“I am only 2cm after that much work?” said the Mama after the vaginal examination which was part of the routine ‘baseline’ checks done upon arrival at the hospital. These words were an indicator that she was discouraged by the findings. Not only was she told that she was “only 2cm dilated” but she was also told that “this is a sign you may not be in labor”. “How is that possible when one has regular, rhythmic contractions that last 45 seconds, are painful and require attention to breathe and focus?” she asked with great concern. She had her doctor check her cervix about a week before this and it was a cm dilated.
“The truth is that women’s bodies are complex, unique and immeasurable. Birth is a multidimensional experience that cannot be accurately defined by anyone outside of the experience.” Dr. Rachel Reed an independent midwife, lecturer and birth nerd explains. I went ahead and tried to explain to this mama that the state of the cervix then does not tell how fast/slow, long/short the labor will be. It also does not tell how fast the cervix will open. I know the text book says that once a woman is in active labor, her cervix should open 1-1.5cm per hour. That is the text book, and studies show that it’s accuracy is about 50%. The accuracy reduces further when a woman is checked by different care providers. Read the full article here.
In practice I have found vaginal findings NOT a guide as to when labor will start( when done at term), nor do they help determine labor’s progress. Mums whose cervix was checked at 38 weeks and have a cervical dilatation of 3cm still deliver way after their Due date while mums with a closed and not ready cervix deliver in a day or two. I have had a Mum like the one in this article deliver an hour later, another 20 hours later. i have been with a mum whose cervix is 7cm and she delivers an hour later while another delivered 7 hours later. As much as vaginal examination is seen and used as the ‘gold standard’ of progress, it is a finding that is not dependable.
Apart from the fact that it gives no certain guideline to progress, here’s more reasons why I DO NOT do any vaginal examinations:
- They are invasive and some what intrusive.
- It increases the risk of infection.
- It is uncomfortable and for some women quite painful.
- It can and does accidentally break the bag of waters.
- It can give false hope and/or be quite discouraging hence destabilising the woman emotionally
Practice makes perfect. My greatest lesson has been that it really does not matter…how the cervix is, is how the cervix is then and very little if anything determines how it will be later. I do not even need to confirm that the cervix is fully open for a Mum to push as her body signs will let us all know.
I have learnt too that, my 5 senses can guide me in determining the labor progress and give me a clue on how open the cervix is.
Ears: Listening to the Woman
At the start of labor, she is quite calm has normal conversation, can even joke about the process of labor and take phone calls. Once labor is established, she cannot be able to complete a sentence straight. Towards the end of labor, she is more groaning, starts to doubt her ability. Most of the time will say she has a lot of pressure. By this time, the cervix is about 8cm and is transitioning to birth if not already there.
Eyes: Look at her body language:
She is able to do a lot more at the start of labor. As it progress she only wants to do what she must, has curled toes, stands on one leg, starts to flush, has goose bumps around the hips and thighs, may shiver. Towards the end when her cervix is almost all open, she has heavy show, she has a crease at her pubic area and has what is referred to as the ‘bottom line’ a purple line that runs along the natal cleft. She may want to be alone and probably not touched, and can get pretty emotional.
Nose: The smell of Birth:
This is sure hard to explain but it is a familiar smell that can be picked when a Mum’s cervix is 6cm open or more. Some midwives describe it as a heavy, dusky smell, could be almost similar to that of the water but different. This smell becomes stronger as the cervix opens and is sometimes referred to as ‘the smell of newness’.
Mouth: Engage her in conversation:
At the beginning, she takes and follows guidance easily. As labor progresses, she will have a harder time following guidance. At the end, which I like to jokingly call the ‘shut up moment’, she is unable to make any decision and may be unable to follow instructions too.
Touch: Tummy size:
At the start of labor, the top of her tummy appears low and the contractions are tight but the skin not so taught. Towards the end, the fundus is high as the top of the uterus pulls up with every contraction and if she allows you to touch her tummy, the muscles are really taught.
There are definite times when a Vaginal examination is required. This is when there is suspicion that something is not right with the Mother and/or baby or with the progress. The vaginal examination is to help with the decision making as to what steps are to be taken next.