Labor is hard. We all know that. The most challenging aspect of labor, aside from the intense sensations and the obvious intricacies of getting a full sized baby out of a woman’s body, is that it’s unpredictable. It’s impossible to know how long any labor will last (until after it’s over, that is). But we’re human. We’re curious. And by gosh we want to measure labor progress!
So we do. We judge labor progress by effacement, or thinning, of the cervix (measured as a percentage), ripeness (whether the cervix is firm, medium or soft), station of the baby (usually anything from -3 to +2 prior to the pushing stage) and buh, buh, buh, BUM! Cervical Dilation: the one number that everyone pays attention to.
But as labor doulas, we have a love/hate relationship with cervical dilation measurements. Why? Because they don’t mean anything. Yes, you read that right. Your cervical dilation at any one moment doesn’t mean anything. Because it tells you nothing about what will happen next. And that’s really what we want to know, right? We want to use the information to predict what will happen next and when the labor will result in a baby.
But the rate of progress changes constantly, so prediction is futile.
And what’s more, it’s not always harmless information. Anyone who has been a doula for a while has seen a cervical dilation report turn a beautifully-coping laboring person, into a woman filled with doubt, discouragement and overwhelm. Often, needlessly so.
Because cervical dilation is just one piece of the labor puzzle and sometimes it has to catch up with what the rest of the body is doing. For example, I was with a laboring woman once, who was beginning to show all the classic signs of transition. She was feeling nauseated, her body was shaky, her contractions were coming close together and she began to say that she couldn’t do it. At this point the nurse checked her and said that she was 100% effaced and 5 cms (100% effaced is fantastic! But all she heard was the 5 cms. Heck 5 cms is fantastic too, but my client wanted to hear that she was farther along than that). After that check she began to ask for an epidural (which she had been adamantly against before). She asked for an epidural and decided to self-impose a 30 minutes waiting period (a strategy suggested by her childbirth class instructor). At the end of the 30 minutes she still wanted an epidural, but opted to get one more cervical check before making the final decision.
This cervical check was just over an hour after her last cervical check, but this time she was 9 centimeters dilated! She passed on the epidural. No wonder she felt overwhelmed! Her outward signals were telling us that she was in transition, but her 5 cm cervical check seemed to contradict what we were seeing. But in the end, our assessment of her labor based on what we could see and hear on the outside was more accurate than her cervical check.
Edit in July of 2020: This example was not an isolated incident. I’ve had so many examples since I first wrote this piece. One client began spontaneously pushing (when your body pushes and you’re helpless to stop it) just after a cervical check revealed that she was 7 cms dilated, and her baby was born about 1.5 hours later. A recent client began to feel lots of pressure just after getting an epidural at 4 cms and her baby was born about 3.5 hours later. Another recent client began to spontaneously push when she was just 5 cms and her baby was born 1.5 hours later. These patterns, while not textbook or typical for first time birthers (and all of these examples were), are by no means rare. It’s healthy to have realistic expectations about how long labor might take, but always leave room for a crazy twist!
The moral of the story is to take any cervical dilation measurements with a grain of salt. As a patient, you may even want to have your provider avoid telling you what your dilation is (unless it will help you to make a critical decision) so that you don’t start doing “fuzzy labor math” that may hurt your morale and your progress.