* Since this post still gets quite a number of visit 2 years after the original post. I want to update also with a link to another resource and possible explanation to many of the questions posed here. After reading this post, do visit Improving Birth to read Cervical Scar Tissue – A Cause of Preventable C-Sections.
The first time I heard a woman say that her body wouldn’t (can’t, won’t, don’t) dilate, it was from my own mother. She was telling me the story of my birth. She held up 7 fingers and told me that her body wouldn’t dilate past 7cm. I went into distress and passed meconium. I was delivered by emergency c-section. It is a story that I can’t remember ever not being aware of.
Since becoming a mother myself and a childbirth educator and birth doula, I have heard numerous women with very similar stories. The common line being - I just wouldn’t dilate. There seems to be a lot of emphasis put on how dilated a woman is and isn’t beginning in her final weeks of pregnancy and continuing on through enduring vaginal exam after vaginal exam to check on the progress of dilation. Dilation is a very necessary part of the labor process. We must open for our babies to be born. However, with this story seemingly becoming more and more common, you must ask. Why aren’t we opening? Are we biologically dysfunctional beings whose bodies are not capable of bringing forth the lives that will carry on our species without medical or surgical help? What is happening? How is the modern woman different from all the women who gave birth before her?
To begin looking into this story a little more, let’s look at the following animated birth video. The video shows what is happening on the inside of our body as we labor. You will see the cervix – opening to the uterus – thin and open (effacement and dilation) so that the baby can come into the birth canal. Another thing to notice in the animation is all the movement happening in the mother’s body and also with the baby.
Labor Progresses in Six Ways!
This video is a great illustration of how dilation is only one of many things that occurs in the woman’s laboring body before the baby can be born. Labor is like a dance. Some of the dance is choreographed and other parts of it are free form. The partners in the dance are the mother and the baby. This dance has six choreographed steps.
- The cervix softens (ripens) – during the final weeks of pregnancy, hormones called prostagladins begin to soften the thick cervix making it able to move and stretch. Earlier in pregnancy the cervix needed to remain thick and long (between 3 and 5cm) as the opening of the uterus in order to maintain the pregnancy.
- The position of the cervix changes - through much of your pregnancy your cervix will be posterior (pointing toward your back away from the birth canal). In the later stages of pregnancy, the cervix begins to move toward the front of your body (anterior) and the birth canal.
- The cervix thins and shortens (effaces) – hormones and pressure from the baby resting lower in the abdomen helps the cervix to begin to thin and become shorter (effacement). This is usually measured by percentages and is told to women after vaginal exams. 100% effacement is a paper-thin cervix.
- The cervix opens (dilates) - This usually begins with regular contractions of the uterus after the previous 3 cervical changes mentioned here occur. Contractions pull the uterus opened and a cervix that is ready for labor responds to this work by dilating. Pressure from the baby moving lower into the pelvis also helps to dilate the cervix. It is also common in some women that they dilate from 1 to 3 centimeters before noticing any other positive signs of labor. The cervix will dilate throughout the labor process to 10cm (almost 4in.) to allow the baby to pass through.
- The baby rotates - The most favorable position for birth is the OA position where the hard part of the baby’s skull is facing the front of the mother’s body. However, this is not a requirement for vaginal birth, and positioning of the baby can vary, some positions making labor and birth a little more difficult than others. Visit the website Spinning Babies for suggestions on how to help your baby get into the optimal position for birth. The baby’s head may also “mold” to better fit through the pelvis and birth canal. The baby’s head becomes longer and thinner. This is normal. A baby’s skull is not fused together so that it is capable of this amazing thing. Your baby’s head will return to the round shape a few days after birth.
- The baby descends – Watch the following animation that illustrates the baby’s descent into the pelvis and birth canal. Descent in measured in “stations”.
Dilation is just one of many things that must happen in labor for birth to occur. For some women dilation happens gradually over time. It isn’t uncommon for a woman to walk around for week dilated to 2cm. However, it also is not uncommon for a woman to not begin dilating until she knows she is in labor, as it is actually the 4th and final change that the cervix makes in preparation for birth.
Another common element to this story of the cervix that won’t dilate, (though not always) is that the labor was either induced or augmented with pitocin. In naturally occurring labor, our body releases oxytocin – a hormone that cause the uterus to contract. Pitocin is a synthetic version of this hormone that care providers use to artifically cause the woman’s uterus to contract before it is ready (induction), or if the uterus seems to be fatigued at some point during labor.
Before an induction is scheduled, a woman should receive what is called a Bishop’s score. This score tells the woman and her care provider how favorable the cerivx is for labor. Inducing labor before a woman’s cervix is ready can increase the risk of complications like stalled progress (no dilation), overstimulating the uterus, fetal distress, and cesarean section. When labor needs to occur for medical reasons or because you have made the personal decision to induce your labor, your practitioner can use artifical means of preparing the cervix as well. Artifical prostagladins are inserted into the vagina around the cervix to cause changes. It is important to keep in mind that many of these medications have great risks. Inform yourself of these risks and decide if the benefits of inducing labor outweigh the risks of the procedure.
Another consideration is that the body is being forced to do something that it has not yet completed the preparation for. As was mentioned before, labor is a dance between mother and baby. So, when inducing labor it could be the case that either the mother or the baby is not ready for the labor process – or both partners.
How long does it take women to go through the labor process? What if labor stalls out? We know that for the first time mother the average time she will spend in labor will be around 16 hours. This means that there are plenty of women who labor normally for longer than that, and plenty who don’t labor that long. Our bodies are unique. Our babies are unique. There are many variations of normal in labor. So, how do we know if we need augmentation with pitocin in labor? The sure answer would be if mother or baby are showing signs of physical decline and the birth needs to happen as soon as is possible.
The thing to consider when deciding whether or not labor augmentation is something that you do need is the normal pauses that happen in many normal labors. There are pauses between contractions. Often there is a pause in between stages of labor before active labor and before the pushing phase. These pauses allow our bodies the break they need to continue the hard work ahead. The question would then be, how are you and your baby tolerating labor? Is there something in your environment making you feel uncomfortable or afraid? If so, remove it. The hormones that orchestrate the music of our dance can be impeded if the mother feels threatened in any way. We don’t want to birth in an unstable environment. Also consider whether or not you may simply need to change positions, have alone time with your loved ones, or take a shower. All of these things have the potential to get labor going strong again.
A recent study concluded that women are being held to unrealistic time tables where labor is concerned. It could be that we haven’t been patient enough with labor.
To Use or Not to Use Pitocin
There are correct and necessary times for the use of nearly every medication that is used in labor and delivery. Many of those times, the answer of whether or not to use pitocin or other medications in labor is obvious. Without the medication the mother or baby would be at a greater risk of harm.
However, is it fair for us to think that somehow our bodies were dysfunctional if they did not respond to medications the way we or our doctors had hoped? It isn’t. It also does not mean that your body won’t labor normally in your next pregnancy. Often, it simply means your body wasn’t ready to do what it was asked to do at that time. It does not mean you are broken or somehow faulty. Pitocin was used in my mother’s labor. She went from being able to walk around the halls to slumping in the floor when her labor was augmented. I went into distress which is a common risk with Pitocin, and emergency cesarean was then necessary for our safety. It wasn’t that my mother couldn’t dilate. It was that we both experienced a side effect of medication.
Of course, there are exceptions to this. Our body’s can naturally have difficulty dilating as well. Malpositioning of our baby. Stress. Possible hormone problems. Past traumatic experiences. These things can factor in to our body’s natural ability to open for birth. The difference is that many of these naturally occurring difficulties can also be worked through to allow our bodies to go on as they normally would. In cases that this is impossible, the experience of medical professionals is needed to help us birth safely.
Our bodies are not broken. With patience, love, and the right environment, we can be witness to them working in their own time to bring forth our babies. For times, when it isn’t possible for us to wait on birth, we can’t continue to place blame on our bodies. Call our babies stubborn. Or fear the next time we face birth. We must realize that it was not our bodies that failed us. It was a situation beyond our control. Take back our bodies. We aren’t broken.