Archive for the ‘Active labor’ Category

Throwback Thursday: Dilation Isn’t Everything

Thursday, September 14th, 2017

A look back at one of our most popular blog posts of the past few years. Originally published May 18th, 2015. And still every bit as relevant!

BESTA mother waits patiently on the small triage bed while the nurse concentrates on what her fingers are telling her about the progress of this labor. After a minute, she pulls her fingers out, and chirps brightly, “You are 5 centimeters dilated!” She flips her gloves into the trash can and turns to the computer to chart.

It’s a universal experience going into a hospital in labor. The progress of labor is reduced to a number between one and ten, and nothing else. An hour later, after being admitted to her room, the mother is told she is “still only a 5.” Once again, she isn’t a mother, she is a number. She is left alone to contemplate that, and to deal with it as she may.

Most of us tell our birth stories in terms of this number. “I was stuck at 5 forever!”

What if I told you that this number means very little when it stands alone? What if I told you that your cervix does a whole lot more than just dilate? What if I told you that there are more ways to measure progress in labor than that ubiquitous range of centimeters?

Well, it’s true.

My preceptor and mentor, Desirre Andrews says:

“There is a mystery surrounding cervical dilation and changes prior to and during labor. I like to think of it as the jobs of the cervix. The cervix does so much more than simply opening.”

So, the next time you have a baby, and you are facing a vaginal exam, make sure you ask about what else your cervix is doing!

1. Effacement
Hold up your pointer finger. Touch the second knuckle. From there to the tip of your finger is about the length of your cervix. In order for the cervix to dilate completely, your cervix has to shorten, or “efface,” completely. This is measured in percentages. If your cervix only reaches from the tip of the finger to the first knuckle, you are about 50% effaced. This process must happen before dilation can even occur. In many women, it occurs at the same time or it overlaps dilation. In first time moms, we often see effacement first, then dilation quickly follows. What if our mother was told that, while she was “still 5,” she went from 50% effaced to 90% effaced? That’s progress, people!

2. Ripening
Touch the tip of your nose. (You didn’t know this would be so interactive, did you?) That’s about the texture of a closed, uneffaced cervix. That’s no good for dilation, and it has to soften, or “ripen” in order to do its other jobs. This primarily happens before labor, but can also happen throughout labor. The texture of your cervix must work its way to the softness of your relaxed lips, and then softer still to match the texture of the inside of your cheek. We call cervixes at this stage “soft like butter.” Yet another measure of progress. If our mother were still at 5, but her cervix was much softer and more difficult to feel, that’s progress!

3. Position
To protect your baby, your cervix points towards your tailbone (posterior) during pregnancy, and sometimes even early labor. In order to open and allow the baby to move through it, your cervix must shift its position until it is pointing directly into your vagina (anterior). If our mother were told that though she were “still 5,” but that her cervix was easier to reach, this job has been done, and she has made progress!

4. Dilation
Last, but not least we have dilation. Your cervix must open up from a tightly closed position, all the way up to “10 centimeters.” Really, it’s not 10, though. At this point, nothing can be felt except baby’s head. It’s often now simply called “complete dilation.” The thing to realize about dilation is that it cannot happen unless the cervix is doing all of its other jobs already. They often happen seemingly in tandem, but sometimes a mother will be “stuck at 5” while her cervix is effacing, softening, and moving forward. Once those jobs happen, dilation is a downhill race to the finish (though it may not seem like it).

So, the next time you consent to a vaginal exam in labor, make sure you get more than a number. Ask about effacement, softness, and the position of your cervix. Your cervix is amazing and has a lot more to do than just open. Make sure it gets all the credit it deserves!

Were you informed of the various ways the cervix works before and during labor? How might this change the way you approach your future pregnancy care?

-Tiffany

Dilation Isn’t Everything: The many jobs of your cervix.

Monday, May 18th, 2015

BESTA mother waits patiently on the small triage bed while the nurse concentrates on what her fingers are telling her about the progress of this labor. After a minute, she pulls her fingers out, and chirps brightly, “You are 5 centimeters dilated!” She flips her gloves into the trash can and turns to the computer to chart.

It’s a universal experience going into a hospital in labor. The progress of labor is reduced to a number between one and ten, and nothing else. An hour later, after being admitted to her room, the mother is told she is “still only a 5.” Once again, she isn’t a mother, she is a number. She is left alone to contemplate that, and to deal with it as she may.

Most of us tell our birth stories in terms of this number. “I was stuck at 5 forever!”

What if I told you that this number means very little when it stands alone? What if I told you that your cervix does a whole lot more than just dilate? What if I told you that there are more ways to measure progress in labor than that ubiquitous range of centimeters?

Well, it’s true.

My preceptor and mentor, Desirre Andrews says:

“There is a mystery surrounding cervical dilation and changes prior to and during labor. I like to think of it as the jobs of the cervix. The cervix does so much more than simply opening.”

So, the next time you have a baby, and you are facing a vaginal exam, make sure you ask about what else your cervix is doing!

1. Effacement
Hold up your pointer finger. Touch the second knuckle. From there to the tip of your finger is about the length of your cervix. In order for the cervix to dilate completely, your cervix has to shorten, or “efface,” completely. This is measured in percentages. If your cervix only reaches from the tip of the finger to the first knuckle, you are about 50% effaced. This process must happen before dilation can even occur. In many women, it occurs at the same time or it overlaps dilation. In first time moms, we often see effacement first, then dilation quickly follows. What if our mother was told that, while she was “still 5,” she went from 50% effaced to 90% effaced? That’s progress, people!

2. Ripening
Touch the tip of your nose. (You didn’t know this would be so interactive, did you?) That’s about the texture of a closed, uneffaced cervix. That’s no good for dilation, and it has to soften, or “ripen” in order to do its other jobs. This primarily happens before labor, but can also happen throughout labor. The texture of your cervix must work its way to the softness of your relaxed lips, and then softer still to match the texture of the inside of your cheek. We call cervixes at this stage “soft like butter.” Yet another measure of progress. If our mother were still at 5, but her cervix was much softer and more difficult to feel, that’s progress!

3. Position
To protect your baby, your cervix points towards your tailbone (posterior) during pregnancy, and sometimes even early labor. In order to open and allow the baby to move through it, your cervix must shift its position until it is pointing directly into your vagina (anterior). If our mother were told that though she were “still 5,” but that her cervix was easier to reach, this job has been done, and she has made progress!

4. Dilation
Last, but not least we have dilation. Your cervix must open up from a tightly closed position, all the way up to “10 centimeters.” Really, it’s not 10, though. At this point, nothing can be felt except baby’s head. It’s often now simply called “complete dilation.” The thing to realize about dilation is that it cannot happen unless the cervix is doing all of its other jobs already. They often happen seemingly in tandem, but sometimes a mother will be “stuck at 5” while her cervix is effacing, softening, and moving forward. Once those jobs happen, dilation is a downhill race to the finish (though it may not seem like it).

So, the next time you consent to a vaginal exam in labor, make sure you get more than a number. Ask about effacement, softness, and the position of your cervix. Your cervix is amazing and has a lot more to do than just open. Make sure it gets all the credit it deserves!

Were you informed of the various ways the cervix works before and during labor? How might this change the way you approach your future pregnancy care?

-Tiffany

Preparing For Birth – Labor Length and Progress

Monday, October 19th, 2009

There are always questions on what is the normal length for labor and what is not.  Women in labor are not static.  Though there may be averages, falling outside of those may not be reason to manage labor by augmentation or cesarean.   Patience and individualized care tend to be the biggest keys to better labor outcomes.   Of course, maternal emotions, fetal positioning, maternal movement in labor or lack thereof, use of epidural or other pain management, provider or staff attitudes, over use of vaginal exams, continuous monitoring without risk association, and other can influence the normal course of labor.  There is no one-size fits all time-line to put on a mom and baby.

Generally as long as a progressing labor doesn’t all of a sudden stall out, become unorganized, or stop without a reason (see above), dystocia may not be present at all.

Below is a compilation list of information relating to progression of labor and dystocia.

Dytocia Defined First time Mothers AAFP

diagnostics – reassessing the labor curve.pages

Varney’s Midwifery Book

http://emedicine.medscape.com/article/260036-overview

Spontaneous Vaginal Delivery – AAFP

Labor Progress Handbook excerpt.

http://www.guideline.gov/algorithm/5587/NGC-5587_6.html

Helpful hints for keeping labor progressing:

  • If at all possible (lacking medical necessity),  do not arrive at the hospital or birth center prior to well established labor (contractions as close as 3 minutes apart and a minute or more long).
  • Eschew labor induction for any reason other than medical.   http://prepforbirth.com/?s=labor+induction
  • Decline pain management if at all possible.
  • Labor in the water.
  • Continue to eat and drink in labor.
  • Hire a labor doula.
  • Attend evidence-based childbirth classes – not good patient classes.
  • Attend meetings in your community who promote natural, healthy birth practices: ICAN, Birth Network, local doula organization, etc.
  • Read variety of books – http://prepforbirth.com/products-page/books-videos-and-more/
  • Surround yourself with those who believe in you.
  • Be confident that you can birth!

Remember, a mother and baby are a unique pairing.  Some labors are short and some are long. Progress is defined by much more than cervical dilation. There is a huge spectrum of normal. No mother and baby will fit into a box.

Lastly, prior to labor also make sure you understand what your provider’s expectations are and how dystocia is defined.  That alone can determine whether or not you will have a successful vaginal birth.

Preparing For Birth – The Passage from She Births

Sunday, October 11th, 2009

The below writing in my opinion is one of the most eloquent and beautiful takes on labor and birth I have read.   I am using it by permission of the author, Marcie Macari from her book She Births.   I encourage you to go to her site and see her offerings.  Inspiring and fantastic. Thank you Marcie for allowing me to bless others.

I have and will continue to use this piece as a visualization with clients and class participants.  Enjoy!

“The Passage” from She Births by Marcie Macari

The earth shook. The women gathered.

The chanting of The Women Of a Thousand Generations began,  their hands intertwined.

I breathe low, moaning deep through my body to touch the depth of sound they generate.

And for a moment I am with them.

“We’re here-with you, you are one of us-you can do it!”

One of them

I breathe.

The coals glow-mocking my strength

Embers flick their tongues tormenting my courage.

I step onto the coals-

The Women Of a Thousand Generations push closer to the embers- their faces glowing from the coals.

I keep my eyes on them, focusing on THEIR ability to push through the pain, to keep walking in spite of their fear- remembering that they made it to the other side.

I find MY courage and step again.

I feel the embers, and wince.

The Women start beating a drum.

I find their rhythm in my abdomen, and slowly move forward:

One step- look at the face.

Second step- focus on the eyes.

Third step…

I see the African dancers, rehearsing their steps as I walk my last few.

I see the circle being set-the fire at the center,  the food and festivities.

This will be the stage for my welcoming into this elite group- this Women Of a Thousand Generations.

My heart swells.

I am close to the end now, and my body starts to shake-

Spirit stronger than flesh.

I want to give up-to step on the cool grass

And off these coals.

I look for the faces, and my eyes meet theirs.

One of them smiles.

She who is With Woman, reaches out her hand

Her face is the clearest, eyes at my level.

“Listen to your body and do what it tells you” She says-no trace of concern.

The chanting changes: “Listen to your bo-dy”

In rhythm, hands are again joined, like an infinite chain.

I realize just how many have gone this way before me.

The one who smiled places her hand on the shoulder

of the One who is With Woman- with me, and I breathe,

stretching out my hand to grasp the outstretched.

I am about to cross over-

Silence comes over the Universe.

I near the end-

my body aches,

my mind is empty of everything but that last step.

Last step.

Hands grasped.

Cool grass. On my toes, cooling my feet-

my arms reach out to claim my prize-

“Reach down and take your baby.”

I hold him to me tightly, and proudly take my place in the chain.

I am now a Woman Of a Thousand Generations.

The celebration begins.

Excerpt from She Births: A Modern Woman’s Guidebook For an Ancient Rite of Passage, by Marcie Macari.

“There is more to Birth than the physical process of having a baby. Birth is a Spiritual Rite of Passage for women, offering an opportunity for profound transformation. She Births challenges each woman to consider how their Birth Choices profoundly affect not only their lives individually, but the world as a whole.”

How real is active phase arrest of labor?

Thursday, September 17th, 2009