Open cervix? Closed cervix? What is it and how does this little organ have to do with dilation and your labor? Read to find out!
What is the cervix?
The cervix is an organ located at the lower part of the uterus, connecting the uterus to the vagina. Despite its small size (measuring about 2.5 to 3 cm), this organ plays a crucial role during childbirth. Some functions of the cervix include:
- Production of cervical mucus: it produces cervical mucus (you probably heard about the “mucus plug”), which act as a protective barrier between the uterus and the vagina to prevent infections from reaching the cervix and uterus;
- Regulation of menstrual flow: as a muscle, our cervix opens and closes to regulate the menstrual blood flow from the uterus;
- Baby’s passage: during childbirth, the cervix dilates (expands/opens) allowing the baby to pass through the vaginal canal.
The role of the cervix during childbirth
When a woman is in labor, the cervix begins to dilate. Unlike TV shows where childbirth happens suddenly and quickly (with a lot of screams and panic, btw), in real life, the dilation process can start several weeks before delivery and it normally continues, slowly and progressively, until the cervix is fully dilated, around 10 centimeters (average).
As the cervix dilates, the muscles of the uterus contract, pushing the baby downward toward the vaginal canal. When the baby’s head reaches the cervix, its weight puts pressure on the cervix, helping to stimulate further dilation.
As the cervix continues to dilate, the baby’s head passes through the birth canal into the vagina. If the baby is in a head-down position (cephalic position), the head is the first part to emerge, followed by the rest of the body.
After childbirth, the cervix begins to contract and closes again. This helps prevent potential infections and protects the uterus. It may take several weeks for the cervix to fully close and return to its pre-pregnancy state.
Open Cervix vs Closed Cervix
An open cervix refers to a cervix that is already dilated or open. A closed cervix refers to a cervix that is not dilated and is in its normal resting state.
The cervix changes in size and shape throughout a woman’s menstrual cycle and during pregnancy. During the menstrual cycle, the cervix remains closed and firm. As ovulation approaches, the cervix becomes softer and may start to open slightly.
During pregnancy, the cervix stays closed and firm until the woman goes into labor. When labor begins, the cervix starts to dilate and open, allowing the baby to pass through the birth canal. When the cervix is fully dilated, around 10 centimeters, the baby is ready to be born.
It’s important to note that cervix dilation can only be checked by a healthcare professional. Women should not attempt to check their own cervix unless they have been instructed on the correct method, as they may not only hurt themselves but also risk causing infections.
How to tell if I'm dilating?
There are several ways to identify if you are dilating or not. Some of the most common methods include:
- Pelvic examination: A healthcare professional can perform a digital cervical exam to check if the cervix is dilating. During the exam, the provider will insert a gloved finger into the vagina and feel the cervix to determine its size and position;
- Electronic fetal monitoring: Electronic fetal monitoring is a device used during labor to observe the baby’s heart rate and the strength and frequency of uterine contractions. The monitor can also be used to track cervical dilation progress;
- Ultrasound: An ultrasound exam can be used to measure the size and position of the cervix during pregnancy. However, during labor, this exam is not typically used to check cervical dilation.
TIP
It’s entirely possible to have a 100% hands-off labor. During labor, there are many ways to monitor progress without the need for pelvic examination. Among them, tracking fetal heartbeats and observing the widening of the hips, which can be seen on the parturient’s back, are some of the simpler approaches. Touch during labor can be quite painful and is essentially unnecessary.
Can a doula check your cervix?
Absolutely not. Doulas are trained professionals providing emotional, physical, and informational support to women and families during pregnancy, labor, and postpartum. Doulas are not trained or licensed to perform medical procedures, whether it’s a cervical exam, episiotomy, or suturing lacerations.
Only a healthcare professional, such as an obstetrician, midwife, or nurse, can perform a pelvic examination to determine cervical dilation during labour. Doulas will normally read your body signs to estimate your dilation (the “purple line”, observing your back bones and your labor progress).
The doula can, however, help explain medical procedures for informed decision-making and offer non-pharmacological techniques to aid dilation progress. Additionally, whether in a home or hospital birth, doulas can advocate for a woman’s preferences and needs during the birthing process.
What happens if I have no dilation during labor in a hospital?
Few women know that the progression of dilation is not always linear. It can be faster or slower, varying greatly from woman to woman. It’s also crucial to remember that the cervix is a muscle, meaning it contracts and relaxes, especially in stressful situations when we feel threatened or intimidated. After all, we are mammals.
Stressful situations are not uncommon in hospital settings, especially if the woman doesn’t feel like she is in control or if she is uncomfortable with the medical team and the environment.
If labor isn’t progressing as expected, the healthcare team can take various measures to stimulate labor progress. Some common ones include:
Use of synthetic oxytocin: Administered intravenously, oxytocin stimulates contractions and encourages dilation.
Artificial rupture of membranes: Although controversial and not recommended, some doctors may decide to break the amniotic sac using a clinical instrument to speed up contractions and expulsion. It’s not recommended to rupture the membranes during the expulsion or in premature babies.
Changing positions: Changing positions can make a significant difference in the labor process, considering the woman’s comfort. Generally, more upright positions (squatting, sitting on a birthing stool, or hands and knees) can use gravity to their advantage and speed up dilation.
Some hospitals may use forceps or vacuum extraction to accelerate labor. These methods are no longer recommended by the World Health Organization and are now considered as an act of obstetric violence.
Consult with your birthing team or doula to clarify any doubts!
Dilation can progress... or regress
Yep, it’s possible for dilation to start regressing instead of progressing during labor. This is known as “cervical regression” or (IMO a terrible name) “cervical inefficiency.” Cervical regression can occur when the cervix starts to dilate but then stops dilating or begins to close again. When this happens, labor may stop or slow down.
Cervical regression isn’t very common but can occur for various reasons, including:
Weak uterine contractions: if the uterus isn’t contracting efficiently, it may not push the baby down to force cervical opening.
Fetal presentation or position: if the baby is in an abnormal position (e.g., breech or transverse) or has an abnormal presentation (brow presentation), it may be more challenging for the baby to descend through the birth canal and stimulate dilation.
Abnormal pelvis shape or size: if the pelvis is too small or has an abnormal shape, it may be more difficult for the baby to pass through the birth canal and stimulate dilation. Note that “cephalopelvic disproportion,” while possible, is not common, and except for cases identified in ultrasound (such as hydrocephalus or macrocephaly), usually, these situations can only be observed during labor. Having a “Narrow pelvis” is not an indication for a cesarean section!
Previous uterine surgery: women who’ve had previous uterine surgery, such as a cesarean section or have a uterine scar, may be more prone to cervical regression.
If cervical regression occurs, the healthcare professional may take measures to try to stimulate labor progress, such as those listed earlier in this text. In some cases, a cesarean section may be necessary.
How to naturally estimulate dilation
There are various non-pharmacological techniques that can help with labor and encourage dilation, including:
Changing positions
Changing position or walking can stimulate contractions and encourage dilation. Walking, swaying, and squatting can help progress labor.
Lower back Massage
Massaging the lower back or abdomen can help relax muscles and stimulate contractions.
Acupuncture: Acupuncture, a traditional Chinese medical practice involving the insertion of fine needles into specific points on the body to stimulate energy flow and promote healing, can be used during labor to encourage contractions and dilation. It should only be done by a trained professional.
Aromatherapy
Aromatherapy involves using essential oils to promote physical and emotional well-being. Some essential oils, like clary sage and peppermint, can help stimulate contractions and encourage dilation.
Note that these techniques should be used under the guidance of a healthcare professional and should not be used as a substitute for medical treatment. Each labor is different, and the approach to managing labor will depend on the individual needs and circumstances of the woman. Your doula can help choose the best approach based on your condition!
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