Dilation and effacement. These are the standard ways that healthcare providers evaluate progress during labour, but there is more to the story! Penny Simkin, author of The Birth Partner and DONA International co-founder, says there are 6 ways to progress in labour.
1. The cervix is moving forward
During your pregnancy, your cervix is long, hard and pointing slightly towards your back. In the last weeks of pregnancy and in labour, the cervix begins to move forward.
2. The cervix is ripening
During your pregnancy, your cervix is hard, but in the last weeks of your pregnancy and in early labour, your cervix begins to soften, to "ripen".
3. Effacement: the cervix is shortening/thinning
During your pregnancy, the cervix is long. In the last few weeks and in labour, the cervix shortens and thins out. This is assessed at a percentage from 0% (long) to fully thinned out 100%.
4. Dilation: the cervix is opening
Dilation can sometimes begin to occur in the last few weeks of your pregnancy, so don't panic if your care provider tells you at 36 weeks that you're 3cm dilated. This can happen. Dilation is measured in cm. the cervix begins closed (0 cm) and will need to open to 10 cm before you're ready to push.
5. Station: the baby is descending
Around 2 weeks before you deliver, your baby will drop slightly lower into your pelvis. You might notice this “lightening” as feeling less out of breath, since your lungs now how more room to expand, and you can once again take deep breaths. Station is usually measured as a negative or positive number from -3 to + 3. You may hear your care provider say that your baby’s head is “engaged” or 0 station, which means that your baby’s head has settled into your pelvis, but has not yet moved down into the birth canal. Once your baby starts moving further towards the cervix and into the birth canal, your baby is moving to +1 to +3 and you bring your baby into the world!
6. The baby is rotating
Your baby needs to rotate into a good position in order to move well through your pelvis. Your baby will need to rotate before they enter your pelvis and as they move down through your pelvis. Movement and changing positions frequently will help your baby to rotate and get into an optimal position for birth.
There is more than dilation and effacement to consider when looking at the progress of labour, so when you’re in labour, be sure to ask your care provider about these other indicators. Don’t be too discouraged if you’ve been 5 cm dilated and 90% effaced for two vaginal exams in a row. Perhaps your baby has descended from -1 to 0! Or your baby has rotated into a more favourable position after you’ve tried some different positions! You need to know the full story, so don’t hesitate to ask your care provider!