Cervical Ripening During Labor – Is it Necessary, Methods Used and Tips to Prepare

What is Cervix Ripening?

Cervical ripening is a starting point for softening the cervix, and dilating it resulting in labor induction. The cervix remains closed during pregnancy, for the baby to stay in the uterus but with nearing the delivery date, the cervix starts to soften and thin. 

The cervix ripens in a natural manner but sometimes few women may require medical intervention or other methods for ripening the cervix. This is done with the help of devices, medicines, and other natural methods like walking and using a birthing ball. 

Why is Cervix Ripening Necessary?

Cervical ripening is necessary and this is the first step for the procedure of dilation and effacement to begin. The process helps the pregnant woman with inducing labor. 

However, labor can be induced with medication as well as procedures for contractions to begin and to even get into labor. This happens in these two conditions

• Any health-threatening risks with the mother and the baby like growth issues, preeclampsia, gestational diabetes, etc.
• If the pregnancy is overdue or exceeds 41 weeks of time.

[Read : Cervical Effacement During Pregnancy]

Methods Used For Cervix Ripening

Cervical ripening helps in thinning the cervix for allowing the baby to come through the birthing canal. Bishop score is a scale that helps to assess the degree of the ripening of the cervix. This helps the doctor to assess the bishop score after they examine the cervix.

The score can range from 0 to 13. The method also allows the doctor to examine if the cervix is thin, dilated, and even its position. If the  Bishop score is lesser than six, the cervix is not ripe enough and needs cervical ripening, but if it is more than 8 then the body is ready for labor. 

Here are a few methods used for cervical ripening to induce labor

1. Non-Pharmacological Methods

Here are a few non-pharmacological methods that are useful for cervical ripening

a) Hot Bath

Taking a hot bath helps to induce labor and helps with cervical ripening. But before you decide to do that, you need to let your doctor know. 

b) Breast Stimulation

Massaging the breast releases oxytocin which helps to induce labor. Applying a warm compress to the breast thrice a day or for one hour helps in inducing labor.

c) Acupuncture

There are certain procedures in acupuncture and acupressure to induce labor. You must get the procedure done under the supervision of an expert therapist. 

*GET APPROVAL FROM YOUR DOCTOR BEFORE GOING FOR THIS*

2. Pharmacological Methods

Cervical ripening, dilation, or softening can even be done through medications. Cervical softening medicines that help with effacement and dilation. The medication will be intravenous, oral, or vaginal.

The common medications that come into practice are

• Oxytocin
• Prostaglandins
• Misoprostol
• Mifepristone
• Relaxin

3. Mechanical Methods

The mechanical methods use local pressure to trigger the release of prostaglandins. According to a study published in Cochrane Publications, balloon dilators used in mechanical methods are comparatively safe and are almost as effective as pharmacological methods in inducing labor. 

The common ways are

a) Balloon Dilators

Once the catheter is put in the cervix, balloon filling is done with the required amount of saline and is left till the rupturing of the cervix takes place. 

b) Hygroscopic Dilators

A duck-shaped device called a speculum helps in dilating as well as visualizing the cervix. After this, the dilators are put in, till the cervix dilation happens completely.

There are high chances of catching an infection, bleeding, placental disruption, etc. with mechanical methods of cervical ripening. 

4. Surgical Methods

This method includes the separation of membranes or the artificial rupturing of membranes.

a) Amniotomy

The method uses a small hook for rupturing the membranes around the amniotic sac. This helps in releasing the prostaglandins which help in the ripening of the cervix. It is the artificial rupturing of the membranes.

Some common side effects are

• Bleeding from the low-lying placenta
• Maternal infection
• Neonatal infection
• Fetal injuries
• Reduced fetal heart rate
• Compression of the umbilical cord

b) Stripping of the Membrane

This activity helps to release prostaglandin by dilating the cervix. A gloved finger is put inside the vagina. Then it is moved in a circular form for detaching the membranes from the lower uterine portion.

Its negative effects are

• Bleeding 
• Discomfort caused to the pregnant woman
• Infection
• Rupturing of the membranes accidentally

Risks Associated With Cervical Ripening Procedure

Several types of cervical ripening methods are available, and each can have its own set of risks and side effects.

Here are a few risks associated with the methods of cervical ripening

• Vomiting, fever, and contractions take place if any medication is used for cervical ripening.
• Uterine contractions due to medications used for inducing labor can have contractions that can be short or long duration, which are detrimental to the health of the baby in the womb.
• It may not be good for your fetus and can sometimes result in an emergency cesarean.

Tips to Prepare For Cervical Ripening

Cervix ripening is a great way to assess if the body is ready to get into labor. This can even happen before the due date for some and for others at the time of labor.

Here are a few tips to prepare your cervix to ripen 

1. Walking

A great way to open the cervix is by walking, this even helps the baby to reach the cervix and helps with dilation as well.

2. Birthing Ball

Movement of hips, whether, rocking, bouncing, or rotating helps to open the cervix and dilate it as well.

3. Working on Body Alignment

The posture of the pregnant lady changes with the growth of the belly. If the weight is kept on the ankles and one does not slouch while in a sitting position, it helps to open the cervix.

4. Keeping Your Feet Parallel

It is common for the pregnant woman to stand with legs apart but if the toes are kept in a parallel position while standing, it helps to open the cervix as well.

5. Stay Relaxed

If your cervix has not ripened even after following everything possible, understand that this is not abnormal. It occurs to many women and doctor interventions are very much helpful at this time. If you have to go through a procedure to ripen your cervix, stay calm and trust your doctors. 

[Read : Water Breaking During Pregnancy]

When Should You Call The Doctor?

Cervical ripening is a natural process but sometimes needs assistance. You must contact your doctor 

• In case of vaginal bleeding 
• Breaking down of the amniotic sac
• Contractions equal to or more than 3 within 10 minutes
• If the baby’s movements are too high or too few
• Contractions lasting for 90 seconds or more

Thus, Cervical ripening happens naturally during labor else the medical practitioners use a suitable method. This, however, depends on the condition of the expected mother. Every method has some side effects as well, so it is important to always let the doctor decide and never try on your own. The process of ripening can happen at the time of labor or before as well.

FAQ’s

1. Is Cervical Ripening Painful?

Cervical ripening is not painful. However, you may experience a bit of pelvic pressure or cramping pain at the time of cervical ripening which is due to softening of the cervix.

2. Can I Sleep During Cervical Ripening?

You can sleep during the time of cervix dilation and effacement. However, lying sideways is more effective and you will not feel the discomfort. 

Read Also: Labor Induction And Augmentation- Everything You Need To Know