Making Progress in Labor is More than Just Dilation

"How far dilated are you?" When you get past 36 weeks of pregnancy, this is most likely a question you'll hear again and again -- from several people. And more than likely, you'll wait in anxious anticipation after a routine pelvic exam to hear the report, and quite possibly feel crestfallen when you hear, "You're about 1 to 2."

We've come to believe that cervical dilation is a magical marker for how soon labor will begin or how long labor will last. But in fact, dilation is NOT a Magic 8 Ball. Some women begin dilating at 36 weeks and go to 41 weeks before they finally go into labor at 7 centimeters. Some women are checked with a routine cervical exam and found to be just "a finger tip dilated," then go into full blown, active labor 24 hours later. And some women have their babies without ever having a pelvic exam! As it turns out, routine pelvic exams are not medically necessary and babies can be born perfectly without ever knowing how far dilated you are.

When assessing your progress in labor, take heart in knowing that cervical dilation means very little and that there are actually six ways to measure progress. They are:

• Position of cervix -- from posterior to anterior. The normal position for your cervix is pointed toward your back. As you progress in labor, your cervix moves forward to face front.
• Cervix ripens or softens. It goes from feeling like the tip of your nose to the tip of your chin.
• Cervix effaces or thins. If you receive a cervical exam, you'll hear things like 10% effaced or 80% effaced. When you give birth, you will be 100% effaced.
• Cervix dilates or opens. Cervical dilation is from 1 cm to 10 cm, with 10 cm being the goal for birth.
• Baby's head rotates and molds. Internal rotation is a key part of baby's preparation for birth. Babies are also beautifully designed with molding bony plates in their skull to fit through your pelvis and vagina.
• Baby descends. As you progress in labor, you may hear your care provider report things like "0 station" or "+2." This refers to baby's head position in relation to your pelvic opening. When baby is at +5, he is crowning.

As you come to the end of your pregnancy, know that it is within your right to refuse a routine pelvic exam. But if you are just too eager to know about your progress, it's also within your right to have one. Just keep in mind that the results may give you a false impression of your progress. Be sure to ask your care provider about the other five markers for progress. When combined, these measures of progression may give you a better picture of how ready your body is for labor and birth. For more information about he benefits and risks of routine pelvic exams, check out this article on Science & Sensibility, the Lamaze blog for maternity care professionals.