Cervical Ripening: Concept, Methods, Benefits & Threats

As you come near the end of your pregnancy, your cervix starts softening in preparation for the birth of your baby. An open cervix is essential for the baby to pass through during delivery. However, in many cases, cervical ripening does not occur as expected. Luckily, there are certain things you can do to help move the process along.

What is Cervical Ripening?

Cervical ripening is the softening and opening of the cervix before the onset of labour. During a major part of the pregnancy, the cervix remains closed and stiff to hold the baby inside the uterus. However, during labour, the process of cervical dilation takes place to allow the baby to pass through the birth canal for delivery. This softening of the cervix during pregnancy is known as Effacement. In many women, cervical ripening happens naturally but some women require assisted cervical ripening. This may be done using medications, procedures, or certain devices.

Who requires cervical ripening?

People who get their labour induced often require cervical ripening. Induction triggers your contractions to allow labour to start. You may require cervical ripening in case you:

• Have an overdue pregnancy (lasting more than 41 weeks)

• Have certain health risks that put you or your fetus at risk for preeclampsia, growth restriction, or gestational diabetes.

How does my doctor know if I need cervical ripening?

Your doctor uses a scale known as Bishop score to check your degree of cervical ripening. The doctor will examine your cervix and determine your Bishop score. They check your cervix for its position and its thinning, softening, and dilating. A bishop score below 6 means that the cervix is not ripe enough. On the other hand, a score of about 8 means your body is prepared for labour, and you may not require cervical ripening.

When does cervical ripening occur during labour?

Cervical ripening happens naturally before the onset of labour. During the first phase of labour, the cervix dilates and thins. During the second stage, it is fully dilated to 10 centimetres.

How is cervical ripening carried out?

Cervix ripening is performed in several ways. These include:

• Non-pharmacological methods

• Medications

• Membrane stripping

• Special devices

Is it possible to naturally ripen the cervix?

Some methods have been used for ages to ripen your cervix naturally before childbirth. However, make sure to consult your doctor before you try them out. These non-pharmacological methods of cervix ripening work by releasing hormones in the body. If you are wondering how to soften the cervix at home naturally, try these:

• Breast stimulation

• Acupuncture

• Herbal supplements

• Castor oil

• Enemas

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• Sexual intercourse

• Hot bath

• TENS therapy (Transcutaneous electrical nerve stimulation)

How can medicine cause the cervix to ripen?

Your doctor may prescribe synthetic prostaglandins to encourage your cervix to ripen. They are naturally occurring chemicals that provide hormone-like properties to your body. Your doctor may also prescribe prostaglandins as a pill, gel, or pessary. A catheter may be inserted with the gel into the cervix to apply it. You may require multiple applications of this medication for the cervix to ripen.

Other medications for cervical ripening include:

• Mifepristone

• Oxytocin

• Dinoprostone

• Misoprostol

How do gadgets cause the cervix to ripen?

Dilators are used to exert pressure on the cervix and widen it. Due to this, the body releases natural prostaglandins to help move the process along. This may be done by inserting an inflatable balloon into the cervix and then filling it with Sterile water or saline.

How does surgery cause the cervix to ripen?

Certain surgical procedures may also be recommended to ripen the cervix. These include:

• Amniotomy: This procedure involves rupturing the amniotic scan to help release prostaglandins naturally.

• Stripping the membranes: The doctor inserts a gloved finger into the cervix to separate or run the membranes between the amniotic sac and the uterus to help release prostaglandins.

What are the risks associated with cervical ripening?

The different methods of cervical ripening bring their own associated risks. The risks of taking medications for cervical ripening include:

• Fever

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• Diarrhea

• Nausea and vomiting

• Excessive contractions

Risks associated with surgery for cervical ripening may include:

• Drop in the heart rate of the fetus

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• Bleeding

• Fetal death or injury

• Umbilical cord prolapse or compression

• Infection in the fetus or the mother

What exactly are the benefits of cervical ripening?

The primary benefit of cervical ripening is that it helps with the onset of labour. It also helps in reducing the length of your labour.

What long-term effects can cervical ripening have?

In most cases, cervical ripening has no long-term effects on the uterus. The reason why you may require cervical ripening may also augment your risk for c-section, which in turn, increases the health risks for your fetus and you.

When should I make an appointment with my doctor?

Talk to your doctor if you want to discuss anything related to cervical ripening or labour induction. You must also contact your doctor if you notice any signs of premature labour, such as pain, vomiting, nausea, bleeding, or uterine contractions.