High cervix during pregnancy

The cervix is the lowest part of the uterus. It’s a small passageway connecting the vagina to the uterine cavity, about 1–1.5 inches or 2.5—3.8cm long (1). The Latin, cervix uteri translates to “the womb’s neck.” In the vagina, the cervix looks like a smooth fleshy O, about an inch or 2.5cm in diameter, with a hole in the middle — similar to puckered lips.

Your cervix does a lot for you: it keeps unwanted bacteria and viruses out of your uterus, it opens and closes to let sperm in and menstrual blood out, it produces its own lubrication and even grows its own plug if you become pregnant (called a mucus plug). Like the vagina and clitoris, the cervix also contains nerve pathways involved in the sexual response (6).

The way your cervix feels to the touch will change throughout your menstrual cycle. Its position in your abdomen may also change* (2–5). These changes happen in response to the hormonal fluctuations that facilitate the ovulatory process. Certain ligaments in the pelvis may become shorter around ovulation, for example, and the consistency of the cervical fluid changes (7, 8).

Around ovulation, the cervix is soft (like your ear lobe), slightly open and may be positioned high up in your abdomen. Other times it’s firmer (like the tip of your nose), tightly closed and may be positioned lower down in your abdomen (2–5). Changes in cervical height may influence how you experience certain sex positions or a pelvic exam, at different times of the cycle.

If you’ve never felt your own cervix, you might be curious to know where it is and how it feels at different points of the cycle.

Here’s a step-by-step feel-guide to finding your cervix:

  1. Start at a time when your cervix is likely to be low and more easily reached (before or after menstruation is great).
  2. Wash your hands very thoroughly, including underneath your fingernails.
  3. Squat on the ground, or lift one leg up onto the toilet seat or side of the tub.
  4. With your palm facing up, guide your longest finger carefully into your vagina (lube can come in handy here).
  5. Feel for a round, raised circle with a dimple in the middle — it’s most likely to be at the top of the front vaginal wall (closer to your belly button than to your back) (1, 5).

Feeling your cervix at different intervals throughout a cycle or two will give you an idea of how it changes for you. Most people don’t learn this until they are trying to become pregnant, and are using cervical position as a sign of approaching ovulation/fertility (cervical position is sometimes used along with other measures like basal body temperature in fertility awareness). But knowing how your cervix changes will give you a new awareness of your body, which is helpful for more than just pregnancy.

Once you and your cervix are cozy acquaintances, the idea of keeping your cervix healthy may be less abstract. You can keep your cervix healthy by 1) getting an HPV vaccine if you’re eligible 2) having regular pap smears and 3) using barrier protection during sex (condoms, dental dams). Cervical cancer was once a leading cause of death amongst people of reproductive age in the United States. Rates have dropped dramatically in recent decades, largely due to the evolution of cervical screening and preventative procedures (9). It’s up to you to get screened. Most cases of cervical infection and cancer are caused by unmanaged infections of two strains of Human Papillomavirus (HPV types 16 and 18). HPV is the most common sexually transmitted disease (10).

Have you gotten up close and personal with your cervix? Let us know your experience or if you have any questions. If you want to take your cervical exploration a step further, you might try asking your doctor to show you your cervix in a mirror next time you have a pelvic exam. You could also host a throw-back to the self-exploration parties of the 70s, and buy your own speculums for at-home use.

*There is little scientific research on the heightening and lowering of the cervix in the abdomen across the menstrual cycle. The phenomenon of cervical height change is most discussed in literature on fertility awareness (5). This material is consistent in its observations, but mostly anecdotal.

What Does a High Cervix Mean?

Q1. At my yearly pelvic exam, the doctor had a hard time finding my cervix. He said I have a high cervix. What does this mean? Also, will the high cervix affect my ability to conceive? Are there any other consequences I should know about that relate to a high cervix?

A high cervix means that your uterus is placed “high” in the abdominal/pelvic cavity — usually it is suspended just above the vaginal canal. This should not affect your ability to become pregnant, though. The sperm can still travel to the area of the cervix and pass through its opening into the uterus to fertilize the egg.

What it may mean, however, is that pelvic exams can be more difficult because the speculum (the instrument a gynecologist inserts to see the cervix) will not extend far enough into the vagina to reach the cervical opening. This is not a health problem, but it may cause discomfort during pelvic exams from time to time.

Q2. I am 17 years old and I just had my first visit with the gynecologist. The nurse called back and said I have atypical type cells. What does that mean? Should I be concerned?

One of the most important reasons for making routine visits to the gynecologist is to have a Pap smear to screen for cervical cancer. During this easy test, which is done during a pelvic examination, the surface of the cervix is gently scraped, and the cervical cells are then looked at under a microscope for evidence of any changes that may indicate cancer or precancerous cells. Sometimes, something as simple as inflammation from a yeast infection or other vaginal infection can make the cervix cells appear abnormal (atypical). If that is the case, the infection can be treated, and then the Pap smear should be repeated to make sure that the atypical cells have gone away.

However, sometimes atypical cells are labeled as precancerous cells. The pathologist who reads the Pap smear looks at the cells and determines just how abnormal they look and assigns a specific diagnosis. The Pap smear sample may also be tested to see if the cervix cells show evidence of the presence of human papilloma virus (HPV). HPV is a sexually transmitted virus that is the cause of cervical cancer (and other gynecologic conditions such as genital warts and vulvar cancer). When an abnormal Pap smear shows evidence of HPV, the risk for the eventual development of cervical cancer is much higher than if there is no evidence of HPV infection, so recommendations for management and follow-up will be different.

Depending on exactly what type of atypical cells are seen in your Pap smear, and on whether or not you have evidence of HPV infection, your doctor may recommend further testing. This might include a colposcopy (an office procedure that permits a close-up view of the cervix and biopsy of abnormal-appearing areas).

Young women who have never had sexual activity with genital contact, or who may have started having sexual activity but are not infected with HPV, should consider having the vaccine that can prevent HPV infection. You should speak with your doctor about the specific details of your Pap smear, find out whether HPV testing is needed, and ask about whether vaccination against future HPV infection may be right for you.

Q3. I just had a Pap test, and I was told I have a slanted cervix. Is this good, bad, or anything to worry about? Is it rare? I’m trying to find out if there are any consequences.

A slanted cervix is generally not worrisome and does not have major medical consequences. The position of the uterus can be anterior (facing the front of your body) or posterior (facing the back). The posterior position is the more common, normal configuration, so the term slanted cervix usually refers to the cervical position of a uterus that is anterior.

The good news is that there is no higher risk of infection, cancer, or other diseases because of an anterior cervical position. That said, if you are trying to become pregnant and do not succeed in a few months, be sure to see your doctor and have a hysterogram (an X-ray that defines the shape and interior of the uterus) to confirm that the inside of the slanted, or tilted, uterus is normal.

Learn more in the Everyday Health Women’s Health Center.

Think of your cervix as the gatekeeper to your uterus. Lots of things—like tampons, fingers, penises, sex toys, and other germ-carrying items—can get to your cervix, but they aren’t getting past it. Your cervix, in its 24/7 role of keeping your uterus happy and healthy, won’t let that happen,

Likewise, there are things—like mucous, menstrual blood, and the occasional baby—that need to get out of your uterus. Your cervix is the bouncer, deciding what and when things go in and come out of your most vital piece of your reproductive system. Yet, despite benefiting from its work, day in and day out, chances are you don’t know much about it.

Like, do you even know what it looks like?

Probably not. Well, your cervix is the “neck” of your uterus, positioned at the top of your vaginal canal. Because of its location, seeing your cervix isn’t as easy as squatting over a hand mirror, like you would if you were examining your other lady bits, but it is possible with the right tools.

All you need is a flashlight, a mirror, a retractable speculum, and a little courage. If you don’t have a speculum just lying around your bathroom (and if you do, we want to hear that story!) you can buy a starter kit for $22.95 from the Beautiful Cervix Project. It even comes with a handy map to guide you through your own nethers. Once there you can admire the beauty of your own, unique cervix and even snap some cervix pictures if you’re so inclined. (Use this handy video guide for tips on getting a good picture of your vaginal canal and cervix.)

The Beautiful Cervix Project, a movement to better understand and appreciate the awesomeness of the underrated cervix. O’Nell Starkey started it as a project for midwifery school, with her husband taking snaps of her cervix throughout her cycle. She quickly discovered, as she’s put it, “Cervices are amazing!” After sharing her images with the world, she found that other women also wanted to see their own cervices (that’s plural for cervix!), leading her to start the Beautiful Cervix Project as well as live workshops dedicated to helping women learn about and appreciate their bodies.

“What I have learned by creating this website is that people from all over the world are curious about their bodies, cervices, and the menstrual cycle—everyone from newly menstruating teens, pregnant people, medical students, people with abnormal Paps, to people trying to conceive, artists, educators, and the list goes on,” Starkey says. “Cervical self-exam is about educating and empowering people by contradicting some of the shame and under-education we have about our bodies and menstrual cycles. The Beautiful Cervix Project is dedicated to people working to reclaim their entire bodies as beautiful and lovable. The more we know about ourselves, the more we feel confident to advocate and care for ourselves.”

Related: This Woman Is Drawing Clitorises On The Ground All Over The World

While each cervix is slightly different (which is why we recommend checking out your own cervix!), they all go through similar changes during your monthly cycle, when you’re pregnant, during labor and delivery, and after giving birth. Curious? Starkey was kind enough to share some cervix pictures to help you see what your cervix is up to… right now.

During the Follicular Phase

Beautiful Cervix Project

When your cervix is just hanging out, the visible part of the cervix protrudes into the vaginal canal and is covered by smooth, pink, squamous epithelium, says Kim Thornton, M.D., a reproductive endocrinologist at Boston IVF. In this picture, the cervix is preparing for ovulation by preparing more fluid.

During Ovulation

Beautiful Cervix Project

The cervix looks a little bit like a donut. When it’s closed, the hole looks like a dimple, but it opens during ovulation to let sperm in, explains Ronald D. Blatt, M.D., gynecologist and chief surgeon and medical director of the Manhattan Center for Vaginal Surgery.

Learn more fascinating facts about the female anatomy:

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During the Luteal Phase

Beautiful Cervix Project

After ovulation, the cervix prepares for menstruation. In this picture the cervix is just doing its thing, waiting for either a pregnancy or shark week to happen. The average cervix measures 3 to 5 cm in length and 2 to 3 cm in diameter, Thornton says.

During Menstruation

Beautiful Cervix Project

When Aunt Flo comes to visit with her monthly gift of gore, you know the blood is coming from somewhere up in there, but this picture shows exactly how it comes out of your cervix. Again, the dimple in the center—called the os—is in the open position to release menstrual fluids, Blatt says.

Related: Here’s Why You Should Always Masturbate On Your Period

During Sex

Beautiful Cervix Project

This is a picture of the cervix just minutes after the woman had an orgasm during sex (you can even see the sperm pooled around the bottom). Depending on the size of you and your partner’s anatomy, the penis can bump into the cervix during sex. Some women find the sensation enjoyable and may even orgasm from it, according to a study published in the journal Hormones and Behavior. Others find repeated thrusting into the cervix to be incredibly painful and it can cause bruising or even tearing of your cervical tissue.

(Get the latest health, weight loss, fitness, and sex intel delivered straight to your inbox. Sign up for our “Daily Dose” newsletter.)

During Pregnancy

Beautiful Cervix Project

Your sex life and monthly cycle may keep your cervix busy, but the real work happens during pregnancy and delivery. In this picture, the woman is about two months pregnant. The white goo, called leukorrhea, is very common type of vaginal discharge that can occur during pregnancy and is nothing to worry about, Starkey says.

Related: Apparently There Are 7 Types of Boobs—Which Do You Have?

During a Pap Smear

Beautiful Cervix Project

Getting swabbed for a pap smear and HPV test isn’t anyone’s idea of a good time but it’s a necessary evil to catch cancer and other diseases before they can cause more harm. But you don’t have to do them every year, says Richard K. Krauss, M.D., chair of gynecology at Aria Health. If their past Pap smears have been normal, women in their 20s should have a Pap smear every three years, and women in their 30s should have a Pap smear every five years, he explains.

Do you have a low, mid, or high cervix?

Knowing the position of your cervix, whether it is located low or high, will help in determining which size menstrual cup may be best suited for you, as well as whether or not you should trim the stem. Knowing how to check your cervical location can also be helpful in understanding when you are ovulating.

Your cervix is positioned at the end of your vaginal canal (usually around 7.5 to 15cm inside the vagina). Imagine a long hallway with a door at the end. The door is the beginning of your cervix. The cervix attaches to the vaginal wall and is sometimes described as feeling like the end of a nose. Where the vaginal canal is soft, the beginning of the cervix is firm.

Please note: If you currently have a yeast infection or any other form of vaginal infection, it is best NOT to check your cervix until this is all cleared up.

How to check the position of your cervix

First things first – wash your hands thoroughly. Not much explanation needed here. You will be inserting your fingers into your vaginal canal, so to reduce any chances of introducing infection, make sure they are clean! Do not apply any moisturizers to your hands prior to feeling your cervix. You may also want to consider trimming your nails if they are long, in order to avoid potential scratches – ouch!

Next, find a comfortable position. Some of the best positions for checking your cervix is either squatting, sitting on the toilet, or raising up one leg and resting it on the toilet seat, side of the bath, or a chair.

Gently insert your index finger into your vagina. Use an inwards and upwards motion and move your finger in as far as it will go. You will know when you are touching your cervix, as your finger will not be able to reach any further. You will also feel the firm donut shape of your cervix. If you are ovulating, your cervix will most likely be located higher. It will then be located lower once you have finished ovulating. To get an idea of whether you have a low or high cervix (for the purpose of choosing a menstrual cup), you may want to check your cervix a few times over the course of your cycle (at roughly the same time of day), to determine an average position. When deciding on your cervix height for a menstrual cup, base it on you’re non-ovulating position. Do not check your cervix before, during, or after sexual intercourse.

Once you have located your cervix, use the knuckle rule to determine whether or not your cervix could be considered low, average, or high. If you are touching your cervix by your first knuckle, then consider your cervix low. In this instance, you may find that the stem of the cup could protrude a little. In this case you could trim the end of your cup to make it more comfortable. However, do not do this until you are confident in removing your cup, as you cervix may move higher up during your cycle.

If you are touching your cervix by the second knuckle then consider it an average height. You should be able to comfortably wear your menstrual cup.

If you are touching your cervix beyond the second knuckle and up to the third, then consider yourself to have a high cervix. Try to position your menstrual cup lower in your vaginal canal. It may travel up the canal a little, however, this just makes it a little trickier to remove. With practice, it shouldn’t cause you any long term grief or difficulties.

Fibroids (myoma/leiomyoma)
When found in the cervix, fibroids (myoma/leiomyoma) are smooth, firm masses which are often solitary and tend to be small (5-10 mm in diameter). They account for about 3-9% of uterine myomata. A fibroid growing down into the cervix from higher up in the uterus is a more common situation. Symptoms relate to its size and exact location: dysuria, urgency, obstruction of the cervix and dyspareunia.

Management is guided by the size of the lesion and the age of the patient (whether she wants to retain fertility). It ranges from simple observation, to medical treatment with gonadotrophin-releasing hormone (GnRH) agonists, to surgery. The latter is tricky on account of the relative inaccessibility of these lesions and the proximity to the bladder and ureters.

Cervical endometriosis
Endometriosis in the cervix is not uncommon and usually considered to be inoffensive. It may be apparent as blue-red or blue-black lesions 1-3 mm in diameter. Occasionally, it can cause postcoital bleeding and it may present as a mass. There has been a case report of it presenting as massive vaginal bleeding. Unless there are significant symptoms, the vast majority of patients are managed conservatively but any patient with suspected cervical endometriosis should be referred to a gynaecologist to confirm the diagnosis and exclude more serious lesions.

More unusual tumours

  • Squamous papilloma
  • Microglandular hyperplasia
  • Papillary adenofibroma
  • Haemangioma
  • Mesonephric duct remnants
  • Heterologous tissue

Abnormality of form

  • Stenosis – this problem may be congenital or acquired and tends to occur at the level of the internal os. There are a number of causes and associations:
    • Diathermy excision of cervical lesions is the most common cause of stenosis (it occurs in 1.3% of cases).
    • Other acquired causes include radiotherapy, infection, neoplasia and atrophy following a cone biopsy.
    • It may also be associated with endometriosis.

    Premenopausal patients present with menstrual disorders, pain and infertility, whereas postmenopausal patients may remain asymptomatic or develop symptoms over a very long period of time, after which they may present with haematometra, hydrometra or pyometra. Diagnosis is made upon failure to introduce a 1-2 mm dilator into the uterine cavity and is confirmed when a large but painless palpable uterus is found. Treatment is with ultrasound-guided dilators or with osmotic dilators such as laminaria tents (where the dried-out laminaria seaweed is packed into the cervix and slowly expands). Prostaglandin pessaries can be used to soften the cervix where access is needed for procedures such as hysteroscopy.

  • Ectropion (previously called cervical erosion or abrasion) – this occurs when the columnar epithelium of the endocervix is displayed beyond the os:
    • The cervix enlarges under the influence of oestrogen and as a result the endocervical canal is everted. It is seen on examination as a red ring around the os and is so common as to be regarded as normal.
    • It is most commonly seen in teenagers, during pregnancy and in women on combined hormonal contraception.
    • It is generally an asymptomatic condition but patients occasionally present with bleeding or excessive discharge.
    • Once a normal cervical smear has been confirmed, it is actively managed only if there are symptoms. Over time, vaginal acidity promotes metaplasia to squamous epithelium when the symptoms will disappear.
    • After stopping any oestrogen-containing contraceptive, treatment options are controversial but include diathermy, cryotherapy, surgery with laser treatment and microwave therapy.
  • Nabothian cysts (Nabothian follicle/epithelial inclusion cysts/mucinous retention cysts):
    • Like ectropion, these mucus-filled lesions are so common as to be considered a normal part of the adult cervix. They look like multiple translucent or opaque, white or yellow lesions ranging from 2 mm to 10 mm in size.
    • They occur as a result of metaplasia leading to a squamous cell cover over columnar epithelium with mucus-producing crypts within it. When the mucus can no longer be expelled, a Nabothian cyst is formed.
    • They are asymptomatic and need no treatment. Very rarely they may be problematic if they grow very large, in which case they may be treated with cautery or cryotherapy.
  • Laceration:
    • This can occur following mechanical dilatation of the cervix; thus, cervical lacerations can complicate hysteroscopy and abortion.
    • Misoprostol prior to hysteroscopy reduces the risk of cervical laceration in pre-menopausal women but has no effect on postmenopausal women.
    • It occurs more commonly in the presence of cervical stenosis or atrophy and may also occur during delivery.
    • Acute lacerations present with bleeding and need suturing once the extent of the laceration is ascertained.
    • Poor repair may lead to subsequent cervical incompetence.

Cervicitis

  • Symptoms – these vary from none to abnormal yellow-green discharge, bleeding (especially postcoital), dysuria.
  • Signs – green/yellow/opaque mucopurulent discharge. Endocervical friability (bleeds easily).
  • Common culprits – Neisseria gonorrhoeae, Chlamydia trachomatis, human papillomavirus, herpes simplex virus and Trichomonas vaginalis.
  • Treatment – antimicrobial, guided by results from swabs..

See separate article Sexually Transmitted Infections for further information.

Inflammatory cervicitis can also be caused by mechanical trauma (tampons, pessaries, threads from an intrauterine device), chemical irritants (douching, spermicides), and systemic inflammatory disease such as Behçet’s disease. The treatment depends on the cause.

Problems with the cervix in pregnancy

Cervical incompetence

This is usually diagnosed in the context of a miscarriage occurring after 12-14 weeks or in premature labour. It presents as a painless dilatation of the cervix through which the membranes bulge and eventually spontaneously erupt. Diagnosis is based on a past history of second-trimester miscarriages, and ultrasound scanning may confirm shortening or funnelling of the cervix.

Treatment involves prophylactic placement of a cervical stitch (cerclage) with the aim to prevent loss of the pregnancy (an emergency procedure can also be carried out). However, there is controversy over the effectiveness of this procedure: it appears to reduce the rate of preterm birth but does not reduce the perinatal mortality or neonatal morbidity and makes caesarean section more likely.It has been suggested that its use is limited to two groups of patients:

  • Those with a history of three or more spontaneous preterm births or second-trimester losses.
  • High-risk patients with a singleton pregnancy who have a short cervix in the second trimester.

Unsuccessful vaginal procedures can be repeated transabdominally or laparoscopically.

Ectopic pregnancy in the cervix

The cervix is the least common site for an ectopic pregnancy, occurring in 0.2% of ectopic pregnancies. It may be seen as a bluish hue on the cervix and, rarely, a gestational sac and live fetus can be identified on ultrasonography. This is such a rare occurrence that there is no management protocol but, from the case studies available, medical termination appears to be the best option because life-threatening haemorrhage may occur.

The structure and function of the cervix during pregnancy

The structure of the cervix is integral to the maintenance of pregnancy, keeping the developing baby in utero and forming a barrier to the ascent of microorganisms from the vagina. Weakness of the cervix may lead to deficiency of this barrier and is associated with subsequent preterm birth. The underlying cause of this structural weakness is poorly understood. In this paper we review the structure and function of the cervix before and during pregnancy. The causes of mechanical failure of the cervix during pregnancy are described, with a specific focus on the internal cervical os. We highlight the role of the internal cervical os in causing preterm birth and discuss research techniques that may provide further insight into its function during pregnancy. It is hoped that clinical translation of this knowledge will enable the early and appropriate identification of women who will benefit from strategies to reinforce the internal os and so reduce the incidence of preterm birth.

Labor: Six Signs You’ll Soon Be There

Just as every pregnancy is different, every delivery is unique. Some women get no clues that labor is around the corner, and then — wham! — here it comes. Others have telltale signs for weeks, maybe even a false start or two, before the real thing begins.

The simple truth is, there’s no way to predict exactly when you’ll go into labor. In fact, no one even knows for sure what triggers the big event, although hormones are thought to play a part. Still, there are at least six concrete clues that your baby is preparing to make his or her grand entrance into the world.

1. Lightening: You can breathe easy again.

“Lightening” is the technical term for the point when your baby drops lower in your belly and settles deep in your pelvis. For first-time moms, lightening can occur a few weeks before your baby’s birth; for second-timers it may take place only a few hours before labor begins. You may feel the baby drop, or you might notice that there is now space between your breasts and abdomen.

The good news here is that you may get some relief from the shortness of breath you’ve been experiencing, since this shift takes pressure off your diaphragm. The bad news is that it puts more pressure on your bladder, so you may be visiting the bathroom more than you ever thought possible. Some mothers feel more pressure on their pubic bones or can even see in the mirror that their belly has lowered after lightening; others may be unaware of any difference.

2. Effacement: Your cervix ripens.

Your cervix — the lower, narrow end of the uterus that protrudes into the vagina — softens as it’s preparing for labor. This process, known as “ripening” or effacement, usually begins during the last month of your pregnancy. By the time the big day rolls around, your cervix will have stretched from around 1 inch in width to paper thinness. Your doctor or midwife may start checking for gradual effacement during your last two months of pregnancy with internal exams during your prenatal visits. Effacement is measured in percentages: Zero percent means no effacement; 100 percent means you’re fully effaced.

3. Dilation: Your cervix opens.

As your baby’s birthday approaches, your cervix begins to dilate, or open up. Dilation is checked during a pelvic exam and measured in centimeters (cm), from 0 cm (no dilation) to 10 cm (fully dilated). Typically, if you’re 4 cm dilated, you’re in the active stage of labor; if you’re fully dilated, you’re ready to start pushing. Your health practitioner will probably check for dilation and fill you in on your progress during your prenatal visits in the later stages of your pregnancy.

4. Bloody Show: Your mucus plug dislodges.

It’s not as gross as it sounds, nor as bloody. Although it’s termed the “bloody show,” this telltale sign of impending labor occurs when the thick plug of mucus that seals off your cervix and prevents bacteria from entering the uterus during pregnancy gives way. Despite its name, the “mucus plug” doesn’t resemble a cork (there will be no popping sound!). It’s more like thick or stringy discharge that you may pass in a clump into the toilet or your underwear. The discharge can appear as pink, brownish, or slightly bloody in color. The bloody show usually debuts either a few days before your labor starts or at the very beginning of labor, although many women go into labor before it appears.

5. Rupture of membranes: Your water breaks.

Not everyone will have the dramatic “Oh my God, my water just broke!” scene from a Hollywood movie. The fact is, when the sac of amniotic fluid that surrounds and protects your baby during pregnancy breaks, it’s more likely to leak from your vagina in a gentle trickle than it is to break the floodgates. The so-called “rupturing of the membranes” can happen at the very start of labor or during the first stage of labor. Usually the doctor, midwife, or nurse will break your water before you become completely dilated, if it hasn’t broken by then. This allows them to learn if you have any problems that would impede the baby’s safe delivery. Contractions usually become much more intense after your water breaks, and the labor goes faster.

Your physician or midwife should evaluate you and your baby as soon as possible after your water breaks. That’s because the baby is at risk of developing an infection in the uterus once the protective fluid is gone. Doctors also advise that women not have sex after their water breaks to avoid introducing any bacteria into the uterus. Your practitioner will want you to have your baby within a day or two after your water breaks.

If you are close to your due date, your water breaks, and you don’t go into labor on your own within a relatively short period of time, you will need to have labor induced. If your labor doesn’t begin within a specific time period, your physician may want to bring on (induce) labor. How long your health practitioner is comfortable waiting before inducing will depend on your individual situation.

Be sure to tell your health care team if your “water” isn’t clear. If your amniotic fluid is greenish in color or smells bad, it could signal either an infection or meconium (essentially baby feces), either of which could cause problems for your baby. Also, if you’re leaking liquid but aren’t sure whether it’s amniotic fluid or urine (some pregnant women leak urine at the tail end of their pregnancies), you should have it checked by your health practitioner so you know what you’re dealing with.

6. Consistent contractions: When your labor really gets going.

Contractions are strong, rhythmic, regular cramps that feel like a bad backache or extreme menstrual pain. These little doozies, if they’re the real thing, are the most reliable of all the signs and officially mark the onset of labor.

A contraction occurs when your uterus tightens and then relaxes. Real contractions usually start in the back of your body and move toward the front. These movements open the cervix and help push the baby into the birth canal. True contractions come closer and closer together in a predictable pattern and last around 30 to 70 seconds each. They get steadily stronger and keep coming, regardless of what you do.

You and your health practitioner should come up with a game plan ahead of time about when you should call and what you should do if you suspect you’re in labor. Most practitioners will probably tell you to call when you have contractions that last for around one minute and occur every five minutes for about an hour, but this could vary greatly depending on your health history and past pregnancy record. Women who have given birth before may have a quicker labor the second or third time around, so it’s important not to wait too long to call if you think things might go quickly. Be sure to discuss this with your doctor or midwife. To time the frequency of contractions, start at the beginning of one and count until the beginning of the next one.

You should definitely call your practitioner if:

  • You are less than 37 weeks pregnant and are showing any signs of pre-term labor.
  • Your water breaks or you think you’re leaking amniotic fluid.
  • You have vaginal bleeding, fever, or severe or constant pain.
  • Your baby stops moving or begins to move less.

When in doubt, call your practitioner. Even if you’re not sure if your signs add up to the beginning of labor, it doesn’t hurt to check in. Your doctor or midwife can give you concrete advice and help you determine if this is the moment you’ve been waiting for. Congratulations!

Mayo Clinic. Signs of Labor: Know what to expect. March 2009.

American Pregnancy Association. Signs of Labor.

Southwestern Medical Center. Health WatchLabor Signaling.

Whitsett, J.A. et al. Hydrophobic Surfactant Proteins in Lung Function and Disease. New England Journal of Medicine. Volume 347:2141-2148.

Harvard University Health Services. Labor and Delivery. http://huhs.harvard.edu/Resources/HealthInformationByTopic/Pregnancy/LaborAndDelivery.aspx

Merck Manual. Management of Normal Labor. http://www.merck.com/mmpe/sec18/ch260/ch260d.html

American College of Obstetricians and Gynecologists. Planning Your Pregnancy and Birth.

The process of giving birth is unique. Some women get no clues that their labor is about to start, and then – wham – here it is! Others have signs for weeks, maybe even a false start or two, before the real thing begins.

There’s no way to predict exactly when you’ll start your labor. No one even knows for sure what really starts the big event.

But here are six clues that your baby is getting ready for the big day:

Lightening

Lightening is the term for the point when your baby drops lower in your belly and settles deep in your pelvis. For first-time moms, lightening can happen a few weeks before the baby’s birth.

  • You may feel the baby drop.
  • You might notice that there is now space between your breasts and belly.
  • You feel like you can breathe again.

Effacement

  • Effacement or “ripening” is when your cervix softens as it’s preparing for your labor.
  • It most often begins during the last month
  • It is measured in percentages:
    • 0 percent means no effacement
    • 100 percent means you’re fully effaced

Dilation

  • As your baby’s birthday gets close, your cervix begins to dilate, or open up.
  • Dilation is checked during a pelvic exam.
  • It is measured in centimeters, from 0 (no dilation) to 10 (full dilation)
  • Typically, if you’re four centimeters dilated, you’re in the active stage of labor.
  • If you’re fully dilated, you’re ready to start pushing.

Bloody show

This is when your mucus plug dislodges, which is not as gross as it sounds, nor as bloody. This is a sure sign that labor is starting.

  • The thick plug of mucus that stops germs from entering your womb while you are pregnant gives way.
  • The “mucus plug” doesn’t look like a cork and is more like thick or stringy discharge that you may pass in a clump into the toilet or your underwear.
  • It can appear as pink, brownish or slightly bloody in color
  • Most often happens a few days before or at the very beginning of your labor
  • Many women go into labor before it appears

Your water breaks

When the sac of amniotic fluid surrounding and protecting your baby breaks:

  • It’s more likely to leak in a gentle trickle than it is to break the floodgates
  • Your doctor or midwife should check you and your baby right away after your water breaks to prevent infection
  • Be sure to tell your health-care team if your “water” isn’t clear

Strong contractions

This is when your labor really gets going! Contractions are strong, rhythmic cramps that feel like a bad backache or bad menstrual pain. These pains:

  • Happen when your womb tightens and then relaxes
  • Most often start in the back of your body and move toward the front
  • Open the cervix and help push the baby into the birth canal
  • Come quicker and quicker in a pattern and last about 30 to 70 seconds each
  • Get steadily stronger and keep coming, no matter what you do

Call your doctor if:

  • You are less than 37 weeks pregnant and are showing any signs of early labor
  • Your water breaks or you think you’re leaking amniotic fluid
  • You have vaginal bleeding, fever or very bad or nonstop pain
  • Your baby stops moving or begins to move less

When in doubt, call your doctor. Even if you’re not sure if your signs add up to the beginning of your labor, it doesn’t hurt to check in.

Copyright © 2010 LimeHealth

Sex after a C-section: Everything you need to know

Share on PinterestSex may not be a high priority after a baby is born.

Many women do not feel like having sex for a few weeks or months after giving birth, either vaginally or by C-section.

There is no need to rush. Most women and their partners are exhausted from taking care of a newborn, so sex may not rank high on the list of priorities.

It is essential to keep in mind that sex should be pleasurable. If sexual activity causes any pain or discomfort, it is best to stop.

If the incision site is sore, try positions that do not put any pressure on the woman’s abdomen.

Hormonal changes after birth may lead to vaginal dryness, so it may be a good idea to use a lubricant.

If penetration is uncomfortable or painful, it can help to focus on nonpenetrative activities. Some types of foreplay, such as massage, can also help people to relax and enjoy their experience.

It is crucial to keep in mind that everyone heals differently. If sexual activity becomes more painful over time, talk to a doctor.

Authors of one study reported that the rate of sexual problems in first-time mothers rose from 38 percent before pregnancy to 83 percent in the first 3 months following delivery. This figure declined to 64 percent 6 months after birth.

In one cohort study, the researchers found no differences regarding sexual problems after delivery among women who gave birth vaginally and those who underwent a C-section.

However, results of another cohort study suggested that women who had undergone a C-section were more likely to delay having sex longer than those who had given birth vaginally.

Is there an increased risk of bleeding?

After giving birth, all women experience a period of vaginal bleeding called lochia. This bleeding continues until the uterus shrinks back to its regular size.

Lochia causes bright red blood to leak from the vagina. Most women wear extra-absorbent pads or padded underwear during this time.

Lochia bleeding eventually changes from bright red to dark red or pale pink. Over time, it fades to an orange or yellowish color.

Activity levels can also affect this period of bleeding. If the amount of blood suddenly increases, it may mean that a woman is doing too much too quickly after surgery.

For 1 or 2 weeks after the C-section, a woman may also notice some periodic, minor bleeding from the incision site.

Strenuous activity, including sex, can increase the risk of opening the incision or experiencing a blood clot.

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