Effacement Before and During Childbirth

What It Is, Its Role in Labor and Delivery, and When It's a Concern

Pregnant woman sitting on hospital bed holding her belly

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When it comes to having a baby, you probably know a little bit about dilation. But, you may not know as much about effacement. Effacement and dilation work together, and they’re both important during labor and delivery. In this article, you will find information about effacement, including what it is, its role in childbirth, and when it’s a concern.

Effacement and the Cervix 

The cervix plays a vital role in pregnancy and childbirth. During pregnancy, the cervix is long, thick, and closed. It helps to keep the baby safe in the uterus as the baby develops. It also prevents anything from getting into the uterus that could cause an infection. But, the cervix is also part of the birth canal. The baby has to pass through it to leave the womb and enter the outside world. For the baby to pass through, the cervix has to go through some significant changes. Effacement is part of these changes. 

The word efface means to withdraw, eliminate, or remove something. During labor, your cervix effaces. It shortens, thins out, and almost disappears up toward the uterus to prepare for childbirth. 

Doctors and nurses describe effacement as a percentage. When you are 0% effaced, your cervix is about 3 cm long and thick. When you reach 50%, you're halfway to where you have to be, and your cervix is about half the size and thickness it was before. Then, when the cervix feels as thin as paper, you are 100% or fully effaced. Once effacement is complete, the cervix can fully dilate or open up for the birth.

Effacement and Dilation

Effacement and dilation go hand-in-hand. Effacement can happen before dilation or along with it. First-time moms usually begin to efface first, sometimes weeks before delivery. But, dilation doesn’t usually start until labor is underway. In later pregnancies, effacement and dilation may happen at the same time once labor begins

How Long Does Effacement Take?

Toward the end of pregnancy, when the baby drops and the head engages into the pelvis, it pushes down on the cervix. On top of that, early contractions begin to pull on the cervix. With all the pressure and pulling, the cervix starts to shorten and thin out. 

However, there's no set time for how long it should take. Every woman experiences it differently.  For some, the cervix can begin to soften and thin out days or weeks before delivery. For others, it may not happen until labor begins. Still, others may need help to get things going two weeks after their due date. 

Can You Get It Moving Along Faster?

There isn’t too much you can do to get your cervix to thin out faster. But you can try:

  • Moving and walking around. It puts more pressure on the cervix.
  • Resting and doing relaxation techniques. A relaxed body can do what it’s supposed to, while a stressed, tense body can prevent progression.
  • Sex, if the doctor hasn’t restricted it. While there isn't much evidence, sexual activity near the end of pregnancy may help to start labor naturally.

Can You Feel It?

You can’t necessarily feel your cervix shortening and getting thinner. However, it may be happening if:

  • You notice Braxton Hicks contractions, also known as practice contractions or false labor. They do not cause dilation but may help to soften the cervix.
  • You feel fullness in your pelvis from your baby’s head after they drop. The pressure could be preparing your cervix.
  • You see what looks like a clump of mucus. As the cervix thins and shortens, the mucus plug falls out. You might notice the passing of the mucus plug, but not everyone does.
  • You see a streak of blood or "the bloody show."

Checking Effacement

Your nurse, doctor, or midwife will wear sterile gloves and examine your cervix by feeling it.

At your prenatal visits near the end of your pregnancy, the doctor will examine you to see if your body is beginning to prepare for labor. Your health care provider will check your cervix for:

  • position (movement toward the front of the vagina)
  • softening (ripening)
  • shortening
  • thinning (effacement)
  • opening (dilation)

Once you're in labor, the doctors and nurses check your cervix regularly to keep track of how effaced and dilated you are as you get closer to delivering. 

Can You Check It Yourself?

Technically, you can check your own cervix. If you're a doctor or a labor and delivery nurse, you certainly know what you're doing. And, if you feel comfortable and are used to checking your cervix for fertility reasons, you'll be more likely to recognize changes.

However, if you don't have experience checking, will you know what you're feeling? You can do it. But, unless you know what you're looking for, you may want to leave this exam to your doctor. 

Delivery

Your doctor may make an educated guess on how close you are to delivering based on your cervix. However, there's no guarantee. Some women have all the signs and don't deliver for a few more weeks. Others have no signs, then they efface and dilate overnight and give birth the next day. 

When actual labor begins, the contractions really start to pull and stretch the cervix. First-time moms may labor longer because they tend to efface before they dilate. But, in later pregnancies, effacement and dilation can happen together and more quickly. Once the cervix is 100% effaced and fully dilated to 10 cm, it's time to push and deliver the baby.

Effacement Concerns

Effacement is a natural part of the labor and delivery process. It usually begins on its own when your body and your baby are ready for childbirth. However, if it starts too early in pregnancy or is not starting when a pregnancy is overdue, it can lead to complications.

Early Effacement

When the cervix is short or not strong enough to stay closed during pregnancy, it can begin to efface and open up too early. 

If the cervix begins to thin out and open up too early, it could lead to preterm labor or premature birth. It could happen if:

The doctor can diagnose a short or weak cervix by:

  • Your health and medical history.
  • Your pregnancy history.
  • A physical exam.
  • An ultrasound of the cervix.

The treatment for an incompetent or short cervix includes: 

  • Monitoring. If the doctors feel that your cervix may thin and open early, they will monitor your cervix during your pregnancy. 
  • Cerclage. A cerclage is a procedure that stitches your cervix closed to keep it from opening up during pregnancy. If you have a history that suggests the need for it, doctors usually perform the procedure between the 13th and 16th week of pregnancy . If you do not have a previous history, it can be done once the doctor sees the need through exam or ultrasound. The cerclage can be removed when labor begins or a few weeks before the baby is due. If taken out a few weeks before, it doesn’t mean that the baby will be born right away. The baby may come immediately after the removal, but not always. Sometimes the baby is even overdue. It’s different for everyone. 
  • Progesterone. Studies show that when prescribed from week 16 to week 36, progesterone can help prevent premature delivery.

Induction of Labor

When effacement and dilation do not happen on their own, the doctor may need to step in to get things moving along. 

The doctor may want to induce labor if the baby is overdue or for other medical reasons. There are medicines and medical devices the doctor can use to help the body to efface and get labor started. 

Prostaglandins. A type of medicine placed into the vagina to help soften or ripen the cervix.

Catheter. A straw-like tube with a balloon end inserted into the cervix to gently stretch it.

Laminaria. A substance that absorbs water to help the cervix slowly expand. 

Stripping Membranes. Gently sweeping over the membranes to slightly separate them from the bottom of the uterus and release natural prostaglandins. 

A Word From Verywell

Effacement might not get as much attention, but it’s just as important as dilation during the delivery of your baby. When you understand more about effacement, it can be a clue that labor is approaching. Of course, if you start to efface a few weeks before your due date, it doesn’t mean you’ll deliver early. And, if you do not efface at all by 39 weeks, it doesn’t mean you’ll be overdue. 

Understanding effacement is also helpful during labor since it makes it easier to follow your progress as you get closer and closer to delivery. On occasion, effacement can start too early and need to be stopped, or require a little help from the doctor to get going. But, most of the time, it happens naturally, on its own, when your body and baby are ready.

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Article Sources

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