cat/cows, lunges whatever I could to keep my leg muscles and hip muscles loose and comfortable. I let this continue all the way through my 3rd trimester, up until the point I am at now.
THEORY NUMBER 4: Chiropractor visits. I was already seeing a chiropractor every couple of months prior to pregnancy but when I was roughly 12 to 16 weeks into my pregnancy, I began going every month. This is something I feel is sometimes controversial depending on who you ask, however, for myself, I feel that it helped me feel good during my pregnancy while things were stretching and loosening. It allowed for my joints and ligaments to be realigned while my uterus was growing and shifting the natural positionings of my organs and internal structures. I think personally, it kept me feeling good enough to stay active and also helped me sleep better at night.
THEORY NUMBER 5: Red raspberry leaf tea and dates. The suggestions for these that I heard of indicated to drink 8 ounces of the tea every day and eat 6 dates every day, starting around 32 weeks. This one, I only followed loosely. I had a glass of tea maybe 3 or 4 times a week starting around 33 or 34 weeks. And some weeks I only had 1 glass or none at all. I made a glass when I thought about it or had time or was home from work. The dates were disgusting, in my opinion. I was only able to make it through one bag in the form of protein shakes. I put 6 dates into a blender with other frozen fruit, milk, peanut butter or Nutella, sometimes an espresso shot or yogurt. This was the only way I was able to eat the dates, and I still only had about 6 of these shakes between 34 weeks and 38 weeks. However, they do say that these two things help prep the cervix, and strengthen the uterus, in order to have an easier labor experience.
THEORY NUMBER 6: USE THAT YOGA BALL! Around 34-36 weeks, I started using my birthing ball religiously. I got one that was specific for my height, and almost every night, I sit on it while I watch tv instead of relaxing back on the couch. Being up right allows for gravity to pull my baby down on my uterus. Using the ball and doing hip circles both ways, front to back tilts, side to side, hands and knees with the ball for upper body support, helped stretch my pelvis and keep me free from major pain and discomfort in my pelvis during the day. They also allow for my baby to further descend into my pelvis and put pressure on that cervix.
THEORY NUMBER 7: This is the last and probably the most uncomfortable for some people to think about, BUT I didn’t shy away from sex during pregnancy. Some people become extremely uncomfortable physically and even mentally during pregnancy for different reasons. Sometimes due to morning sickness. Sometimes physical pain and discomfort from the uterus growing and stretching. Some people just become uncomfortable with the way they look or the way the body changes during pregnancy. And that is okay. Not everyone loves being pregnant. In my case, I had a very easy pregnancy and felt good for the most part during the entire thing. This meant that I was having regular sex throughout my entire pregnancy. It is said that the way to get baby in, is also the way to get baby out, and this is often due to the hormone in semen having the effect of softening the cervix and allowing it to begin effacement. While orgasms include the uterus muscles, which allows for contractions or tightening’s, helping jumpstart dilation.
After listing these handful of things, I can think that together they may have had an effect on the results of my cervical exam during my 38 week appointment. Or, they could have not had an effect at all. Some people have bodies that dilate quickly or early just because. And some people have bodies that don’t dilate at all. So, it is possible my body would have done this prep work even without some of these things that I listed.
If you decide through research and discussions with your OB provider that some of these things are possible for you, and you do them as a way to prepare your body and cervix, don’t get discouraged if you don’t have the results you hoped for. It is still possible to come in for an induction or even in labor with a cervix that has only begun the process of dilation and effacement and still have wonderful results during your labor. It is also possible for a person to come in with a favorable cervix and still have a long induction or labor with bumps in the road as well.
This is why putting a timeline on labor and the time of delivery of your baby is not possible, even when knowing what the cervical exam is. A cervical check is merely a tool to help assess for continued progression of labor in one way or another, but does not always equal a set timeline. Give your body grace and patience and understand that labor is not a race. It is the long walk. And your cervical check is not the predict all.
*Emma
