Monday, March 22, 2010

Inquisition Monday: Dilation

Melodie emailed me and asked,

How do you/will you check your cervical dilation? (I'm sure you must know how to do this. It's one thing I never figured out and since I have had midwife attended births I never felt the need to know). Or will you even check it? Will you instead just wait for the instinctual need to push and not bother with checking dilation? Have you read "The Rule of 10 Versus Women's Primal Wisdom?" This article really spoke to me and I wondered if it resonated with you too.

I will probably not check my dilation. I actually have no idea why I keep dreaming about dilation because it was never a factor in Margaret's birth.

I didn't check my dilation during Margaret's birth for two reasons:
  1. I didn't want to find out that 12 hours of back labor had done nothing for my cervix. I'm pretty sure that the reason my labor was so long was because Margaret was not putting pressure on my cervix evenly because of a slight malposition issue, despite the fact that she was anterior and head down. The fact that 2 dawns happened with no baby in my arms was discouraging enough. I didn't want to find out I was only at a 4. But most importantly,
  2. I don't believe in 10 centimeters.
I once tried to find out where "10 centimeters" came from. I expected to find some study that took X amount of women in labor and stopped them during their pushing stage so that the researcher could stick a measuring tape up there and find out how dilated they were. Then I expected the study to analyze that data, giving us a mean and median near 10 centimeters.

But I didn't find that study. I don't think it's out there, although if it is, I would definitely be interested in it- send it my way!

What I did find, I mentioned in this blog post: namely a page suggesting that it's possible for women to get to 13 centimeters (!) and another page saying that "10 centimeters" comes from the measurement of the diameter of a newborn's head.

Now, I'm just a lowly mommy blogger with a degree in mathematics, but basing cervical dilation on the diameter of the head after it passes through it doesn't make sense to me at all. In general, women are one-size-fits-all. Women have vaginally birthed babies with large heads, babies with broad shoulders, babies whose birth weights are above 10 pounds. And then there's the baby, whose skull plates mold and even overlap to fit through the birth canal. And how soon are they measuring these heads? Margaret's was very very molded- moreso than any baby I've ever seen, but within hours it was going back to round- and within a day you could never tell it was once elongated.

I have seen the "Rule of Ten..." article you linked to, and I agree: some women are probably ready to push at 8 or even 6 centimeters. I would also say that 10 is no upper bound for cervices. Instructing or coaching a woman to push once she gets to 10 centimeters could mean hours of ineffective "purple pushing" if she's an 11 or 12 centimeter women. And my guess? It's probably different for each birth. Maybe a woman needs to get to 10 centimeters for one birth, but only 9 for another.

I do think it's important to know how to check your dilation, though. I never felt compelled to check mine during Margaret's labor, but I can't say I won't ever feel the need to in the future. It's also important to know the dimensions of your fingers. Ten centimeters is 4 inches- be familiar with the width of your hand and fingers because "2 fingers" for one person is "3 fingers" for another. Also, being able to recognize and reach your cervix is important. It's a useful skill for fertility awareness and I think it's important for women to be familiar with their bodies. Also, if you practice feeling your cervix throughout your pregnancy, you'll maintain flexibility. If you can reach your cervix, you can bend over and catch your own baby whether or not you originally planned to. Sometimes midwives don't make it on time and sometimes hospitals are just 5 minutes too far away. Knowing that you have the flexibility to catch your own baby can help you stay calm in a situation you didn't originally plan for.

I check my cervix when I shower because I know my fingers are clean at that time. Right now, my cervix is too high up for me to actually feel it, but I also have short fingers. Most descriptions of the cervix say that it's "hard" like the tip of your nose. As you near your due date, it softens to be like lips. This happens earlier if you've had more than one pregnancy. The "hardness" of your cervix also changes throughout your monthly cycle. The beautiful cervix project features images of the cervix throughout the month and even during pregnancy. Those might be helpful to you or even your partner if you'd like for them to know how to check your dilation, too.

7 comments:

  1. I am not planning on checking my dilation with this labor either. I think that it can be very discouraging. I want to rely on my own instincts, rather than some ACOG generated number! But, I do agree that women should be familiar with their bodies, and understand what the cervix is like. I LOVE the beautiful cervix project!!!! I remember when I first saw it, I was amazed (and I had even been aware of cervical changed due to practicing FAM!)

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  2. I wonder if I am an 11 cm girl. I wasn't ready to push at 10 cm. The midwives were basically saying "Okay, GO!" but I was like, "No, I'm fine thanks." I did a practice push to suit their request, but it took me a couple times before I actually felt the need.
    It's funny. I thought I knew so much about everything going into birth #2 but I can't believe how much more I have learned since then and how much differently I would do things if I had a third child. Thanks for providing further insight for me. :)

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  3. My baby was also anterior and head down but I too had to endure almost 36 hours of back contractions before I even got to 3 cm and went into full-blown labour. Mercifully, it was only 5 more hours till she was born. When she finally did emerge, the midwife noticed she had a funny ridge on her head - a sign that she had been slightly malpositioned early in labour. Sounds like a very similar experience to yours.

    By the way, I've never figured out whether I had a "back" labour or not. I felt zero pain on my front - it was all in my back. But she was anterior. Did I have a "back" labour? I always thought they only happened with posterior babies.

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  4. Cace Mother- it was probably back labor. Having a posterior baby increases the chances of back labor, but I think a mom can experience back labor with a baby in any position.

    I had back labor from Friday morning (maybe even Thursday night, I don't remember) until Saturday afternoon around 2. Then she was born at 6:45pm. So once she got into a "good" position, it was pretty quick.

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  5. Interesting!

    I remember with Ariana they checked me and declared me 7 cm. I got up, made for the tub, but at the next contraction I declared she was "coming - now!" They checked again and just said "Oh yes she's right there, come and push". I always just assumed I went from 7 to 10 in matter of minutes (considering I had a very short labour, it isn't as implausible as it sounds), but maybe I indeed just pushed sooner than "10". For the record, I only had a teeny minor tear (I know pushing "before 10" is a concern for tears and for damaging the cervix - so they say.)

    I think I will present this to my doula and midwife and gauge what they think about it ;-)

    P.S. I also want to note that, personally, my cervix was soft pretty much throughout, which prompted (along with some consistent contractions, though no dilatation) the bed rest at 23 weeks. Ariana was born at 38½ weeks, with no other major complications/mishaps. I now think that my body sent me a "slow down" signal with the semi-contractions, and my cervix is just, well, soft. I don't think I'd do full out bed rest again (though I would take head and slow down! The body is a smart thing :) ).

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  6. Hmm, so maybe it was back labour. Does that mean it will be less painful in future if I have a normal non-back labour? I hope so! Although it wasn't unbearably painful anyway - I wouldn't want to scare any pregnant readers!

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  7. Interesting! I had back labour with both my kids and both were anterior.

    With my daughter, I was declared a "10!" and told to start pushing even though I felt *no* urge. With my son, I was checked to be a 7 and was pushing not five minutes later - 17 minutes between being checked and holding a baby.With my son, the urge to push was unmistakable and unstoppable.

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