As the pregnant woman approaches her due date, she might have a question in mind: how do I know if I’m dilating? This doubt is normal, especially for first-time mothers. But don’t worry! There are several signs that show you are moving toward labor.

What is dilation?

The cervix is the opening of the uterus and is located at the top of the birth canal (vagina). During pregnancy, its consistency feels like the tip of your nose. But during labor it becomes softer, like puckered lips.

During labor, the cervix opens1. This is because contractions serve to tighten the uterine muscle, causing that tight and closed cervix to open up to 10 centimeters. This process is called dilation. Sometimes, some women are dilated one, two, or even more centimeters before labor actually begins.

How can I check my dilation?

During prenatal care, there is no need to check for dilation unless there are symptoms or a medical indication2. Usually, checking for dilation is recommended when there are regular contractions, bleeding, or loss of fluid. Without these symptoms, an unnecessary exam can increase the risk of infection, cause the membranes to rupture which could trigger premature labor, and also generate anxiety for the expectant mother or disappointment due to the possible “lack” of dilation.

Methods of verification

The most effective method to check a pregnant woman’s dilation is the vaginal exam, performed by an obstetrician experienced in this type of exam. However, it is possible to observe some signs that may indicate dilation:

  • Mucus plug
  • The purple line
  • Birth sounds
  • Emotions
  • Physical indicators

All of these methods are observational. They have been developed and refined together with countless healthcare professionals who assist births every day.

It’s important to remember that women are not machines; they are organisms in the process of labor. Not all of these methods can be applied to every pregnant woman, because each woman is unique.

Mucus plug

A woman may or may not show a bloody discharge at the start of labor. This blood and mucus often appear in large amounts during contractions, especially as the woman reaches 6 to 8 cm of dilation.

Purple line

A study conducted and published in The Lancet journal showed that a purple line “grows” between the buttocks, indicating cervical dilation. The line starts at the anal margin at the onset of labor and rises like a “mercury thermometer.” When it reaches the top, the woman is in full dilation3.

The authors state that an “increase in intrapelvic pressure causes congestion in the veins around the sacrum, which, together with the lack of subcutaneous tissue over the sacrum, results in this purple-colored line”.

Birth sounds

One indicator that may help detect progress is the characteristic sounds a woman makes in labor. Usually, in the first stage of labor (0-4 cm), there is little or no “birth” noise, and the woman may speak with or without some effort during a contraction.

Around 4-5 cm of dilation, talking becomes quite difficult or almost impossible during a contraction. The woman begins to make noises that sound like open vowels or a resonant humming.

Between 5-7 cm, the noises are louder, it becomes practically impossible to talk during a contraction, and the sounds may become repetitive. If a woman has a quiet labor, a good way to get an idea of her progress is to wait until a contraction starts and ask her a question that requires a full-sentence answer.

The way she is able or unable to respond during the contraction is an indicator of the labor’s progress.

Emotions

Early labor (1-4 cm dilation) often makes mothers think “It’s time,” and feel happy, excited, or even in denial about actual labor.

Moving into active labor (4-6 cm dilation), women often remain smiling and may even laugh between contractions, joining the conversation between them.

In active labor (5-7 cm dilation) the mother is generally more irritated by small talk or by people who try to distract her.

It might take some time after a contraction for her to return to the outside world, or she may prefer to simply stay in her birthing space, known as “laborland”, inside her bubble, and not interact with her surroundings.

Around the transition phase (in general, 7 cm dilation), even between contractions, the mother may become doubtful, unable to make concrete decisions (“I don’t know,” in response to questions), or irrational. This restlessness, these doubts, are a good indicator that the mother is in the final stretch.

This method can be difficult to notice, because this ‘emotional mapping’ may be distorted by the baby’s position or by the mother’s emotional state.

Physical indicators

Many women will find that near the pushing stage, they may show symptoms similar to the flu. If a woman suddenly feels like vomiting or complains of nausea, has a flushed face, feels hot, or begins to shiver uncontrollably, she may be progressing to the second stage of labor.

Vomiting alone may just be emotions or fatigue, facial flushing is a good sign of dilation, and uncontrollable shivering can mean tiredness or fever. These indicators are more reliable when two or all three are noticed together.

  • Involuntary curling of the toes during contractions, even when the rest of the body is loose and relaxed (6 to 8 cm).
  • If standing, instead of curling the toes, the mother stands on tiptoe leaning over something (6 to 8 cm).
  • Goosebumps on the lower back, buttocks, and thighs (9 to 10 cm).

Conclusion

The methods presented can give us an idea of how dilated a woman is and how the labor process is progressing, but there is no way to make statements about this dilation without a physical vaginal exam performed by an obstetrician who specializes in this area.

The journey of some women in labor may be like a short walk, while for others it may be a long journey. But above all, these methods can help mothers understand what the next step will be to bring their child into the world!

See Also: Thinned Cervix – It’s Time for Labor!

Photos: Federal Senate