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!

A 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

 

One night, you are awakened from slumber at the beck and call of your compressed bladder. No, wait. That’s not it. There’s a crampy tightness that feels familiar. Where have you felt that before?

Menstrual cramps! It feels crampy. Weird. You decide to get up and move to the bathroom. After a few minutes, you get back and bed and feel more cramps. Hm. Weird.

Could this be it? It could be! This is it! You’re finally in early labor!

You know this because the contractions are coming, no matter what you do. You’ve had a big glass of water. You’ve gotten up to pee. You’ve had a snack. You’re content to let the rest of your house rest while you anticipate the birth day to come.

So you’re in early labor. Now what?

You think back to what your midwife told you, and you remember that she gave you several things to do during this slow building time.

1. Let Your Midwife Know. As soon as you know you’re definitely in labor, she’ll want to know. She or her assistant might swing by to check on you and baby, or just triage you over the phone, depending on what’s happening and your needs.
2. Rest. This is not the time to try and “get things moving” by taking a long walk, doing nipple stim, or anything else that is supposed to speed things along. This is the time to conserve energy. If you can talk through your contractions, you can sleep through them.
3. Eat & Drink. Whatever time your labor starts, eat normally. One good meal is often enough to sustain you through the work to come. No food is off-limits, though it’s wise to keep in mind that you may throw up, so avoiding choking hazards or harsh foods might be a good idea. Comfort foods are wholesome, nourishing, and encourage happy hormones. Also, keep drinking. Water, juices, herbal teas that you enjoy, smoothies, and broth are all great candidates. Whatever sounds good.
4. Do Life. There is no reason to put off that quick trip to the store to get milk and bread, or going to the movies. There is no reason to go out if you didn’t plan to, but just going about your day, doing your best to ignore what’s happening. At this point, it’s really no big deal, and it helps your progress if you can be content, happy, and moving.
5. Distract Yourself. Sometimes, especially when it’s your first baby, it’s so hard to keep your mind off your contractions. But the rule of thumb is that you must ignore them until they demand all of your attention, whether you like it or not. Conserving energy in early labor is paramount! Don’t use breathing or coping techniques from your classes yet either. They contribute to the sense of time, and can make you far more tired than you need to be. Instead, watch funny movies, go to the park, go out on a date with your partner, bake a birthday cake, start a slow cooker meal for after the birth, or call a friend to chat.

I like to tell people to “be in denial” about their labor until their labor gets all up in their face! Just take care of yourself, pretend like everything is normal, that nothing is going on, and let your body keep the secret just a little while longer. You will be shouting to the world in your own way soon enough, so save your breath. Smile. 

“To move into active labor, a woman must give up ideas of how she thought labor might be; in other words, she must surrender.” ~Elizabeth Davis in Heart & Hands

Open up to the path your labor has chosen, and surrender time.

Grace & Peace,
Tiff

We’ve all heard the horror stories. The homebirth turned cesarean. The induction gone wrong. The horrible hemorrhage. Cracked and bleeding nipples. Breastfeeding sabotaged by circumstances. And more. There is almost a compulsion to tell these stories, and we are often left feeling a little dazed as we walk away.

These are valid experiences, but hard to hear. Even harder is our response. Smiling and nodding seems shallow and awkward. What do you say in such situations when it doesn’t seem like there is anything right to say? None of us want to be trite, or offer mere platitudes, but what else is there?

Some advocate for setting firm boundaries and asking that only positive stories be shared. This may work among our own circle of acquaintance, where people know us and can understand where we are coming from. However, that often doesn’t feel right to do with someone we don’t know well or have only just met. It just feels wrong to hold up our hand and stop someone from telling their story.

I would like to offer another option.

Listen to their story.

Then, validate their experience. “Wow, that sounds like it was really hard for you.” A simple statement that honors the fact that they have shared part of their life with you.

Go a step further and ask them one question:

“If you could go back and change anything about your experience, what would it be?”

No one has likely asked them anything of the sort. More than likely, they have only been told “At least you have a healthy baby, and that’s all that really matters.”

Imagine what that one question could do for someone struggling with a traumatic experience. Someone who has told her story dozens of times, only finding those who could one-up her story, or who spoon fed her “healthy mom, healthy baby” platitudes.

Imagine being the first person to open up the door in the wall between this precious woman and her own healing. Perhaps no one has confirmed her struggle. Perhaps she has not been allowed to grieve what she lost. Perhaps she has been expected to get over it, no matter how much it hurt, or how few answers she has about her circumstances. Perhaps her experience has only ever been marginalized, even by well-intentioned loved ones who are simply uncomfortable with trauma.

Imagine what you could learn from hearing the answer to such a question. The information that may be between the lines of her answer that can help you confirm or change the decisions you yourself are making. Perhaps her story will be the means of preventing your own traumatic experience, and make you better equipped to handle unexpected outcomes.

Imagine being the means of turning horror into healing.

How have you handled horror stories in the past? How might you handle them in the future?

Grace & Peace,
Tiffany

When I set out to be by my father’s side in 2012, I had no idea what to expect. My sister and I both lived in Colorado Springs, so naturally we caravaned to Oregon together. We talked about it a lot. What would we have to do? How would we help our mom? This was not a typical visit in any way. I felt ill-equipped and unprepared.

Once we arrived in Oregon, and we settled in, I began to discover just how similar labor and postpartum doula work is to supporting not only the dying man, but his family.

Here are 5 more ways I found that my doula work had prepared me for this in ways I did not expect.

1. Dying has a natural, typical process.
I will never forget the social worker who came to visit and explain the process of death to us as a family. It’s a lot like labor, where the signs of impending death get “longer, stronger, and closer together,” like contractions do. Like labor, the dying process is made up of stages, but they are not set in stone, and it looks different for everyone. No one can ever predict when or how the dying process starts, nor how or when it will end. You just have to wait and see. Like labor, when you are more familiar with the basic physiology of the dying process, caring for your loved one is a lot easier. It helps to have a general idea of what to expect.

2. The family needs support as much as the dying one.
Much like the expectant father, the dying man’s loved ones need education and support to help them navigate this painful, sometimes confusing journey. The social worker told us that we would all feel like we were going crazy, “but that’s okay–it’s normal crazy.” Pretty much everything we would experience would be typical of the dying process, but we would all feel as though it wasn’t. And that was normal. Dying is weird. So is birth. And for those who haven’t seen it, it helps to be able to hear an expert tell you that it’s all normal. This is a major role a doula plays. Supporting the father, partner, or family members through the birth process largely consists of smiling across the pregnant woman’s back and giving the thumbs-up to a dad who thinks the love of his life just might be dying based solely on the sounds she’s making. That calm professional presence meant so much to us as a family and enabled me to put on my own doula hat and love my family through the process.

3. Doulas are comfortable with bodily fluids and nudity.
My only regret in helping care for my dad is that I didn’t step up sooner to help my mom with the actual physical care. It took seeing my mom in tears, needing help to get Dad up off the floor for me to see the need for what it was. Dad was reluctant to let me help, because he didn’t want his daughter seeing him that way. However, Mom needed me. So, I gently insisted to Dad that he needed to let me do this for Mom’s sake. He agreed, and it didn’t take more than one trip to the bathroom together for him to feel okay about it. I happen to have a natural bent toward a clinical mindset, and I knew it wouldn’t bother me to help Dad get to the bathroom while he could, and when he couldn’t, to hold the portable urinal. It’s not much different than letting a pregnant woman lean on you while she’s on the toilet during labor, or hold her hair and an emesis bag while she throws up. It’s just part of life. And death.

4. Everyone involved has a vital role to play.
Part of a doula’s job is to understand the roles everyone involved in a labor and birth are going to fill, based on their gifts and what the mother needs. She assesses the expectations, then sees where she best fits in, and can enhance and help everyone’s roles. It’s the same at the deathbed of a loved one. Everyone has natural personality quirks and gifts and roles, and it is vital to let each play the part they are most comfortable with. Granted, we all have to step out of our roles once in awhile and make do, but generally, we each got to do what came naturally to us. Our kids even filled a role, keeping joy front and center even in the midst of our death watch. It was comfortable and seamless for the most part.

5. It’s not about me.
No birth I attend has anything to do with me. I am along for the ride, for better or worse. I am there to comfort, support, encourage, and anchor. I am not there to fight battles, rescue anyone, or to make a statement. My father’s death had nothing to do with me either. It was his journey, and I was there to comfort, support, encourage, and anchor as well as I could. I could have done a better job, I know, but I did the best I could with what I had, and I know that it was enough. It had to be, because I offered everything I had. We all did.

We each of us, my mother, sisters and I were utterly drained at the end of it all, but we had no regrets. Dad passed into his Father’s arms exactly the way he wished to: with minimal pain, at home in his own bed, surrounded by those he loved. We all of us were his doula team. And we didn’t even know it.

To read the first part, click HERE.

If you have lost someone, what would you add to this? Feel free to share your story in the comments.

Grace & Peace,
Tiffany

A 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

Thank you.

Thank you for choosing me to walk with you, whatever your journey.

Thank you for asking questions.

Thank you for learning and growing, and letting me be a part of that.

Thank you for sharing your strength, dignity, and unique experiences with me.

You are amazing. You are the reason I love this work.

Grace & Peace,
Tiffany

We at Preparing for Birth are always striving to be more and more relevant to our clients and students, and we cannot do that without input from you! We are starting up the ol’ blog again, but we would rather not write about anything that you are not interested in. Of course, we want to cover new ground as more and more new evidence and information come to light, but it’s always nice to revisit topics that are key to you, our readers.

So, would you be so kind as to share in the comments what topics you are most interested in reading more about? Here are some ideas to get you started:

 

• Doulas: Labor, antepartum, postpartum, and more.
• Informed consent and conscious agreement.
• Pregnancy myths debunked.
• Home birth and midwifery.
• Client and student birth stories.
• Photos and videos.
• Podcasts.
• Book and product reviews.
• Birth art/poetry/music.
• Childbirth education.
• Tips, tricks, and hacks for pregnancy, labor, birth, postpartum, and newborns.
• Babywearing.
• Breastfeeding myths.
• Pregnancy fitness.
• Pregnancy & special food needs (vegan, paleo, etc).

What else would you add? This is where you come in! Leave a comment, and share what you would like to read about here!

Welcome to Birth In Joy, and a new, short series on essential oils you can use in pregnancy, labor, and birth by my dear friend and colleague, Kim Prather.

Kim Prather is a wife to Ryan and mom of 5, learning how to use therapeutic grade essential oils to live a healthier life! Join her, as she learns more about the wonders of God’s creation and how to use essential oils in everyday life, and special situations! She is learning and sharing about Young Living Therapeutic Grade Essential Oils, and loves to help those who are interested in learning more themselves. You can contact her at Front Range Scentsabilities by clicking HERE.

Disclaimer: The essential oils described in this post refer only to therapeutic grade essential oils. I only recommend Young Living essential oils, as I am certain of their high quality. This is for informational purposes only. Different people will respond differently to the use of essential oils.

Essential Oils in Pregnancy, Labor, and Birth: Part I ~ Safety Guidelines for Essential Oils

I created this information sheet for a class that I taught recently to birth professionals. A few of the warnings at the beginning I included as I wasn’t allowed to ONLY promote Young Living, so I wanted to be sure to have my bases covered in case they tried inferior oils. I’ve added a few personal notes in here too! Please comment with questions and your stories!

Important Essential Oil Safety Rule:

Always have carrier oil or pure vegetable oil close by to wipe off essential oils if needed. Apply the pure vegetable or carrier oil to a cotton ball, tissue or handkerchief to dilute and remove the oil. Keep essential oils away from the eyes and the eye area. DO NOT rub your eyes or handle contact lenses with essential oils on your fingers.

The most common Essential Oil Safety Mistake:

If you get oil in your eye, immediately remove the oil by gently dabbing your eye with a cotton ball or tissue that has vegetable or carrier oil on it. This will help dilute the oil. Do not flush the eyes with water! Water spreads the oil and could make it worse. Oils are not water soluble.

One of the most important rules for essential oil safety is to always test an essential oil on the skin before use. Each person has their own unique body chemistry and just as foods affect people differently, so do oils. Testing the oil on the soles of the feet is the safest place. Always test here for babies and children and for those with allergies. Another location is on the inside of the arm just above the elbow. 10-15 minutes is usually sufficient. If the person you are testing is prone to allergies, or unusually sensitive, allow for 30 minutes. Testing allows you to see how their body will respond. Always ask about allergies.

The following are essential oil safety guidelines that are important for you to know:

1. Always have vegetable oil or carrier oil close by when applying essential oils. This is to dilute and remove the oil if necessary. Do not try and dilute the essential oils with water, it will spread the oil and could make it worse.

2. Certain oils should always be diluted. They can burn and injure the skin. Oils high in phenols, citrals and cinnamic aldehyde, such as Thyme, Oregano, Clove and Savory (phenols), Lemongrass (citrols), Cinnamon Bark (cinnamic aldehyde).

3. Always use a dispersing agent, such as bath gel base, when adding essential oils to bath water. Never add undiluted essential oils to bath water as they can injure or burn the skin.

4. Do not apply undiluted or neat essential oils to parts of the body that are hot, dry, or tender. Instead, use a compress that has been soaked in cold water filled with dispersed essential oils.

5. Use only therapeutic grade essential oils and oil blends. This is extremely important regarding essential oil safety. Before ingesting essential oil, or applying it to your skin, know and trust your source. Most oils contain chemicals that may be dangerous and toxic. I only recommend Young Living Essential Oils because of their purity and quality.

Sources:

• Essential Oil Safety
• Pregnancy, Birth, & Recovery with Young Living Essential Oil Products
• Essential Oil Birth Stash
• Essential Oils in Pregnancy (PDF)
• Gentle Babies, Essential Oils and Natural Remedies for Pregnancy, Childbirth, Infants and Young Children by Debra Raybern, $12.95 on Abundant Health4U.com