The body starts preparing in several ways for labor as the due date draws near. One of the most significant changes is to the cervix, which is essential for childbirth. These alterations may indicate that the body is preparing for the baby’s arrival.
Pregnant women may feel more prepared and aware of the phases leading up to labor if they are aware of the symptoms and characteristics of the cervix before giving birth. As these natural processes take place, it can also provide peace of mind.
This article will describe the changes that occur in the cervix in the last few weeks of pregnancy, what to expect from it, and how these changes will affect the impending delivery.
Maturation mechanisms
The cervix is a round, tight muscle that, like a locking device, closes the entrance to the uterus from the vagina. During pregnancy, the strength of the cervix and how well it copes with the locking functions determines whether a woman will carry the baby to term, and whether the baby will be at risk of intrauterine infections that have penetrated from the genital tract into the uterine cavity, premature birth. Many people believe that the cervix begins to prepare for childbirth only shortly before this physiological process. But in fact, this preparation begins already in the first trimester, and this round muscle matures throughout the entire period of gestation. Already a month after conception has taken place, the cervix becomes more mobile (this is one of the gynecological signs of pregnancy, noted during examination on the chair already 2 weeks after the start of the delay). The structure of the muscle tissue changes not immediately before childbirth, but in advance. By the 20th week, the cervix shortens due to the fact that by the middle of the term it is already quite softened. The shortening does not yet look significant, it does not exceed 5 mm. The muscle tissue becomes slightly hypertrophied due to the fact that the loads on it increase (it becomes more difficult to hold the constantly growing baby). But it is still far from real elasticity.
Only at the end of the third trimester, when the concentration of progesterone in the body of the expectant mother begins to decrease steadily, the cervix rapidly shortens and smooths out. As a result, activated neutrophils move to the area of the round muscle, producing prostaglandins, enzymes that should make the cervix elastic. After 35 weeks of pregnancy (on average), the fetus descends lower in the uterus, presses its head against the internal os and begins to provide the cervix with all possible assistance: pressure from the inside leads to stretching of the cervical fibers, the os begins to open slightly. During maturation, dense collagen fibers of the cervix are destroyed under the influence of hormones. With the onset of labor contractions, the muscles of the uterus come into tone, and with each contraction the cervix begins to open more and more. The end of contractions is the complete opening of the cervix, which makes it possible for the baby to exit the uterus. After passing through the birth canal, the baby will be born. The cervix ripens at different rates in different women, smoothing and opening depends on many factors, including individual ones. But in childbirth, the disclosure mechanism should be approximately the same, on which the determination of the three periods of childbirth is based. In primiparous women, the cervix matures longer than in multiparous women, and the opening occurs differently.
The internal os opens first during the first birth, and the external and internal os open nearly simultaneously during subsequent births. As a result, the second birth typically occurs sooner than the first.
How maturity is determined?
During the final weeks of pregnancy, the antenatal clinic physician measures the height of the uterine fundus, the circumference of the abdomen, and assesses the condition of the cervix. By hand, this is verified using the "obstetric fingers" technique. Two fingers are placed into the genital tract while wearing sterile gloves, and the cervix is palpated to determine how many fingers can pass through. When the opening reaches one to 1.5 fingers by 39 weeks of pregnancy, the cervix is fully developed and prepared for giving birth. Its consistency softens and its length drops to less than a centimeter.
- density of the cervix: hard, dense, hard – 0 points, soft at the edges, but dense in the center – 1 point, uniformly softened – 2 points;
- length of the cervix: more than 2 centimeters — 0 points, shortened from 1 to 2 centimeters — 1 point, less than a centimeter and smoothed — 2 points;
- opening: does not let a single finger through — 0 points, dilation of the cervical canal — 1 point, 1-2 fingers — 2 points;
- position of the cervix: backward deviation — 0 points, above the entrance to the vagina — 1 point, middle position — 2 points.
According to Bishop, the gynecologist can determine the overall maturity score following examination.
- 5-8 points — the cervix is completely ready, labor is possible at any time;
- 3-4 points — insufficient maturity;
- less than 3 points — the cervix is not ready, it is immature, long.
Based on these indicators, a suitable decision is made, either to wait (if time permits) or to admit the woman to a hospital, where a medical procedure will be performed to prepare the cervix for the impending birth once the underlying cause has been determined.
Preparation
By 39–40 weeks, the cervix is not fully matured or mature enough to be prepared medically. The cervix can be made more elastic and relaxed with the use of medications and mechanical techniques. The second uses kelp sticks and a Foley catheter to widen the cervical canal. First, there are oral medications, suppositories, and hormonal gel that are applied directly to the cervix.
Antispasmodics (Buscopan, No-shpa, Papaverine in suppositories) may be prescribed by the physician. These medications cause the muscles to relax somewhat and speed up the smoothing process. These medications are safe to use at home by women in conjunction with exercise regimens, increased physical activity, and raspberry leaf tea. Other preparatory activities are only done in a medical facility.
- Foley catheter – a thin latex-silicone tube with a small balloon. Inserted by a doctor into the cervical canal, the balloon at the outer end is filled with saline. Mechanical pressure allows you to accelerate the maturation and opening. The effectiveness of the method is no more than 50%, this means that in half of the cases the catheter does not give the desired result.
- Laminaria – these are sticks made of dried kelp, which are inserted into the cervical canal. Gradually the canal expands due to the swelling of the algae. After 24 hours, the sticks are changed or removed completely if there is a result. The effectiveness is higher than that of a catheter, but not by much.
- Medicines – these are mainly prostaglandins and estrogens. The effectiveness is high, but again, not 100%.
A thick and lengthy cervix is not ready for opening if, despite preparation, it still refuses to open. In this case, labor stimulation is not carried out. The indications can determine whether to perform a cesarean section.
| Feature | Description |
| Softening | Before childbirth, the cervix becomes softer to prepare for labor. |
| Dilation | The cervix gradually opens to allow the baby to pass through the birth canal. |
| Effacement | The cervix thins out and shortens, making it easier for the baby to be born. |
| Position Change | The cervix moves from a posterior to a more central position in preparation for labor. |
The cervix changes significantly in preparation for the baby’s arrival as childbirth draws near. During the last weeks of pregnancy, expecting mothers may feel more knowledgeable and confident if they are aware of these changes.
Cervix softening, thinning, and dilation are normal physiological changes that signify the body’s preparation for labor. These are significant prenatal milestones, though each woman’s experience is unique.
As their due date draws near, expectant mothers can feel more at ease knowing that their bodies are getting ready for one of life’s most amazing experiences by being aware of the warning signs of cervical changes.
The cervix changes significantly before childbirth in order to prepare the area for delivery. It begins to shorten, soften, and dilate, facilitating the baby’s passage through the birth canal. These are normal changes that occur during labor, and doctors keep an eye on them to make sure everything is going according to plan.
