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Your Pre-Labor Cervix is Not a Magic 8-Ball

Photograph by Twenty20

If there's anything that a pregnant person wants to know at the end of their pregnancy, it's this: When the hell will my baby be born?

It's an understandable question. Nine-plus months of carrying a human being in your uterus can put a strain on your body and your patience.

But there's just one catch: No one can predict with any certainty when a baby will be born. Even scheduled births don't always go as scheduled. Just ask the person whose planned cesarean section or induction has been delayed by hours or days because of an overcrowded Labor and Delivery unit.

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Yet the maddening unpredictability of birth still doesn't stop some people from trying to predict when labor will begin. And doctors, midwives and laypeople alike love to rely on one particular bit of information when making these predictions: pre-labor cervical dilation.

As a birth doula I can't count the number of times I've heard pregnant people exclaim (or lament) the following:

"My cervix is already 4 centimeters dilated! My OB says that I'll probably go into labor in the next 24 hours!"

"My midwife says my cervix is still closed. She told me that labor is probably weeks away. I'm already 40 weeks pregnant. I'm never going to have this baby."

"So if I'm 2 centimeters dilated and 50 percent effaced, does that mean that I'll go into labor by the end of the week? Help me!"

When your doctor or midwife is putting you through the "fun" of a pre-labor cervical exam, they are not twisting and turning a Magic 8-Ball so that they can read the future.

For those of you who've made similar exclamations or laments, allow me to let you in on a little secret: Your pre-labor cervical dilation cannot predict exactly when you will go into labor. At all. Ever.

"Oh, goodie, I'm 4 centimeters dilated!" can just as easily turn into, "Oh goodie. I've been 4 centimeters dilated for two weeks now."

"Woe is me, my cervix isn't dilated at all" can also easily turn into, "Oh wow! I had no cervical dilation yesterday afternoon, and today I have a baby in my arms!"

And a cervix that is 2 centimeters dilated and 50 percent effaced only means that the cervix is approximately 2 centimeters open and halfway thinned out. It means very little else. And it can predict absolutely nothing, either.

Here's the thing: When your doctor or midwife is putting you through the "fun" of a pre-labor cervical exam, they are not twisting and turning a Magic 8-Ball so that they can read the future. They are not peering into the eerie glow of a crystal ball. They are not performing a cervical check with one hand and calling the 1-800-PSYCHIC hotline on the other.

They are simply taking a measurement. That's all.

To be fair, sometimes these measurements are necessary even before labor begins. If your care provider suspects that you are at risk for preterm labor, then it makes sense for them do to a cervical exam. If you are planning an induction, then your doctor or midwife will probably perform a pre-labor cervical exam to check your body's readiness for an induction.

'Why can't my doctor just examine my cervix and tell me when I'm going to have this baby?'

But if you're not at risk for preterm labor, and if you're not planning an induction, then, frankly, there's no predictive information that a cervical exam will give you.

Most maternity care providers have very good intentions when they make their pre-labor-cervix predictions. They want to raise their patients' hope. They want offer reassurance. They want to give some perspective and some reasonable expectations. But too often, their predictions backfire. And too often, they can make women feel as if their bodies are broken.

"Why is my body not going into labor if I'm already 4 centimeters dilated?"

"Why is my cervix not dilating at all?"

"Why can't my doctor just examine my cervix and tell me when I'm going to have this baby?"

But it's not women's bodies that are broken. It's the pre-labor cervix prediction model that's broken.

So the next time your doctor or midwife offers to check your cervix before you're in labor, ask them if it's a necessary exam. Are you at risk for preterm labor? Are you planning an induction? If the answers are "no," then you have a couple options.

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You can say, "OK, sure!" Though the exam itself might not be exciting (to say the least), the information you receive might be encouraging. But you can also say, "No, no thanks. Not today. I'll wait for a cervical exam until I'm actually in labor."

Either way, know that the information you'd get from a pre-labor cervical exam can't really predict anything anyway.

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