Cervical Ripening – Why It Is Necessary for Childbirth

If you are exploring natural or vaginal birthing options, understanding cervical effacement and dilation is crucial, as these processes play a significant role in determining the progress of labor. Cervical ripening or thinning typically occurs naturally and can begin weeks before the due date as the body prepares for childbirth. However, in some instances, this process may only start just before labor begins, or it may require medical assistance to ensure the cervix is adequately prepared for delivery. In this article, we will delve into why cervical ripening is so vital for successful childbirth, how it impacts the labor process, and address other related concerns.

What Is Cervix Ripening & Why Is It Necessary?

Your cervix is closed during the entire pregnancy. As you near your due date, your cervix undergoes changes, and begins to soften and become thinner to prepare for childbirth. This is known as cervical ripening (1).

In cases where this process does not happen naturally, medical intervention may be required for the procedure. This can happen if your doctor feels that it is in the best interest of the baby and the mother. This usually happens when there are certain health concerns for you or your baby, or you are overdue by more than a week.

When the procedure to soften the cervix is performed, it may not only help you get into natural labor (without medical induction), but, sometimes, it may also shorten the duration of labor, too.

When Does Cervical Ripening Take Place During Labor?

How long does cervix ripening take? Cervical ripening can take anywhere from a few hours to 1-2 days, depending on the method used and how the cervix responds. Cervical ripening usually occurs in the final weeks of pregnancy or during early labor as the cervix softens, thins (effaces), and begins to dilate. For some, it starts weeks before the due date, while for others, it happens only as labor begins. If the cervix doesn’t ripen naturally, medical interventions like prostaglandins or a Foley catheter may be used to aid the process. The timing varies based on factors like whether it’s a first pregnancy or if labor is induced.

Can You Encourage Cervical Ripening at Home?

Here are some effective ways to soften the cervix at home:

1. Birthing Ball

Rotating, bouncing, or even rocking your hips on a birthing ball can not only help in opening up the cervix, but it may also aid in the dilation of the cervix (2).

2. Working on Body Alignment

Pregnant women tend to change their posture as their belly grows. Keeping your weight on your ankles, and not stooping or slouching while sitting, can prove to be of great help in opening up the cervix.

3. Keeping Your Feet Parallel

Though most pregnant women stand with their legs apart, keeping your toes in a parallel position while standing may prove to be helpful in separating your sitz bones, and thus opening up your cervix, too.

4. Walking

Walking is a great way to let gravity do its job in opening up your cervix! It is a great exercise, and it helps your baby to gently move down your cervix, and aids dilation, too (3).

5. Having Sex

Having sex also helps in ripening your cervix, as the prostaglandins in the semen helps in softening the cervix. Also, experiencing an orgasm during sex can further lead to uterine contractions (4).

6. Relaxation and Stress Reduction

Stress and tension can slow down the body’s natural preparation for labor. Practicing relaxation techniques such as deep breathing, meditation, or prenatal yoga can help reduce stress and create a more favorable environment for cervical ripening.

7. Acupressure or Massage

Gentle acupressure or massage on specific points, such as the webbing between your thumb and index finger or the inner ankles, may stimulate uterine activity and encourage cervical changes (5). Always consult a professional before trying these techniques.

These are some natural ways to ripen the cervix for labor. However, it will be a good idea to get in touch with a doctor before trying any of these methods!

Methods Used in a Hospital

The cervix has an important role in the induction of labor, and if it does not soften and ripen naturally, then your doctor may recommend certain methods of doing so medically. Here are some methods used in hospitals for ripening the cervix (6):

1. Cervical Ripening Drugs

Your doctor may use cervical ripening drugs such as misoprostol cervical ripening drug, or drugs that have prostaglandins, for softening and dilating the cervix. These medicines can either be given orally, or placed directly in your cervix. These drugs may make you 2 to 3 cm dilated and, in some cases, women may also go into labor. The medicines to soften the cervix are usually considered a safe option, and are tolerated well by most women.

2. Mechanical Ripening of Cervix

Mechanical ripening means ripening the cervix forcefully. This procedure requires inserting a Foley catheter with a very small balloon. The Foley with the balloon is inserted in the cervix and then the balloon is inflated slowly. This makes the cervix open up. Sometimes, the cervix is dilated by using the finger, in a process called membrane stripping. The membrane that is attached to the uterine wall is separated using fingers. Though it can be a painful procedure, it works in most cases.

3. The Combination Method

Sometimes the doctor may feel the need to use both the methods simultaneously for cervical ripening. According to some studies, using a combination of both the above-mentioned methods is often considered safe.

Are There Any Risks Associated with Cervical Ripening Procedure?

Cervical ripening is a very common procedure and often does not lead to any risks. However, sometimes, the contractions can come too fast after induction of cervical ripening. In some unlikely cases where the contractions are for 90 seconds or longer, fetal distress could become a major threat. Under such situations, the doctor may recommend an emergency cesarean delivery.

What Are the Long-Term Effects of Cervical Ripening?

Cervical ripening is a process used to prepare the cervix for labor, often through medications or mechanical methods. While generally safe, there are potential long-term effects to consider. These may include:

1. Increased Risk of Cervical Insufficiency

Repeated cervical ripening procedures, especially mechanical dilation, may weaken the cervix, increasing the risk of cervical insufficiency in future pregnancies.

2. Higher Risk of Preterm Birth in Subsequent Pregnancies

Some studies suggest that women who undergo cervical ripening, particularly with mechanical methods, may have a slightly higher risk of preterm labor in later pregnancies.

3. Uterine Sensitivity or Scarring

Use of medications like prostaglandins or mechanical devices may lead to minor uterine scarring, which could affect the uterus’s response in future pregnancies or labor.

4. Hormonal or Menstrual Irregularities

In rare cases, cervical ripening agents may temporarily affect hormonal balance, potentially leading to irregular menstrual cycles post-pregnancy.

5. Pelvic Floor Weakness

Depending on the method used, cervical ripening and labor induction could contribute to pelvic floor weakness over time, potentially leading to issues like urinary incontinence.

How to Prepare for Hospital Procedure

In most cases, the procedure is done in an OPD. However, sometimes it may result in labor, and thus it will be a good idea if you pack a bag with your overnight essentials.

On the day of the procedure, you can have a light breakfast that can include toast, juice, or cereal. For lunch, you can make a sandwich, soup, or salad. However, you can take your regular meals after you go back home.

When Should You Call the Doctor?

Here are some conditions that require immediate medical intervention and thus must be reported to the doctor at the earliest:

• In case your amniotic sac or water breaks
• If you notice any excessive increase or decrease in your baby’s movements
• If you experience your contractions for more than 90 seconds
• If you have any kind of vaginal bleeding
• If you experience 3 or more contractions in a span of 10 minutes

FAQs

1. Can cervical ripening affect fertility in future pregnancies?

In most cases, cervical ripening does not impact fertility. However, repeated mechanical dilation or excessive cervical manipulation may weaken the cervix, increasing the risk of cervical insufficiency, which could affect future pregnancies.

2. Does cervical ripening cause long-term pain or discomfort?

While short-term cramping and discomfort are common, long-term pain is rare. However, some women may experience lingering pelvic discomfort or sensitivity, especially if mechanical methods like balloon catheters were used.

Cervical ripening is a natural process, and may sometimes begin several weeks before the actual due date. However, it is completely normal for the cervix to remain closed until you go into labor. In some cases, the doctor may feel the need to conduct a cervical ripening procedure. It will be a good idea to talk to your doctor if you have any concerns about your cervical ripening.

References/Resources:

1. Cervical Ripening; Cleveland Clinic; https://my.clevelandclinic.org/health/procedures/22165-cervical-ripening

2. Shen. H, Wang. H, Sun. B, et al.; Birthing ball on promoting cervical ripening and its influence on the labor process and the neonatal blood gas index (World Journal of Clinical Cases); National Library of Medicine; https://pmc.ncbi.nlm.nih.gov/articles/PMC8717508/; December 2021

3. Shojaei. B, Loripoor. M, Sheikhfathollahi. M, Aminzadeh. F; The effect of walking during late pregnancy on the outcomes of labor and delivery: A randomized clinical trial (Journal of Education and Health Promotion); National Library of Medicine; https://pmc.ncbi.nlm.nih.gov/articles/PMC8395880/; July 2021

4. Kavanagh. J, Kelly. A, Thomas. J; Sexual intercourse for cervical ripening and induction of labour; National Library of Medicine; https://pmc.ncbi.nlm.nih.gov/articles/PMC7017007/; April 2001

5. Smith. C, Armour. M, Dahlen. H; Acupuncture or acupressure for induction of labour; National Library of Medicine; https://pmc.ncbi.nlm.nih.gov/articles/PMC6953318/; October 2017 

6. Santiago-Munoz. P; Cervical ripening methods when induction is part of the birth plan; UT Southwestern Medical Center; https://utswmed.org/medblog/cervical-ripening-techniques/

Also Read:

Easy Labour and Delivery Tips
Cervical Position in Pregnancy
Labor and Childbirth Complications
Cervical Length During Pregnancy
How to Check Your Cervix for Dilation