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What Does Effaced Mean in Pregnancy?
Having a baby is such a joyous time. Most everyone knows by the time it’s their turn to become a parent that dilation to 10 centimeters is necessary to vaginally birth a baby. Still, some people are often unaware that dilation isn’t the only necessary step. The baby must also move down through the station positions. As the baby presses downward, another process will happen, known as effacement. This process involves softening of the cervix until it is fully effaced. The pressure from the baby’s head causes this to occur. In addition, prostaglandins are released during contractions that help to soften the cervix.
Dilation VS Effacement
Dilation is the process of the cervix opening up to allow the baby’s body to pass through the mother’s body. As the female’s uterus contracts, this causes the cervix to begin to open up. The initial stages of labor actually occur with very little pain. Some women will be completely unaware that they are even dilating. The first few centimeters of dilation often occur in the weeks leading up to a woman’s due date. Many women spend several weeks at two or three cm dilated before the real contractions begin that lead to her water breaking and the birth of her child. In contrast, some women will spend weeks at even four or five cm and others will go into labor and have a baby one day not having been dilated at all. It is not a prediction of when labor will begin or how it will continue onward.
Many first-time mothers won’t dilate at all until they are in labor. This means nothing. It’s not cause for concern and mommies-to-be shouldn’t worry that they won’t progress when they are ready to give birth. Many women worry about this because almost every female knows someone whose labor didn’t go as planned. In a culture where birth has been made into an industry instead of a natural event that occurs on its own, intervention has become a favorite in the medical industry because it makes money.
There is no artificial way to cause dilation directly. Instead, artificial means can be employed to cause contractions, such as Pitocin. However, this drug comes with a lot of controversy and significantly increases the risk of the need for interventions. A Journal of Clinical Anesthesia study notes cesarean sections are higher among women who are induced with Pitocin, even more so than among women who just need Pitocin for the augmentation of labor.
As previously noted, dilation and effacement are not the same, but both are necessary for labor to occur. If the cervix isn’t fully thinned out, then it will not recede completely to where a baby can be pushed out. Instead babies can get stuck behind something known as a cervical lip when the woman fails to fully dilate. In some cases, the midwife or doctor can manipulate this lip to get the baby to rotate and come through at another angle.
In the majority of cases, though, a woman cannot be fully dilated if she isn’t fully effaced. This is why most women remain at roughly 80 or 90 percent effaced until they reach 10 centimeters in dilation. Understandably, this situation is not ideal and can be quite painful for the mother. In addition, not all midwives and doctors are proficient with this process. Women can be effaced but not dilated or dilated but not effaced, too.
Cervical Effacement Symptoms
There aren’t really telltale symptoms of effacement. As the baby descends further into the pelvis, some women will experience a sensation known as lightning. This experience is also sometimes referred to as lightning crotch by moms who know it personally. That’s because it literally feels like someone has zapped you in the crotch with a taser or bolt of lightning. It comes on quickly and passes just as fast, but it might make its appearance several times a day in the final weeks of the third trimester.
In addition to lightning, that baby’s descent into the pelvis might also cause the mucus plug to become dislodged. This too is nothing to be worried about. It is normal and totally safe for both the mom and the baby. The mucus plug may actually come out in bits and pieces throughout a pregnancy. The female body being the amazing thing that it is actually regenerates the plug and causes more of it to form when some is lost. The mucus plug looks a bit like snot or egg-white cervical mucus tinged with blood. It won’t hurt when it comes dislodged, but it might feel a little bit gross. It doesn’t mean labor is imminent either, so don’t get your hopes up too much. While the primary thought behind the loss of the mucus plug is that the cervix is dilated, it is effacing too in all likelihood. The two events tend to happen pretty simultaneously and it can be hard to determine which one is really to credit with unhooking from that plug.
How to Measure Cervical Effacement
Some women may be up for checking for effacement at home on their own. This is perfectly safe as long as it’s done correctly. The hands should always be washed well first and nails trimmed. In addition, it isn’t recommended that any woman try this when she is alone. The squatting position is the easiest to assume and reach the cervix. It will be high during pregnancy.
The cervix will feel somewhat like slipping the finger into a sleeve. It is long and thick. That means getting to the baby is more of a chore. This is a good thing, obviously. When it comes to effacement, women often assume that it has something to do with dilation, as though the cervix just disintegrates as dilation occurs. It doesn’t. It actually recedes into itself. When you think about it, it’s a bit more magical than dilation is really. If the space within the cervix extends to where you can insert a finger to your second knuckle, there is no effacement happening.
Women who visit their midwife or doctor frequently in the end stages of pregnancy may be accustomed to being asked if they would like to be checked for progress. There are pros and cons to this, but most are notably negatives. First and foremost, let’s be clear on how effacement is measured. When the midwife or doctor says a woman is zero percent effaced, that means she hasn’t made any progress at all in this department. If she’s 50% effaced, she’s halfway there. Again, this doesn’t mean she’s halfway to labor, but rather that she is halfway effaced. She still needs to efface fully, dilate to 10 cm and the baby needs to come down in station for labor to occur.
When a woman is 100% effaced, the cervix is completely thinned out and out of the way. There is no longer a cervical lip. Instead, only the opening to the uterus is present. The thinned cervix is what allows the baby to pass out of the uterus and into the hands of the provider — or a courageous mom or dad that wants to deliver their own baby. While many women will sit at 70% to 80% effaced for a while in labor, the last bit that needs to move out of the way generally happens close toward the time that it is time to push.
Effacement is also very subjective. There have been countless complaints from expectant moms who have gotten their hopes up over effacement. First a doctor tells them they are nearly fully effaced and progressing well. Then the next week a nurse checks them at a follow-up appointment and tells them they aren’t effaced at all. This is because fingers come in varying sizes and the percent of effacement a woman is at is truly only as good as the individual who is measuring it. A Journal of Obstetrics and Gynecology study reports that percentage measurements for effacement are often quite inaccurate when compared to ultrasound measurements of the cervical thickness and length. It suggests that using rings or straight ruler devices via calibrated fingers may be a more effective method, but this has yet to be implemented into standard medical practice.
Getting checked for progress is mostly for appeasement. The only time it serves a purpose is during labor. Before that, when you’re just going to your regular appointments checking the heartbeat and so on, cervical checks are completely unnecessary. This is because whether a woman is progressing or not doesn’t indicate at all when or if labor will start on its own. Again, some women will spend weeks dilated and effaced and not go into labor until 43 weeks. Others will go into labor three weeks before their due dates with no effacement or dilation in place at all. In addition, cervical checks can cause premature rupture of the membranes and introduce infection. They are best opted out of until you are definitely in labor.