Imagine its 2am, you have been in labor for quite a few hours but you are happy because the moment you have been waiting for, the moment you get to meet your baby is drawing near. Your care provider did an internal exam 3 hours ago and said you were 2cm dilated and 20% effaced. You keep going, your baby is coming, and you are doing it. A few hours go by and you grow excited again as your care provider tells you it is time to do another exam, as you wait patiently while your care provider completes the exam you can’t help but have a number in your head like I think I’m at 5cm, yes definitely 5cm and then your care provider gives you a blow, you are at 3cm and 50% effaced. Now your head starts getting to you, if it is going to take me 3 hours to go 1cm and I need to get to 10cm I might as well give up now, how am I going to handle this. Hopefully you have a great support system that encourages you onward telling you how great you are and you keep laboring on. Another 3 hours goes by and you have been trying to stay positive in hopes of a good ‘number’ the next time. So here it comes, the big number you have been waiting for after another exam and you are 3cm dilated and 100% effaced. WHAT? How could this be? I have been in so much discomfort, going through so many contractions and nothing has happened in the entire 3 hours, what is wrong with me?
This is where I say STOP! The biggest disservice a care provider can do to a pregnant woman is not explain what I like to call the 1, 2, 3’s of labor; there are 3 number systems you will hear about: dilation, effacement and station. They are all equally important and yet you normally only know about one of them – dilation, there should be a prenatal appointment strictly on the importance of these 1, 2, 3’s and how long they can take. Effacement (image 1.1) is the softening, shortening and thinning out of the cervix and needs to happen before your baby can be born. When a woman is not pregnant her cervix is quite hard, is generally 3-5cm in length and is quite thick. During early labor your contractions are working to soften your cervix, shorten it by pulling it back and by thinning it out all to make way for baby and further dilation. With this new found knowledge let’s think about what has happened so far; at the initial check you were 20% effaced, another 80% to go so still lots of work to be done, at your second check you are now 1cm further dilated and 30% more effaced so things really are happening down there, more than you had originally thought as you were focused only on how dilated you were. At your third check, although you have not dilated any further you are now 100% effaced, this means that the contractions have done all that they can do when it comes to the cervix with the exception of dilating it, that is all the contractions have left to do right now, that is now their sole job, they have nothing else to focus on. Now here is the best part; generally speaking once you are completely effaced you dilate quicker and get into rocking and rolling active labor. During this time your contractions will become more intense, become closer together and last longer. These contractions are working hard to get your baby further down into your pelvis and dilate you further.
Don’t get me wrong, once you are completely effaced it does not necessarily mean you will have your bundle of joy in your arms in the next couple of hours, every labor is different and you never know what you’re going to get until after you got it. As you get further along in active labor a whole new word will be introduced and that will be the station (image 1.2). So let’s say another 3 hours pass and you are now 6cm dilated and baby is at 0 station which tells you where babies head is in position to the pelvis. This number will generally range from -3 which means babies head is still high up in the pelvis to +3 which means babies head is fully engaged. So now your contractions are really working hard on getting you to 10cm and getting baby further into the pelvis so you can start pushing. So now you can keep laboring on with your support system by your side and be confident that your body is doing something and it knows exactly what to do. At your next check you are 9cm and baby is at +1 station, you are so close, keep laboring on and you might start to feel some sensations near your rectum which may make you wonder if you have to have a bowel movement, you are normally welcome to try but it might just be that your baby is further into that pelvis of yours. Your care provider notices your sounds during contractions are different and you explain that you are feeling pressure, they do one last check and HOORAY you are at 10cm and you may or may not have the urge to push, if you do then go for it, if not you might get a small welcome break from the intense contractions to build up some energy before that urge comes and you get to start birthing that baby. Congratulations you got through all of your numbers and baby will be with you before you know it.
This is where I say STOP! The biggest disservice a care provider can do to a pregnant woman is not explain what I like to call the 1, 2, 3’s of labor; there are 3 number systems you will hear about: dilation, effacement and station. They are all equally important and yet you normally only know about one of them – dilation, there should be a prenatal appointment strictly on the importance of these 1, 2, 3’s and how long they can take. Effacement (image 1.1) is the softening, shortening and thinning out of the cervix and needs to happen before your baby can be born. When a woman is not pregnant her cervix is quite hard, is generally 3-5cm in length and is quite thick. During early labor your contractions are working to soften your cervix, shorten it by pulling it back and by thinning it out all to make way for baby and further dilation. With this new found knowledge let’s think about what has happened so far; at the initial check you were 20% effaced, another 80% to go so still lots of work to be done, at your second check you are now 1cm further dilated and 30% more effaced so things really are happening down there, more than you had originally thought as you were focused only on how dilated you were. At your third check, although you have not dilated any further you are now 100% effaced, this means that the contractions have done all that they can do when it comes to the cervix with the exception of dilating it, that is all the contractions have left to do right now, that is now their sole job, they have nothing else to focus on. Now here is the best part; generally speaking once you are completely effaced you dilate quicker and get into rocking and rolling active labor. During this time your contractions will become more intense, become closer together and last longer. These contractions are working hard to get your baby further down into your pelvis and dilate you further.
Don’t get me wrong, once you are completely effaced it does not necessarily mean you will have your bundle of joy in your arms in the next couple of hours, every labor is different and you never know what you’re going to get until after you got it. As you get further along in active labor a whole new word will be introduced and that will be the station (image 1.2). So let’s say another 3 hours pass and you are now 6cm dilated and baby is at 0 station which tells you where babies head is in position to the pelvis. This number will generally range from -3 which means babies head is still high up in the pelvis to +3 which means babies head is fully engaged. So now your contractions are really working hard on getting you to 10cm and getting baby further into the pelvis so you can start pushing. So now you can keep laboring on with your support system by your side and be confident that your body is doing something and it knows exactly what to do. At your next check you are 9cm and baby is at +1 station, you are so close, keep laboring on and you might start to feel some sensations near your rectum which may make you wonder if you have to have a bowel movement, you are normally welcome to try but it might just be that your baby is further into that pelvis of yours. Your care provider notices your sounds during contractions are different and you explain that you are feeling pressure, they do one last check and HOORAY you are at 10cm and you may or may not have the urge to push, if you do then go for it, if not you might get a small welcome break from the intense contractions to build up some energy before that urge comes and you get to start birthing that baby. Congratulations you got through all of your numbers and baby will be with you before you know it.
Image 1.1 Effacement & Dilation
Image 1.2 Station
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