Birth is not just about dilation – don’t forget effacement
(This post first appeared in March 2015 and has been updated).
I was at a birth a few years back. When mom was admitted to the hospital she was 4 cm dilated and 40% effaced. Three hours later, after hours of long and strong contractions, it was time to evaluate her progress (aka examine her). The conversation went something like this:
Nurse (with a look of pity): Oh, you’re still at 4.
Mom: What? Still at 4 cm? OMG!!
Me (interjecting quickly): Can you please tell us how effaced the cervix is now?
Nurse: Almost fully effaced.
Me: That’s great!! You’re almost fully effaced! Yay!
Nurse (looking at me as if I had two heads): But she’s still only at 4 cm….
Twin Sisters: Dilation and Effacement
Now there are few things during that exchange that got me all riled up, but in this blog post, I don’t want to discuss the discouraging tone and language of the caregiver, or even her seemingly lack of knowledge regarding the cervix. What I want to share with you is the magic of EFFACEMENT.
I LOVE effacement!! I really do. Enough to jump for joy! Unfortunately, it is always overshadowed by dilation. Almost everyone knows one thing about dilation: ‘When you dilate to 10 cm, you can push your baby out!’ This is reinforced during the usual prenatal class, which informs parents about the importance of dilation, but omits to tell them that she has a twin sister who is just as important!
Because without a fully effaced cervix, you will not fully dilate.
The ins and outs of effacement
So what is effacement exactly? Its origin comes from the French word ‘effacer’ which means to erase. Here, in Quebec, it is quite a common word that we use a lot in French. Not so much in English.
The cervix is about 4 cm long and is the opening to the womb, in between the vagina and the uterus. As the baby comes down the birth canal during contractions, the pressure of the baby’s head on the cervix effaces – or thins out – the cervix. Sometimes, moms will efface and dilate at the same time, sometimes they will begin to efface first and then dilate later. No two birthing women are alike.
But both dilation and effacement have to happen before baby will come out.
How many times have I seen a mom at 9.5 cm with just a slight lip of cervix left!? Frustrating, I know, but baby won’t come out until that smallest of rims disappears. When it does disappear she’ll be at 10 cm and baby will come down further.
What I also find interesting, is that first time moms will efface faster than they dilate, but moms who have birthed before dilate faster than they efface! How cool is that? With my third baby, I was 4 cm dilated for at least three weeks before giving birth. This is why 2nd time births can go quickly – once you’re in labour, a lot of the work has already taken place!
Why should you care about effacement?
So, what does this all mean for you? It means be patient! Tather than just look at dilation as a means of progression, remember her cool twin sister: effacement. Contractions don’t just happen so you dilate. They also help your cervix soften and melt away. They also help bring baby down. And trust that once you are effaced, in the majority of cases (barring those rare exceptions) your cervix will fully dilate.
So, yeah, I love effacement.
What happened to my client? After her cervix was effaced 100%, she dilated gradually, reaching 10 cm several hours later and then proceeded to push out her beautiful baby. Just as nature intended.
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