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Cervical Ripening

Cervical ripening is the process of preparing your cervix for labor and delivery. A healthcare provider may recommend medication, a Foley balloon or other procedures to help soften and open your cervix.

Overview

What is cervical ripening?

Cervical ripening describes the process your cervix goes through before childbirth. It involves your cervix changing from being stiff and closed to being open (dilated), thin and soft. This allows the baby’s head to pass through your cervix and out of your vagina during a vaginal delivery.

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Often, cervical ripening often happens on its own, naturally. Changes in hormones and pressure from the fetus’s head often cause this to happen. But, for some people, this doesn’t ripen their cervix enough or at all. Pregnancy care providers may recommend medication, procedures or other devices to help ripen your cervix. You can think of ripening as the process that needs to happen before true labor can begin.

Cervical ripening might help you if you need a labor induction. You might need to be induced if you:

  • Are past your due date (pregnancy that lasts longer than 41 weeks)
  • Have health risks that threaten your health or the health of the fetus (these may include preeclampsia or gestational diabetes)
  • Live far from a hospital and need to plan your labor at a closer location

How does my healthcare provider know if I need cervical ripening?

Your healthcare provider performs a cervical exam to see if your cervix is softening, thinning and dilating. Then, they use a scale called the Bishop score to determine how ripe your cervix is. The score can range from 0 to 13.

A Bishop score of less than six means that your cervix isn’t very ripe. So, your provider might need to ripen your cervix to prepare you for labor. A Bishop score of more than eight means your body is getting ready for labor to start, so you probably won’t need cervical ripening if your labor is induced.

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What is the difference between cervical ripening and induction?

There are a few main differences between the two terms:

  1. Cervical ripening is a process, while induction is a procedure or medical intervention. Labor induction tends to be more immediate when you need to give birth sooner rather than later. Ripening can be a gradual process that happens days or weeks before labor begins.
  2. You have an induction in a hospital or birthing center, while cervical ripening can happen at home or in your provider’s office. Inductions almost always involve medication, while cervical ripening can involve medication as well as other methods.

Procedure Details

How is cervical ripening done?

There are a variety of ways to perform cervical ripening, including:

  • Medication
  • Special devices
  • Membrane stripping or breaking your water
  • Natural techniques (not using medication)

Medications to ripen the cervix

Your healthcare provider may recommend synthetic (artificial) prostaglandins to ripen your cervix. Prostaglandins are naturally occurring chemicals in your body that soften and open your cervix. They can also cause contractions to start.

Prostaglandins come in many different forms:

  • Gel. To apply gel, your provider inserts a catheter containing the gel into your cervix. You might need multiple applications (up to three doses in 24 hours).
  • Pill. Your provider can also give you a pill that you swallow.
  • A suppository. Your provider inserts medication directly into your vagina. Your vagina absorbs the medication.
  • An insert. Your provider puts a tampon-like device inside your vagina. It expands and releases medication into your cervix. You often need to keep a device in for up to 12 hours, or until active labor starts.

Specific names of medications that can ripen your cervix include:

Devices to ripen the cervix

Using a Foley balloon is one way for pregnancy care providers to ripen your cervix. Your provider inserts an inflatable balloon into your cervix through a catheter. Then, they fill the balloon with saline or sterile water. Some providers use special dilators (osmotic dilators) that expand once inside your cervix. Both ripening methods put pressure on your cervix, which can make your body release prostaglandins.

Procedures to ripen the cervix

Some providers chose to perform one of the following procedures:

  • Membrane stripping. Your provider inserts a gloved finger into your cervix. Then, they loosen the amniotic sac from the walls of your uterus. This can cause your body to release prostaglandins.
  • Amniotomy. Your provider uses a small hook to rupture the membranes around the amniotic sac. This is called artificial rupture of the membranes (AROM). Breaking the sac can help release prostaglandins.

Natural ways to ripen the cervix

Some people choose to ripen their cervixes naturally in the days or weeks leading up to childbirth. It’s important to note that these techniques don’t have support from evidence-based research. You should talk to your pregnancy care provider before trying them.

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Natural and at-home cervical ripening methods include:

Remember, it’s not safe to try these methods on your own to start labor. Always consult with your healthcare provider.

Is cervical ripening painful?

It’s typically not incredibly painful because it happens before labor begins. But you may feel uncomfortable symptoms like cramping or pelvic pain. How much pain you experience also depends on whether your healthcare provider has given you medication to manage pain.

How do you know if your cervix is ripening?

You probably won’t know if your cervix is ripening. If you have cramps or lose your mucus plug, it may be a sign that your cervix is ripening. But only a healthcare provider can tell you for sure by examining your cervix.

Risks / Benefits

What are the risks of cervical ripening?

The different cervical ripening techniques each carry their own set of risks. The risks of medication are typically mild, but may include:

Risks of procedures like amniotomy or using a Foley balloon may include:

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There are risks of trying natural cervical ripening methods, too. Some of those include:

What are the benefits of cervical ripening?

Cervical ripening helps shorten the length of time you’re in labor. This means you can possibly spend less time in the hospital and get to meet your baby sooner. Another benefit is you may be less likely to need an induction or assisted delivery.

When To Call the Doctor

When should I see my healthcare provider?

Talk to your healthcare provider if you have questions about labor induction or cervical ripening. Never try to induce labor at home. Your provider can talk to you about ways they can ripen your cervix, as well as the pros and cons of each method.

Contact your provider if you experience any signs of premature labor like contractions or your water breaking. You should also contact them if you’re bleeding during pregnancy.

A note from Cleveland Clinic

When you think of the word “ripe,” your cervix probably doesn’t come to mind. But it’s a term your pregnancy care provider may use to describe how your cervix needs to soften and widen for childbirth. People who need a labor induction are most likely to need cervical ripening. There are several cervical-ripening techniques your provider may suggest. Don’t hesitate to ask questions about the pros and cons of each one. Never try to induce labor or ripen your cervix without talking to your provider.

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Medically Reviewed

Last reviewed on 12/18/2024.

Learn more about the Health Library and our editorial process.

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