When you're not dilated prior to labour

published 17 June 2022

It makes me so sad when I hear of women who have a prenatal visit at 39 weeks and the care provider tells them it’s “time for a cervical check”. Then the woman is left feeling discouraged when she is told “Oh you’re only 0-1cm dilated….”

The doubts start piling up. “Why am I not dilated yet? Will I ever go into labour? Maybe I have to be induced? Maybe my body is broken?”

Dear one.
You are NOT broken. Please, don’t ever let anyone make you feel bad for your body working perfectly.

Cervices are MEANT to stay closed until labour starts!! That’s their job! They're made to protect baby from infection (mucus plug, closed tight) and keep baby in (closed tight). What would be the point of it opening prior to labour?

When your body receives signals from baby that baby is ready to come out (lung and brain readiness), your body will produce hormones that soften, efface, and dilate the cervix along with the contractions that prime your uterus to push baby out. (Remember that you dilate UP not out.)   This is also why “natural induction" doesn’t *really work* - your body and baby actually have to be ready)   

(Note: Some women dilate a little bit prior to labour. This is because every woman is unique and their hormone levels, previous number of births, and angle and pressure of baby’s head on the cervix can all contribute. This is normal too.)

Remember that once in labour, everyone dilates at different speeds as well. You could make steady progress over 12 hours. You could stay at 3cm for hours and then go from 5cm to baby in 2 hours, and you can go from 0-10cm in 10 minutes (quick labours are called precipitous.)

What will not happen is a linear, mechanical, predictable labour and dilation. The scale that labour dilation is based on is an average called Friedman’s Curve from a study of 500 white, first time, drugged and augmented women’s labours and should NOT be the basis for judging how your individual labour is progressing. And is definitely not a reason to submit to a pre-labour cervical exam!

So why are they offering a check at 39 weeks? I don’t really know when there’s no real evidence to back it up!

What they want to know from the check at 37-39 weeks is:

- dilation 

- effacement 

- whether they can feel baby's head and "station".

Literally none of that will tell them anything except just *that*. It tells you your dilation and effacement at 3pm on Wednesday. It doesn't anticipate labour or predict issues. It doesn’t tell you when labour will start or how long labour will go for.

There’s very few reasons that cervical checks prior to labour can be of any benefit. One is with a history of preterm labour. Another might be if you present to hospital with injuries or contractions and you need a thorough assessment. And routine checks at 39 weeks are not going to pick up preterm labour….haha. If you are going to be induced, it’s helpful to know your “Bishop’s Score”. But otherwise, we don’t need to gather information if it’s not going to be acted on.

Your cervix is meant to be closed and firm until labour starts- that’s its job! So with that in mind, you can comfortably decline a pointless and invasive exam 💗

If you feel that you might want or need a check, have a discussion using the BRAINS acronym decision making tool to weigh up pros and cons. Ask your care provider WHY they want to do it (and to “know dilation” is not a good enough answer)

If you want to consider checking your own cervix prior to, or during labour, or look at more reasons for  and against a cervical check, see this article

https://aucontemplativelife.wixsite.com/unassistedhomebirtha/cervical-checks 

Please remember that you deserve to be treated respectfully in all medical procedures and you have the right to always decline or STOP a procedure. If you are feeling pain, or change your mind, speak up. Having someone present with you can give you the courage to advocate for yourself. Hospital policy is not law. You don't have to consent to "just one VE" for admittance, or "Let me just check for baby's head so you know when to push" 

Wherever and however you choose to birth, please know this. You do not need to have anyone examine you if YOU don't want them to, ever. No one should put their fingers into your vagina without your consent - ever. You want to be sure that the cervical examination is really necessary and will add important information to the decision-making process, and that the person doing the exam will ensure your privacy, dignity and comfort, and explain the findings and their impact sensitively.

One final thing to consider is that sometimes care providers will “sweep your membranes” while they are in your vagina. This is a form of induction and MUST be consented to. Unfortunately many care providers will casually state “Oh I just did a little sweep while I was in there” (if they even tell you). Side effects of sweeps can be uncomfortable cramping, bleeding, infection risk, and prodromal labour. Please choose a trustworthy care provider and talk over your wishes beforehand - that you do NOT consent to extra procedures while they are in there. You can report them if they assault you by performing unwanted procedures or demean, harrass, or coerce you.

You do not need a “sweep” to go into labour. You do not need to be dilated prior to labour. It’s ok to “not know” what your cervix is doing before labour starts. Just know that your cervix has done its job up until this point, and that there’s usually no reason to think that it would abruptly discontinue doing its job. Or that someone’s fingers in your vagina holds the key to understanding or confidence in your ability to birth vaginally.

Have faith in your body and the mystery of birth, of which cervical dilation is such a tiny part. You’ve got this!