Folks coming to my site from Google use the most interesting keywords. In the interest of answering the keywords, here is the search criteria and then my answer.
cervix ripe how do you know
There are criteria called a Bishop Score that "measures" the cervix and its readiness. Determining the cervix's position inside the vagina, whether it is soft or firm, how dilated and effaced a woman is and where the baby is stationed all contribute to the final score. The Bishop Score was developed to see how induce-able a woman was.
0, 1, 2, 3's are given depending on the following factors:
- Is the cervix posterior, mid-vagina or anterior? As women get closer towards labor or, for second and subsequent babies, once in labor, the cervix moves more anterior. Some women are told their uteri are retroverted or tilted... this has no bearing on what your uterus does in labor AT ALL. No worries that you will have a harder time than anyone else.
- Is the cervix hard (like your nose), sorta soft (like your upper lip) or really soft (like your lower lip when you're really relaxed and just about to drool... some people describe it like butter, too... like butter that's been sitting out on the counter for a few hours)?
- Is the cervix tightly closed? 1-2 centimeters? 3-4? Greater than 5? Each progression offers another point towards ripeness.
- How effaced is the cervix? Remember, effacement is the cervix's shortening and thinning. Look at a donut as an example - if we shaved off some of the height of the donut every few hours, it would be getting shorter, right? At the same time as you shave off the height, you also carve around the sides, too, like peeling an apple sort of motion. That's what the thinning does.
Of course there is no shaving or carving of your perfect cervix, but the uterine contractions (even so-called Braxton-Hicks contractions) pull the height of the cervix and the thickness of it up, pulling it up into the uterus as it gathers its strength and muscle to eventually push the baby out.
So, is the cervix effaced at all? Halfway effaced? Three-quarters? Or completely effaced (also called "paper-thin").
Measuring effacement is not exact (well, none of these measuring methods is, as a matter of fact). It doesn't take long, when learning to do vaginal exams, to figure out that a cervix hard and pretty long isn't effaced at all. When it gets softer, you can feel the shorter-ness of it. The first time I felt a completely effaced cervix, it was so wild! It really is just like putting a piece of paper on a baby's head and running your finger over it, sliding the finger back and forth... barey perceptible.
- The baby's station is the last measurement. Is the baby high, high above the pelvis? Can you feel the head, but it bounces up when touched? Is the head nice and engaged in the pelvis, not bouncing out with pressure from fingers? Is the head so low you are surprised by how close it is?
All of these measurements gather together information that can help a woman know how an induction might go if she needs one. Again, none of this is scientific and women with low Bishop Scores have absolutely been induced and deliver vaginally successfully. It might take a little longer, but can be done.
A quick note about pre-induction medications.
Women with very low Bishop Scores might be told they need some ripening before Pitocin is started. Women are given one of two types of prostaglandins. Prostaglandin E-1 and Prostaglandin E-2.
E-1 is Cytotec and and is a synthetic E-1 (important to know) we could talk for a hundred hours about Cytotec, but I encourage knowing about it before stepping into an induction because the likelihood of getting it is pretty good. Cytotec usage seems to be regional sometimes and trends do change, so even if it isn't popular in your area right now, knowing about it is a good idea.
Cytotec melts cervices like nobody's business, but it also has a plethora of other effects that many women find anywhere from annoying to life-threatening. I'm still pretty middle-of-the-road about Cytotec (much to many women's surprise, I am sure!); it's good for some women, not so good for others.
E-2 can be either a gel or a tampon with the medication in it (Prepidil or Cervidil). These can soften cervices, but the success rate isn't nearly as dramatic as E-1.
Babies do react to all of these methods, so they are always done in the hospital with mom on monitors. Very occassionally, once the tampon is removed and all is well, mom can go home.
Physical ways to ripen a cervix includes laminaria - seaweed "sticks" that swell and open the cervix as they swell.
A Foley catheter's balloon can also be inserted into the cervix and inflated to nudge the cervix open, too.
So, there you have it... more than you ever wanted to know about a ripe cervix, eh?
Soften, you cervices! Be ripe and open! (When the baby is safe to come out, of course!)
06/28/06 - 248.5
07/02/06 - 242