About Cervical Ripening

During your pregnancy, the cervix is thick and closed to keep your baby inside your uterus. Before your labor actually starts, the cervix grows soft and thin to allow your baby to pass out of the uterus and into the birth canal. This is a natural process, but this doesn’t mean that all women easily go through this process at the same time in their pregnancy as their body prepares for their baby’s delivery.  

So in your discussions with your physician, ask to have the difference between cervical ripening and induction explained so you know what any suggested treatments involve. You can have cervical ripening leading to a natural labor and delivery. However, if you are going to be induced, you must have some form of cervical ripening before induction.  

How Do You Know If You Need Cervical Ripening? 

The Bishop score is a scale used to determine how ripe your cervix is. Your doctor’s examination of your cervix will give an idea of where you are in the 0-13 Bishop score range. A score of less than 6 would indicate that cervical ripening is necessary. But if you get a score of more than 8, then you are ready for labor without any additional procedures. 

How Is Assisted Cervical Ripening Achieved? 

To help you prepare for a possible assisted cervical ripening, you should familiarize yourself with the different ways it can be accomplished, either with the help of manual manipulations or medications. 

  • Manual Manipulations

     

Manual manipulations are designed to stretch and thin the cervix. The most commonly used manual dilators are Foley catheters inserted into the uterus and filled with a few milliliters of sterile water.   

A second way to manually cause cervical ripening is to break the baby’s amniotic sack (called amniotomy). I always pregerred to wait until the cervix was 6 to 7 centimeters dilated before breaking the amniotic sack. I personally believe the amniotic sack helps protect the baby’s head as it is pushed against the cervix in the early states of labor and delivery when the cervix is only slightly dilated. 

  • Medications

     

To ripen your cervix, your doctor might suggest artificial prostaglandins. Prostaglandins are the natural chemicals in your body that can soften the cervix. Cytotec in low doses is commonly used for cervical ripening. Typically, a 25 mcg tablet is inserted in the vagina close to the cervix. Cytotec as a cervical ripening agent will only work if the cervix is favorable. If the cervix is not favorable, even increasing the dosage of the Cytotec will not cause cervical ripening.    

Ask Your Physician Why Cervical Ripening is Being Suggested 

The reasons for cervical ripening can vary widely. If your physician is suggesting cervical ripening for you, ask why. Perhaps you are at 41 or 42 weeks and your physician is becoming concerned about carrying your baby too long. There is risk that the placenta will separate or deteriorate if you carry your baby more than 42 weeks. Yet many women carry their babies that long and have no problems.  

Even if you undergo cervical ripening, you may not go into active labor for some time after the cervical ripening, perhaps because your cervix was unfavorable to begin with. Physicians will then often want to proceed with actual induction with Pitocin. You will need to make the decision whether or not you want to let your baby decide when to be born or rush the process and be induced. If you are healthy and you have no pregnancy complications, you may decide to forgo the induction and wait for nature to take its course. I always prefer to keep labor and delivery interventions to a minimum, but the choice is always yours to make, with the advice of your physician. 

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Dr. Alan Lindemann

Obstetrician-Gynecologist (OB/GYN)​

He is an obstetrician and maternal mortality expert with 4 decades of medical practice beginning in Minnesota and presently in North Dakota. He has delivered around 6,000 babies with zero maternal deaths.