Self check of dilation, how??

[Seznebi]

Self check of dilation, how??

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I am wanting stay home as long as possible and if we end up having a home birth so be it .

So Im wondering is it possible to check dilation for yourself? Is it necessary? What other signs will show where Im at.
How do you check dilation?

Thanks
Sarah

Re: Self check of dilation, how??

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IMO checking your dilation is only necessary if you're going to make decisions based on the info. Most mamas who birth at home don't find it necessary because they're not expecting to birth to a schedule, yk? You can check it yourself if you want to coz hey, sometimes it's fun to know! There's a thread all about it on NP which I'll dredge up for you Other things you might like to keep an eye on, and inform your supporter/s is a need to go inward, stop talking or communicating during cx, getting snappy, feeling overwhelmed, saying stuff like "I can't do this any more" because those things happen to lots of women in roughly that order through a labour. I tend to think that the best VE occurs when you put your hand down and find you're patting your baby's head

Re: Self check of dilation, how??

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This was written by a MW and posted on another list. It's very interesting and will help us understand how dilation and other things are "measured" or as she often says, "guessed" It will also give you some hints if you want to examine your own cervix :-)
J
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This is another email address for Barb who is pleased we're reading her work Lord knows we need it!

Barb@NavelgazingMidwife.com.


Note before beginning: I utilize several food analogies below that
might offend some who feel I am not seeing the woman for her Self.
Please know that isn't so at all, but I *am* trying to find common
items we can touch and experience. I am not objectifying the woman
at all. I promise.

Another note: When I speak of "we" throughout, I am speaking as a
midwife. As a mom, I never did vaginal exams (was too fat to reach),
so, reading over this, it sounds like midwives have exclusive domain
over these learned skills. I don't imply that at all... am actually
writing this so folks not only know what we are doing (when they are
done), but so they can do them themselves if they want to!

Learning to do vaginal exams 101/201/301. No test given, ask any
questions when they come up!

IMPORTANT NOTE FOR PARTNERS: When putting fingers in, washing hands
is a given, but we have found that the index and middle finger are
easiest to maneuver inside a vagina. Just watch that thumb! It, all
too often, finds the clitoris... please be aware of your thumb and
keep it to the side.

DILATION:

We (midwives... can't speak for docs) start by measuring our
forefinger and middle finger as they are stretched apart. Mine are
8cm apart. Then, we begin guess-timating stuff... drinking glasses,
soda cans (I was going to say what it was, but thought you could do
that yourself!), salt shaker's bottoms... anything in a circle...
small and large. We guess, then measure; first with the tape
measure, then our fingers to verify... then, when we are guessing
correctly more than not, we switch that order... fingers, guess, then
measure.

When I first went into a vagina to find a cervix, it was mush. I was
lost in the terrain. Mind you, I had been lesbian for MANY years
*and* had assisted CNMs and L&D nurses for a long time so knew what
cervices (plural for cervix) looked like and all (with speculums)...
but finding one with my fingers was a whole 'nother story! Non-
pregnant cervices feel like the tip of your nose. Pregnant cervices
feel like your soft, gooshy lips. Being slow and gentle and patient
helps you or your partner find your cervix (foreplay for some).

I can tell when someone looking for a cervix finds it. They get an
Ah-HA lightbulb over their head because, even in the gooshy terrain,
there is a distinct difference once the cervix is felt.

Many descriptions abound: a soft, full donut (yum!) is the most
common... the "hole" of the donut (the "os" of the cervix) closed and
tight when not dilated... warm and open and varying in size as
dilation begins and progresses.

EFFACEMENT:

The length of the cervix is now actually measured when women are
having pre-term labor issues... their finding that the length of the
cervix can be indicative of early labor (along with the fetal
fibronectin test, but that is another story).

From http://www.babycentre.co.uk/expert/557301.html:

A vaginal scan is the best way to measure your cervix because it can
be seen much more clearly this way. The cervix looks like a tube on
the scan, between 3 and 5 cms in length, with one end at the top of
the vagina (the external os), and the other end inside the womb (the
internal os). It is the internal os that can begin to open first, and
this will look like a V shape on the scan. As the os opens further it
becomes U shaped. This is called funnelling. (2) If the closed part
of the cervix measures less than 2.5 cms, a stitch will be put in to
stop the cervix opening further. <my note: that is cerclage>

(Barb again.)

But, in normal labors, cervical effacement (as the shortening is
called) can occur weeks ahead (not uncommon) or not until labor
begins (not usual). Judging effacement again begins with measuring
your (or your partner's) middle finger and finding where 4cm is...
touch that... *feel* where that is on your finger. 4cm is kinda long
to me, especially as we move closer to birth, so maybe finding where
4cm and below is is better.

See, what they measure in the u/s is from external os to internal
os. Early in pregnancy and unless sweeping, the internal os isn't
reached by someone's finger, so judging that is a tad erroneous.
Instead of putting a finger IN to measure, we feel the cervix from
the outside... feeling the os, then running our finger up the outer
portion up to the upper vaginal wall and guess there. And it IS a
guess. And, of course, to make things more confusing, we don't guess
in centimeters, we guess in percentages effaced (gone/shortened).

And, with practice, we don't need to have felt a cervix early to know
what the effacement is in labor, either... it is an intuition...
a "feeling" of where that cervix was/is.

*thinking* *trying to find proper words*

So, remembering that the cervix IS the uterus can help. The uterus
uses her muscles to pull *up* in preparation for pushing down of
second stage. The cervix (the actual donut part if we go back to
that analogy) thins as the uterus pulls those muscles up. From thick
like rigatoni (yeah, I know... food thoughts everywhere, sorry)...
gooshier than rigatoni... like rigatoni filled with jello or pudding,
maybe... to thin like over-cooked fettucini (but wider... not as wide
as lasagna noodles, though) and no more pudding... just flat and
soft.

*thinking hard and thinking these are pretty good descriptions,
actually*

When the cervix is 100% effaced, the it is unable to be felt at
all... called "paper thin" because the cervix is flush with the
baby's head... barely a perception of change between vaginal wall and
baby's head... a fraction of an elevation... like when you put your
hand on a sheet of paper lying on your desk and slide it off with
your eyes closed... like that.

The rigatoni to fettucini stages are subjective since they are done
in percentages... and I don't put *too* much stock in effacement
since it happens with dilation anyway. If the cervix is 1-2cm,
that's about 50% effaced. Less than that, 75%-100%... not usually
100% until 10cm (and withOUT a cervical lip!). However, women DO
have 100% dilation pre-labor. I know to RUN to their home (or have
them run to the birth center/hospital if that is where they are
delivering) when labor begins... 100% effacement is a pretty darn
good gauge of a quick labor in the making.


STATION:

Station is measured in -4, -3, -2, -1, 0, +1, +2, +3, +4 (those are
minuses, then zero, then pluses for those whose programs do funky
things to the symbols). Minus 4 is high, high (some texts discuss
minus 5 and plus 5, but not all)... the head floating... ballotable
(bounce-able... pronounced buh-LOT-able). Even a minus 2 or 1 is
ballotable. Once the baby gets down deeper in the pelvis, it can no
longer ballot (buh-lot).

How do we make the baby ballot? With fingers inside the vagina, we
can actually touch the baby's head, even with a closed cervix...
alongside the upper vaginal wall... we can feel a head about minus 2
(longer fingers can reach minus 3s and 4s). Touching the baby's
head, we put pressure there and if it bounces out of the pelvis, it
is ballotable. It is possible to ballot externally, but they (those
that judge) wouldn't consider that accurate. When there is a
question about head/pelvic compatibility, docs and midwives have been
known to kinda push the baby into the pelvis to see if the baby
fits. We can actually feel the head above the pelvic bone (pubic
symphasis, actually) if it doesn't go in.

Of course, for goodness sake, that is ZERO indication of being able
to fit through the pelvis and is nearly absurd to even put a mom
emotionally through the experience. The baby's head isn't in the
position of its own choosing, the woman is lying down, the pelvis
isn't open to its full capacity, the baby's head hasn't molded... la
la la.

What does a baby's ballotability mean for me? It gives me warning
about cord prolapse... that is about it. While I share about cord
prolapse with each client, if I find a baby high during prenatals
(even externally), I have the woman look me in the eye so she
understands what to do if her water breaks before I see her again to
see where that baby is. (A midwife is the product of the sum of her
experiences... and I have had 2 cord prolapses in my hands.)

So, the baby's head is easily felt? (HARD compared to the soft and
gooshy vagina and cervix... even through the vagina, it can be
felt.) The baby is probably at a zero station. If the baby feels
like it is really close (5-6cm in) to the introitus of your vagina,
it is probably at a plus 1 or 2 station (nearly always in good active
labor). Able to be seen with pushes, but not inbetween
contractions/surges? Plus 3. Able to be seen between contractions
and birthing? Plus 4. Plus 5 is crowning if a plus 5 is used.

Now, I know that stations typically are described as the widest
diameter of the baby's head being aligned with the ischial spines of
the mom (zero if even with the spines). Whatever. That is obscure
to me and not terribly tangible. I hope that how I described it is
more easily "seen."

Stations, like effacement, mean virtually nothing in the grand scheme
of things UNLESS progress is an issue during active labor. Station
*can* give us a heads up on what might be happening with a baby's
head position... with inability to mold easily... or if mom has
pelvic issues (a former accident or severe anorexia as a teen).
Otherwise, it is just another measurement I kind of shrug off.

CERVICAL LIP:

Since I mentioned this above, I feel I should yack about it for a
moment. Lips can be anywhere, but always called "Anterior Lips"
mostly because when a head is entering the vagina during 8-10cm
dilation, feeling behind to find a posterior lip is nearly
impossible. We usually will mention/chart where it is... the most
common locations are between 11:00 and 2:00.

We've talked about what to do for lips before, but a reminder. Do
NOT put pressure on it first... rest the lip (lie on opposite side),
then flip sides to put pressure on the cervix and see if that helps.
Some midwives use ice to take the swelling down. Some midwives lift
the floppy cervix over the babe's head. Some midwives
shove "stubborn" (thick) lips out of the way. Some midwives manually
dilate their client's cervices (for a number of reasons including
selfishness [tired], or when a baby needs to get out fast). I let
women do what feels right, generally... and put my hands in less and
less, so am finding lips less frequently. *wink*

The common belief is if a woman pushes before she is fully dilated
(the excuse for vaginal exams), she will tear her cervix. In 21
years and over 800 births, I have seen a torn cervix ONE TIME (with a
non-instrumental [forceps] birth) and the woman delivered her 6th
baby so fast that baby just fell out, no exams at all. All those
women pushing on lips, pushing before they were ready, pushing when
told not to... no tears at all. I *have* felt cervices swell closed
(a couple three centimeters more closed) with pushing, but not torn.
Listening to the body cannot be stressed enough and, when upright,
the body rarely forgets what to do.

Okay, if I missed anything, please holler.

Thanks for letting me share this with everyone. Long overdue, I
would say.

Barb Herrera
http://www.AmaMama.us

[Seznebi]

Re: Self check of dilation, how??

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Fantastic thanks Janet

[la]

Re: Self check of dilation, how??

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brilliant information, i think i understand so much better after reading this,

bump!