Thursday, March 4, 2010

Cervical checks in Labor

I had heard that having a pelvic exam, or cervical check, once your cervix has begun preparing itself for labor can be extremely uncomfortable.  I then saw with my own eyes the pain and discomfort it caused for a mom in labor to have the doctor's fingers inside of her. But, we think, its necessary, right? The doctor/midwife must check so we can know her progress (how many centimeters dilated, what station and effacement), true? And she was asking for it, right?

But what if you never had your progress checked? What if you didn't ask, and the doctor or midwife never told you he/she had to? Would you never give birth? Of course you would!

So why would you feel the need to know? If the dilation turns out to be a low number you will be disappointed, and surely your labor is going to last forever!?  If its a high number and you will feel triumphant - you think that surely this means you will be done very soon! But both of these assumptions may be false. As Stephanie writes in her post Cervical Exams: Who Needs Them?:
Checking your cervix now does not tell us what it is going to do, it only tells us what it has done!

Your labor could halt at 8cm and last many hours longer, or it could speed ahead from 4cm and be done as quick as can be!

The reason we all want to know is fear - we want reassurance that our bodies "work." As Stephanie puts it:

If you are not dilated yet, then that means you will begin doubting your body, feeling broken, doubting that this baby will “ever be born”. Please be reassured, the longest human pregnancy ever recorded was not “forever”...
Your body has known how to conceive this baby, it has (without our assistance) been able to grow from a teeny tiny egg mixed with an even teenier sperm into an entire person!! A full grown baby with toes and hair and the cutest butt cheeks you’ll ever see!! It’s done this miraculous thing…and now, based on a stupid cervical check, you will lose a huge amount of faith in its ability to finish the job it started so perfectly? SHAME ON YOU! Your body is amazing, incredible, creating life! It deserves our utmost adoration…now is not the time to start doubting it! What has it done to deserve your skepticism of its perfection? Nothing…absolutely nothing!

Stephanie is a midwife who writes a blog on Nurturing Hearts Birth Services and I really love the post that I have been quoting from. She also writes:

The only time I can see the value in an internal exam is if labor doesn’t seem to be progressing in a way that we would expect, and I may want to check to see if there is an answer I can find (such as a baby’s head being crooked in there, for example). It is not to see how fast your progressing, really…as long as you are moving forward, I do NOT care how fast it is going! Take your time, have your baby in your own time…so long as everything is healthy. But for a normal labor, I don’t care how long it’s taking, I don’t care what your cervix is doing…I accept your labor is what it is and will take as long as it needs.

So, what if mom is feeling the need to push and wants to be checked to make sure she is "allowed" to start pushing? Well, this is a tough subject.

The "Rule of 10" that Lydi Owen writes about in Midwifery Today is a rule widely accepted by care providers that forbids women from bearing down and pushing until her cervix is completely dilated to 10 cm. Many women feel the urge to bear down and being pushing before they are fully dilated, but are told that this will swell or tear their cervix.

Lydi asks, "Could it be that the instinctual wisdom of our bodies has become our enemy? Why would we feel the need to begin bearing down at 5–6 cm (or sooner) if it would shatter the gateway to the baby’s outer world?"

The "Rule of Ten" came about from observations done in the 1950s of women who were drugged for childbirth. Lydi writes, "...let me say that a non medicated woman will never push so hard against her undilated cervix that it tears, because it will hurt. Pain is a natural deterrent to pushing too hard."

Both Stephanie and Lydi emphasize that they have seen women push and successfully birth babies prior to being fully dilated and not harm their cervices at all. They also both mention what I have heard many midwives also emphasize: Listen and Respond to your internal, primal instincts, your Body is Wise, or as Ina May Gaskin puts it, "Let your Monkey do it." 

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