169 All About the Cervix with Julie and Meagan

Come listen, learn, and laugh with Meagan and Julie today in our ode to the cervix. We discuss the role of the cervix in birth, cervical checks, cervical changes, and how to navigate policies to make choices that are best for YOU. The cervix is an amazing, powerful muscle that we love talking about!Additional linksHow to VBAC: The Ultimate Prep Course for ParentsAdvanced VBAC Doula Certification ProgramEmpowering Gynecologic Exams: Speculum Care Without StirrupsLenihan et al. (1984). ” Relationship of antepartum pelvic examinations to premature rupture of the membranes.” Obstetrics & Gynecology 63: 33-37Full transcriptNote: All transcripts are edited to correct grammar and to eliminate false starts and filler words. Meagan: Hey hey, this is Meagan and Julie. Today we have an episode with us. We don’t have a VBAC story today, but that’s okay. We are excited to be sharing an episode with us because we haven’t done one for a while and so we were like, “Oh, let’s get on and talk about the cervix.”This is something that obviously, the cervix has a big role in our deliveries, and so we want to talk about what it means, what it looks like, what it means if we are not dilating or if we are dilating, what it means to be checked during labor or before labor even begins, and all of the crazy things that we hear about these amazing cervixes of ours. Julie has a Review of the Week, and so we are going to turn the time over to her to read that, and then we will dive right in.Review of the WeekJulie: Yes, yes. So excited to do a whole episode all about the amazing cervix. I’m going to read a review that was just left a couple of weeks ago. Get a fresh new one in here. This is from Karen. Karen says, “Thank you,” is the title. Actually, this was an email. Oh my gosh! It’s not even a podcast review. I just read that it is an email that she sent us. So, Karen, we are going to read your email. This is really fun. Okay, so she says, “I have written this email in my head so many times in the past year. It has been a bit over a year since my little girl was born and I am still thinking about how helpful your podcast was. She was my eighth baby and was born by VBAC after two Cesareans. While I was blessed to have a very supportive doctor and birth team, something that would be more common in Canada where we are not dealing with insurance companies calling the shots--”That’s something to think about later when my mind will go off on a tangent.“I still feel like your podcast helped me to be informed about the benefits and risks of VBAC after two C-sections and empowered me to take an active role in the decision-making before and during labor and birth. I was induced and able to recognize and slow down the cascade of interventions that hospital staff assumed was going to happen. It helps to know my options for induction, a catheter, a Cook’s catheter instead of a Foley. Two balloons, so double the pressure—“Double the pressure, double the fun. That’s what just came to my mind. So, oh my gosh. Let me get back on track.“And after a while, a very slow and low Pitocin drip was the way we went. In the end, after a very calm labor with as little interference as possible, my sweet little daughter was born and I enjoyed the peaceful natural labor and birth, plus the easy recovery that I had been so hoping and praying for. My OB was so excited too. Thanks again for this wonderful work that you’re doing.”And thank you, Karen. That just touches our hearts and makes us so happy when we get reviews on our podcast, when we get emails, Instagram messages, Facebook messages. I am pretty sure we are really good at responding to all of them still. It might just take us a few days. So if you ever feel so inclined, we would love for you to reach out and tell us how we are helping you or things that we could do better to better help you and better serve you. That’s the whole reason why we created The VBAC Link-- to serve and help parents and birth workers just like you listening right now.Meagan: Yes.Julie: Yes. Another thing I wanted to talk about before we get into the magical cervix is our podcast sponsors. We have started implementing ads and sponsorships into our podcast and we have been really particular about who we invite into our space so that we make sure the sponsors that we are bringing onto our podcast will really benefit you and your family in whatever stage of parenthood, and birth, and pregnancy that you are in. Our sponsors allow us to keep bringing you this amazing podcast, so we really appreciate it when our listeners go and visit our podcast sponsor’s website and see if what they have to offer is a good fit for them. So, we want to thank you for checking out our podcast sponsors because, in the end, it all makes the world go around. We get podcast sponsors, and then when you support the sponsors, you are supporting us and allows us to keep bringing you this wonderful podcast. Right, Meagan?Meagan: Right. I love you. It’s like a little merry-go-round. Everyone is merry.Julie: Everyone is merry. I love it.Meagan: Oh my goodness. Okay, well we got a good laugh this morning. We are on podcast three of podcast five of the day. So, yeah. I think when this happens, we get a little bit more giggly. It’s just so funny.Julie: And we are not under the influence. I want to clear that up.Meagan: We are not.Julie: Except for maybe a little bit of caffeine here and there.Meagan: Wait, I thought you let caffeine go.Julie: Oh my gosh, I haven’t even told our podcast listeners yet. Yes. I have had to give up caffeine for health reasons that I won’t get into, but it makes me feel really, really old. But yeah, I have given up caffeine. I feel like I have lost my identity a little bit because I am the “always caffeinated computer geek”. That’s in my bio and now, I am not always caffeinated. I am really grumpy about it, but I have stopped caffeine six weeks ago. I started drinking homemade bone broth. Guys, I am making homemade bone broth.Meagan: Okay!Julie: I drink two to three cups of it every single day to help my gut health and overall health like that, but in line with that, I had to cut out caffeine. But now that it has been six weeks since I cut out caffeine completely, I occasionally allow myself a caffeinated beverage when I am feeling particularly stressed out because the caffeine really does calm me down and that’s because I have anxiety. So if you have anxiety, you can totally relate to what I’m saying. So, yeah. Just occasional caffeine.Meagan: Good for you. Good for you.Julie: I’m going to have to rewrite my bio. I am going to have to do that.Meagan: I know.Julie: Because now, I am just a “computer geek” and that’s not as exciting as an “always caffeinated computer geek”, right?Meagan: Yeah, no. You are a very exciting person.Julie: Oh, thanks.Cervical ChecksMeagan: We are so excited. This is actually something that Julie has been wanting to talk about for a long time and it’s the cervix. Let me just start off by saying a cervical exam is where-- just in case you don’t know. You might be a first-time mom listening, I don’t know. A cervical exam is where a skilled provider will insert their fingers into the vagina and check the cervix. When they are checking the cervix, what they are checking is how soft, how forward, how thin, and how much it opens, the cervix is. So right now, grab your lips and squeeze them together in a kissy face. Are you doing it? Are you doing it, Julie?Julie: Oh my gosh. Squeeze them together with my fingers? Like, squeeze them? People are going to think we’re nuts. If you are a first-time listener, I promise we are legit. Okay. I am grabbing my lips and squeezing them together.Meagan: This is what a midwife a long time ago told me. (Laughing) I am just laughing so hard, you guys.Julie: I am squishing my lips.Meagan: So if you squish your lips, not with your fingers. With your lips.Julie: Oh. Oh. (Laughing)Meagan: Like in a kissy face.Julie: Okay, okay. Starting over. Starting over. I am pursing my lips.Meagan: Mhmm. So if you feel that, now with your finger. Feel the tip. Can you feel how it is thick because of your lips? Maybe if you have thin lips, it’s thinner.Julie: I do kind of have thin lips.Meagan: But it’s kind of thick and harder. Does that make sense? Do you feel it? That’s kind of the way--Julie: I always say push on your forehead, and your nose, and your chin, and that kind of gives you the firmness of your cervix. On your forehead, it’s more firm. Your nose is a little softer and your chin is a little squishier.Meagan: Uh-huh. Yeah. I had a client that was texting their midwife and asking what they should be feeling for and it was that. She was like, “Pinch your lips together, like tight with your lips.”Julie: Like, pucker them?Meagan: Yep. Pucker them up like a kiss, tight, and then feel what that feels like with your finger. That’s what you are looking for if you are checking yourself. That’s why she suggested that. So anyway, that gets really hard and high. It might be far back and not open. It’s closed. It’s tight. You can’t get into your mouth.Anyway, the cervix can sometimes be like that, and then as labor becomes closer, it will start thinning, and opening, and softening. I love what Julie just said. Your forehead-- it’s hard. Your nose-- okay, it’s softer, still hard. And then, your lips. So that’s something that they are looking for. Now, in order to deliver-- I hate saying that all of the time. Rebecca Decker, you have got me. I love it. She has got me thinking all of the time. In order to give birth, you have to reach 10 centimeters, which means your cervix is all the way open and goes away.When a provider is checking a cervix, they are checking to see how dilated you are, how effaced you are, which means how thin you are, because that could be an indicator on how close you are to giving birth. However, it is not always. It is not always a great indicator and this is something that usually starts around 36 weeks. So when you reach 36 weeks, they typically will check for something called group B strep and then they will check the cervix. Julie is that when you-- I mean, you delivered early. It was before 36, but do you feel like at 36 weeks is typical for your clients? Like, “Oh, 36 weeks. I’m going to do my GBS test.”Julie: Yeah. They‘ll go in and they’ll be like, “Yeah, they are doing my GBS test. The doctor wants to do a cervical check. What should I say?”Meagan: “Should I do this?” Yes.Julie: Well, do you want to know what I always tell my clients? It’s scripted perfectly. I always tell them the risks and benefits, obviously, of a cervical check is a higher risk of introducing infection or bacteria into your vagina that is not already there, so it could increase your chance of infection. But what I say is that “If you decide to get a cervical check, it is a very personal choice. Nobody can decide for you, right? But if you decide to get a cervical check before labor starts, expect your cervix to be hard, closed, tight, and tilted backwards, and expect them to have to dig around for it, and it might be a little bit uncomfortable. If you go into your cervical check expecting that, your cervix is doing exactly what it needs to be doing at 36 weeks, which is keeping your baby in until it is time to deliver.” And then my clients always say, “Well then, what is the benefit of getting a cervical check if it is just to make sure my cervix is still closed and high?” And I’m like, “Well, exactly.”Meagan: Well, exactly.Julie: If you are concerned that you are in labor, or you are worried or whatever, then that might be something helpful. If you are 36 weeks and you’re dilated to 4 centimeters, that might be a problem, but also, I mean, there are some unique circumstances where it might be a normal thing, but the cervical check will only tell you what your cervix is doing at that exact moment in time. And at 36 weeks, and 37 weeks, and 38 weeks, and 39 weeks even, when you are getting cervical checks, expect it to be hard, low, closed, tight, and backwards.Even at 41 weeks sometimes, I have had clients going to get a cervical check. Their cervix is doing nothing. Their provider says that and then they get sad, and then emotions affect how labor starts, right?Meagan: Yes.Julie: But I have also had clients be completely low, closed, tight, hard, and then go into labor the next day and have their baby.Meagan: Exactly. That is something that I wanted to focus on is this is the crazy thing about cervical exams. One, they can be uncomfortable. They most likely will be especially if you’re a first-time mom and have never had any dilation, right? And if it is far back, then they are reaching back and around to try and check that cervix, so it is uncomfortable both physically and emotionally. And if you are a survivor of sexual abuse, or any trauma, or anything like that, it can be traumatizing and downright scary to have that happen because it is scary. It is scary.Julie: Yeah, triggering.Meagan: It is not someplace that you want people to be. Right? And so, to put yourself through that when you are potentially finding out really nothing that matters, then that is hard. I always tell my clients this when they ask me because it is a typical question, “Hey, I am 36 weeks. I am getting my GBS test today and they want to check my cervix. What would you do?” You know? I always tell people this, “A cervical exam means nothing, not even when you’re in labor because even when you are in labor, your body will tell you where you are at.” I have gone to home births where there has never been a cervical exam ever. I have never seen--Julie: Yeah. I didn’t have any with my last three births. My home births. I didn’t have any.Meagan: Yeah. I’ve seen it where this midwife never put her hands inside of this mom and she was like, “Oh, she is probably about this. Oh, she’s probably about this.” And then, the mom was ready to push and she was like, “Yep, okay.” This is following and trusting birth.So anyway, it doesn’t really mean much. I tell my clients, “If you feel you need to know, if it is going to hang over your head because you don’t know what you are, go ahead and get a cervical exam. But if it is something that is going to upset you when you hear a result that isn’t exactly what you are hoping, do not do it because it is not worth it.” Because like Julie just said, you can be high, closed, tight, posterior, and go into labor and be 10 centimeters in less than 24 hours later. Or guess what? You could be 6 centimeters for weeks. For weeks!Julie: Yeah, Meagan just had a client like that.Meagan: Yes I did. It was crazy.Julie: And do you know what though? On the other end of that too though, if you go and get a cervical check and they are like, “You are at 4 centimeters. Your body is going to have your baby soon,” and then it takes five days before you go into labor, that is equally just as discouraging.Meagan: Yes, absolutely.Julie: You’re like, “I am 4 centimeters. Why the heck is nothing happening now?” And guess what? Your mind can affect your hormones and prevent labor from starting when everything is all out of whack.Meagan: Mhmm, exactly. Yeah. And something else-- when I was preparing for my VBAC journey with Webster, I wasn’t even pregnant yet and starting my interviewing process of all the providers, and one of the providers that I spoke to said-- so, something I got was kidney stones when I was pregnant. I’m just one of those lucky people. It’s awesome. And my water breaks early on, so I have PROM, premature rupture of membranes. Not PPROM, just PROM. It breaks first before labor starts.Julie: Can kidney stones affect that? Does having kidney stones increase your chances of premature rupture of membranes?Meagan: So that’s what he was thinking. He was thinking--Julie: Interesting. I haven’t looked into that.Meagan: Yes. He said because my body-- I haven’t even looked into it since then. I just took his note and I was like, “Oh. That is something to note.” So my body was working to fight infection. So all the stuff on my kidneys, that weakened my amniotic sac, which, I have no idea, again. I have not found any proof. However, coincidentally enough with my first two, it was two days after a cervical exam that my water broke. And so, I just wondered--Julie: Oh yeah, because it does increase your chances of premature rupture of membranes.Meagan: Or infection, right? And so, anytime you put your hands in someone’s vagina, it increases infection of some sort. And so anyways, I was like, “Oh, I wonder. I wonder.” I don’t know. It was interesting to me, you know? So, yeah. It’s just-- it’s hard. Cervical checks can also be done for different reasons, not just to check if you are dilated or effaced, but it can check fetal positions. A provider can go in and be like, “Oh, yep. I am feeling an ear right here. We have got a transverse baby.” Or, “Oh, I am feeling the wrong occiput. We have got an OP baby.”Julie: But that’s not if you are low, hard, closed, and tight. That’s during labor.Meagan: Exactly. That’s usually if you are in labor, right? Yeah. That’s usually when you’re in labor. And even then, we can test with palpitations on the outside to figure, “Oh, I feel like we have got a back here,” or “I feel like they’ve got an OA baby.” Maybe baby’s looking transverse based off of a pattern or something like that, but it’s not necessary. It’s really not necessary and so, I just have to say that first of all. But I always tell my clients, “If it’s going to drive you crazy-- literally, if it’s going to drive you crazy because you have to know where you are at, then do it. That’s fine.” It’s not like it’s the end of the world to get a cervical exam either. You know?Julie: Yeah. I think that that’s just the most important thing is it can just be such a mental block and that’s why I chose not to be checked at all for my first VBAC. Obviously, you know I already have had home births and I chose not to get cervical checks at all because I knew if I was doing all that hard work and I was only 4 centimeters dilated, I would feel so defeated. I would. And I knew that because I knew myself. I knew my personality. I knew that I would not be able to reason with myself at all, even though I know cervixes can change in an instant and all of those things, but I know that it would totally mess with my mind.And so, I chose not to. I chose to just go with the natural progress of labor and like Maegan said, my midwife trusted in the natural processes of labor. Everything was progressing smoothly. There was no need for it, but if there was a cause for concern or if I was having some type of bleeding or, I don’t know, they saw a foot coming out or something, maybe a cervical check would have been necessary or beneficial. But as long as labor was going smoothly, I knew eventually a baby was going to come out and my body was going to start pushing. You can also tell by labor patterns, and how contractions are coming, and the space between contractions about baby positioning because typically, not always, but typically if there is a posterior baby or a baby whose head is a little bit turned sideways, or frontwards, or backwards, then the contractions will couple. They will be back to back, or there will be a lot of really intense contractions and then a long space without any contractions. It will be a really irregular contraction pattern and in that case, you can just do some positional work while you are in labor and usually get that position fixed. But again, sometimes that brings peace of mind like Meagan said. When you are in labor, if you want to know if you’re progressing or you just need to know if anything is changing, then that could be very beneficial. Another thing when cervical checks are beneficial is if you are being induced with Pitocin, they need to know if the strength of the Pitocin is doing enough to cause cervical change if it’s making your uterus contract enough to cause cervical change, and the only way they can do that is by doing a cervical check. You don’t want to be maxed out on Pitocin. Pitocin is more often than not described as having contractions that are more intense than contractions without Pitocin. And so, it’s hard to gauge labor by how the mother is acting based on Pitocin contractions. And in a hospital, I mean, let’s just call it like it is. Doctors like data. They like to see things and they like to know numbers. They like to know how things are progressing. They don’t like to just sit, watch, and observe, and they can’t because they are delivering a dozen other babies that day. I don’t know, probably not 12 babies in a day. And there are nurses in and out and everything like that. That’s the way to get your continuity of care and to make everybody happy is by looking at the charts and that’s how they see that everything is going normally unless you have somebody that is constantly by your side, like a midwife at a home birth, that can monitor and knows what the natural, normal flow of labor looks like without Pitocin or other interventions, then a cervical check is a pretty useful tool to make sure that induction, or Pitocin, or whatever is doing enough to cause cervical change.Meagan: Right. I wanted to add a number, a study about PROM. We were talking a little bit about it, but there were some studies. There weren’t a ton of people enrolled in this study, so you have to take it with a grain of salt, but at the same time it was still a study done, and so you can just look at it. What they did was, there were groups, and the one, they didn’t get checked until 40 to 41 weeks, and then the other one started getting their routine checks starting at 37 weeks. When they compared the rate of PROM in both groups, the rate of PROM was 6% in the group without vaginal exams. Sorry, yeah. So, 6% versus 18% of the women who had weekly exams had PROM.Julie: That’s three times the amount.Meagan: Yeah so, exactly. Yeah. Isn’t that crazy?Julie: Wow.Meagan: I remember when my water broke with Lainey, my nurse was like, “Only 10% of people have PROM,” and then it happened with number two, with Lyla, and then it happened with Web and I’m like, “Well, frick.”Julie: You’re like, “Sure feels like 100% to me.”Meagan: I feel like 100%, yeah. But that’s interesting to me, 6% versus 18%. Seriously, that’s pretty crazy. That’s a pretty big number. So something to think about especially if you are someone who has had PROM in the past. You may want to avoid cervical exams for that reason. I know for me, I wanted to avoid cervical exams and I wanted to avoid stripping of my membranes. Those two things were very important to me that I avoided. I started contracting and then my water broke early on still with Webster, but at the same time, I had a whole different experience with Webster and someone who trusted birth more and gave me the time that I needed. But to me, 6% versus 18%, that to me was pretty substantial.Julie: Yeah, that is pretty crazy. So, my second and third babies actually started with PROM. PROM is, I don’t know if we have said this or not, premature rupture of membranes. That’s basically just a fancy way of saying your water breaks before labor starts. So two out of my three VBACs, which were my spontaneous labors, started with PROM. But then again, I don’t know if it was really PROM or not because with my VBAC baby, I was in early labor at the wedding night before I went to bed.I woke up to my water breaking both times. I very well could have been in labor, but I labored for a long time afterwards. But then with my last baby, my third VBAC which is my fourth child, my water didn’t break until two minutes before she was born. So it’s really interesting. Yeah. That’s really good information, Meagan, to consider about cervical checks. The reason why they are forced so much and offered so much is because doctors like data. It’s just, it’s not a good way, but it’s a way for them to feel like there is some kind of control or that they have some kind of information that they can use to base the rest of your care on. And so, what I would always say if your provider is getting really pushy about a cervical check, one thing I tell my clients to do is say, “Okay, so we do my cervical check, then what will change in my care based on what we find in the cervical check? What are we going to do with this information that you get from the cervical check?” Your provider might say, “Well, we just want to make sure that your cervix is getting ready for labor.” Then you can say, “Well--” Sorry. That was said in a dumb voice. I’m sure that most providers-- I didn’t want to portray providers in that way. But if they just tell you, “Well, we want to make sure your cervix is getting ready for labor,” then you can say, “Okay, but what if it’s not getting ready for labor? What if it’s hard and closed, then what would you do?” And then they’ll say, “Well, we will probably just watch and want to do another cervical check next week to see if there has been any change.” Then you can say, “Okay. Well then, in that case, I think I would rather just wait.” You know? Or to say, “No. I’m going to decline.” I have never had clients, at least in pregnancy, get any kickback when they say, “No. I don’t want to do a cervical check.” Usually, the provider is like, “Okay, cool.” Because you know why? It’s because most parents-- I don’t think that anyone likes to get a cervical check, but it has become such a standard thing, most parents agree to it. They think, “My provider says I should get a cervical check. I guess I should get a cervical check.” Right? But then what happens is, if you’re 40 weeks or 41 weeks and your cervix is still hard and closed, and tight, and your provider takes their hand out of your vagina and says, “Well, your cervix is still posterior and pretty hard. There hasn’t been much change since last week. It doesn’t really look like your body is going to go into labor, so we should probably schedule a Cesarean.”Meagan: Yes, or an induction.Julie: Yeah, or an induction. But if the cervix isn’t opening, or I guess they could do a Foley bulb, but some providers won’t do a Foley with a VBAC which is not evidence-based either.Meagan: It depends on the place. Yeah. It’s so interesting. I have seen some pressure and kickback for people that are like, “You know, I am going to avoid doing that,” or “I am going to decline that.” It’s like, “Well, we really need to do it next week then because we need to know.”Julie: Yeah, and then next week just say, “No” again.Meagan: Yeah. “Because we need to know.” It’s like, no. They don’t need to know, you guys.Julie: Why do you need to know?Meagan: They don’t need to know. No one needs to know because your body will go into labor. It just will.Julie: Babies just don’t stay in forever. They just don’t.Meagan: I know. I know. So there is this website called feministmidwife.com and I love it because she has got a lot of awesome stuff on there. She has a blog. It’s kind of older, but I think it’s awesome. It’s called Empowering Gynecologic Exams: Speculum Care Without Stirrups. You guys should go read about it because she talks about how you don’t have to have your feet up in these crazy big stirrups to get vaginal exams and things like that. You just, you don’t. I also have seen that in labor where my clients are like, “Oh yeah. Hey, we need to do a cervical exam.” “Okay, that’s fine. Can you do that right here?” Because they are laboring comfortably and they are in their zone. They found it on their side, or on their hands and knees, or whatever, and providers are like, “No. We have to have you on your back,” and you are crisscross applesauce and I’m like, “No, you don’t.”So give that website a look for sure because sometimes even just the way you are checked can bring on the pain and discomfort, right? But yeah. It’s just hard. Cervical exams-- they kill me a little bit. They just kill me a little bit, I’ll be honest. But sometimes, it’s really nice to know when you want to know, and it’s for a convenience for you for your mind. You’re like, “Okay. I want to labor at home as long as possible, and so I would like to know where I am starting so when I am in labor, I know I am already 6 centimeters, so if things are intense, I probably need to go because I’m in transition,” or things like that. I understand that, too. You just have to go with what is best for you and what you feel that you need, but don’t let anyone pressure you or force you into something that you are not comfortable with. If you are presented with a provider that is like, “No. We are doing a cervical exam. That is what we do. You are 37 weeks today. We do it.” You know? You don’t have to. If that’s not what you want, say, “I decline. I am not going to do that.”Julie: Just walk out. Say “No.” Say, “I’ll sign a waiver saying I am refusing treatment and you document in my records that I declined a cervical check,” and then bam. Then it’s documented.Meagan: No one needs to be in your vagina. They just don’t.Julie: Just say “No”.Meagan: Just say “No”. Again, unless you want to. Unless you want to and if you do, that’s fine. So, yeah. Do you have any other--Cervical ChangesJulie: Yeah. Should we talk about the different changes that the cervix does go through?Meagan: Yeah, Mhmm.Julie: Because sometimes just hearing a number, the centimeter number can be pretty frustrating. I wish I had a video. We go over this in-depth in our How to VBAC Prep Course for Parents and also for our doulas in our Doula Course. The cervix-- most of the time when people say “cervical change”, they’re like, “Oh, 4 centimeters, 5 centimeters, 6 centimeters, 7 centimeters”. But what they don’t think about is all the other changes that the cervix is making on its way to 10 centimeters. A cervix, at the very beginning, during your whole entire pregnancy, we talked about it at the very beginning of this podcast, your cervix’s job is to be hard, tight, closed, thick, and pointed backwards. It is Fort Knox. It is keeping that baby in. That baby is not coming out and by the time your baby is born, it has to be wide open and create all of the space and room for baby. In order to do that, it does more than just open, which is when you say, “Oh, 5 centimeters dilated.” That’s what we are talking about when we say your cervix is opening. Okay?Now, one of the first things that your cervix will do is start to straighten out, which will move from a posterior position to anterior position. Not to be confused with baby’s position. Sometimes, I have my clients who will come back to me and they will be like, “They said my baby was posterior during the cervical check” and I am like, “Well, I think they might have meant that your cervix is posterior.” Posterior just means to the back, so your cervix is pointing backwards. It straightens out to become more anterior. It moves forward. It also softens. So like we talked about before, your forehead, your nose, and then your chin, and then your lips. It goes through those softening phases. By the time it’s all the way soft, it will be really squishy like your lips are, and then it thins. Which, if you think about it, it starts pretty thick. I don’t know. How long is a cervix? An inch or something long? And then it thins out until it is paper-thin, and then eventually it pulls all the way over the baby’s head and you can’t feel it anymore. So that is called effacement which means thinning. Effacement. And then it also--Oh no, wait. I got it mixed up. The softening is different from effacement. It softens until it gets soft and squishy like your lips and then it thins out. The thinning part is called effacement. And then also, your baby descends. How high your baby is in your pelvis is also part of cervical change because a baby whose head is pressing against the cervix is going to cause the cervix to change more. So it goes through those changes of moving forward, becoming softer, thinning, and then opening is actually one of the last things that it does.Now, it doesn’t do these things in order, but usually, they do them simultaneously. But I will tell you, a cervix that is forward, and softer, and thinner opens a lot easier than a cervix that is harder and thicker. Right? Can you envision what I am explaining here?Meagan: Yeah.Julie: So if you get checked when you are in labor and you are 4 centimeters and 50% effaced, which means halfway effaced, right? You would need to go from about 1 inch thick-- I think, I’m just guessing. I don’t know if it is 1 inch, so don’t really quote me on that. I just am thinking in my head based on the visuals I have seen. Which means, now you are half an inch thick, so 50% effaced and 4 centimeters dilated, and then you get checked again two hours later and your nurse is like, “Well, you are 4 centimeters dilated.” Then you are automatically going to think, “Oh my gosh. I’m still 4 centimeters dilated. My cervix hasn’t made any change at all.” Then I always want to you ask, “Okay. Well, how effaced am I?” And then, the nurse will usually say, “Oh. Well look, you are 80% effaced.” Going from 50% effaced to 80% effaced is a huge deal because that means your cervix is thinner, and thinner cervixes open more easily. So even though you might still be 4 centimeters, going from 50% effaced to 80% effaced is a lot of cervical change.Meagan: Mhmm, yeah.Julie: And also, where is baby in the pelvis? What station is baby? I know we-- oh my gosh. There is so much. I feel like I am teaching our course now. We go way in-depth into all of this in our VBAC Parents Course which you can find at thevbaclink.com/shop, but how low baby is into the pelvis can also make a big impact on cervical change. If your baby goes from a -2 station or a -3 station to a -1 station, the baby has gotten a lot lower and again, a baby that is lower in the pelvis also can create cervical change quicker. So don’t get discouraged if you are 4 centimeters. 4 centimeters is a really commonplace for your body to hang out for a little while. Getting to 6 centimeters is always the longest part. Getting from 1 to 6 usually progresses slower than getting from 7 to 10, right? 7 to 10 usually goes relatively quick compared to 1 to 6. But it’s also kind of common to hang out at 6 centimeters for a little while as your baby is descending and your cervix is thinning out more and getting softer. Those are two really common centimeter dilations to hang out at while your cervix finishes getting ready for the next stage of labor.So, always ask. If you’re still 4 centimeters, or 5, or whatever, ask about your effacement. Ask where baby is. Ask if your cervix is feeling any softer or if it is still pretty firm because all of those things contribute to cervical change and all those things will help your cervix dilate faster as they progress.Meagan: Nice. That was awesome. Good job.Julie: I am trying to go through it fast without teaching on our entire course for, you know, time’s sake.Meagan: Yeah. Moral of the story, don’t get defeated if your cervix hasn’t made the amount of change that you hoped for or thought your provider said you had to make. Sometimes it takes longer.Julie: Yeah. And before labor starts, if you feel like a cervical check has the possibility of making you feel really down and discouraged, then it’s okay to say no and not get checked. Just assume that your cervix is doing exactly what needs to do by keeping the baby in until it is ready to come out.Meagan: Yep.Julie: Ode to the cervix. The cervix is a pretty powerful thing, you guys.Meagan: It’s an amazing thing. It’s an amazing thing. We are grateful for our cervix, and our uterus, and all of the amazing things our bodies do, really. So, okay. If you have any other questions on the cervix, give us an email. We love to talk about the cervix.Julie: Really, we love to talk about anything.Meagan: Anything, yeah.Julie: We just love to talk. That’s why we have a podcast. All right. Well, yes. Let us know what your other questions are and now, hopefully, you’re walking away from this episode knowing a little bit more about cervixes and cervical checks.ClosingWould you like to be a guest on the podcast? Head over to thevbaclink.com/share and submit your story. 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