Cervical Ripening

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:

• Dinoprostone
• Misoprostol
• Oxytocin

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.

Natural and at-home cervical ripening methods include:

• Acupuncture
• Nipple stimulation
• Castor oil
• Enemas
• Herbal supplements

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

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.

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.