What Is Effacement?

Effacement is when the cervix thins, shortens, and softens to open the vaginal canal for childbirth. During pregnancy, the cervix is long, thick, and closed. The cervix helps to keep the baby secure and safe from germs getting into the uterus that could cause an infection. The cervix is also part of the birth canal. For the baby to be born, 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. Effacement may also be called the ripening of the cervix. During labor, your cervix effaces by shortening, thinning out, and almost disappearing up toward the uterus to prepare for childbirth. 

How Long Does Effacement Take?

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 from medications to get things going a week or two after their due date. 

Why Effacement Is Essential

When actual labor begins, the contractions really start to stretch the cervix. First-time moms may labor longer because they tend to efface before they dilate. But, in later pregnancies, effacement and dilation usually happen together and more quickly. After having already had a child, your cervix is already less firm and more flexible from the delivery of the first child.

In the last week or two before your due date, 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. 

Once the cervix is 100% effaced and fully dilated to 10 cm, it's time to push and deliver the baby. As noted above, the cervix needs to become fully effaced in order for the baby's head to move through the vaginal canal and be delivered.

Signs of Effacement

You're unlikely to feel your cervix shortening and getting thinner. However, it may be happening if:

• You feel fullness in your pelvis from your baby’s head after they drop. The pressure could be ripening your cervix.
• 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 see a streak of blood from the vagina or "the bloody show."
• 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.

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

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

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 Speed Up the Process?

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

• Moving and walking around: Movement and gravity put 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.

Concerns With Effacement

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 shorter than normal or not strong enough to stay closed during pregnancy, it can begin to efface and open up too early, which could lead to preterm labor or premature birth. Causes of early effacement include the following:

• Your cervix is shorter than average.
• Your cervix is weak (incompetent cervix). 
• You had surgery on your cervix.
• You had an injury on or near the cervix.
• You have a genetic issue with the cervix.

The doctor can diagnose a short or weak cervix by reviewing your medical and pregnancy history, conducting a physical exam, and doing an ultrasound of the cervix.

The treatment for an incompetent or short cervix includes:

• 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 if the doctor sees the need through an 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, the baby may come immediately after the removal, but not always. Sometimes, the baby is even overdue.
• Monitoring: If the doctors feel that your cervix may thin and open early, they will monitor your cervix during your pregnancy. 
• Progesterone: Studies show that when prescribed from week 16 to week 36, progesterone can help prevent premature delivery

Late or No Effacement

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 several medicines and medical devices the doctor can use to help the body to efface and get labor started, including the following:

• Catheter: A straw-like tube with a balloon end is inserted into the cervix to gently stretch it.
• Laminaria: A substance that absorbs water to help the cervix slowly expand. 
• Prostaglandins: A type of medicine placed into the vagina to help soften or ripen the cervix.
• 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

Understanding effacement is 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 it can be slow to happen and require a little help from the doctor to get going. Most of the time, it happens on its own, when your body and baby are ready. However it happens, the process of effacement, along with dilation, opens the door to bringing your baby into the world.