You’re not 4cm dilated. Do not pass Go. Do not collect £200.

Today we’re talking vaginal examinations. Most mums will have at least one when giving birth, many will have multiple and some will even have them before labour has started. I think it’s a generally accepted part of having a baby and we (i.e. midwives, mothers, birthing partners, etc.) put a lot of emphasis on the importance of this one examination. Well, actually we put a lot of emphasis on one tiny part of the examination- and that’s the dilatation. This one small piece of information can make you feel elated and joyous or it can make you feel deflated and disappointed. It can be your golden ticket to the labour ward if you reach the 4cm mark, otherwise you are often encouraged to go home. I could ramble on here about the care mums are offered at this point and what’s best for them and their babies but that’s a whole other debate for another day. Today I just want to shed some light on the importance of the other aspects of vaginal examinations and how paying attention to them can make you feel more positive if you’re not granted with that ‘golden ticket’.

A vaginal examination is very simple. It doesn’t require any fancy technology and there are certainly no rulers involved. It involves the midwife or doctor slowly and gently inserting the index and middle fingers into the vagina, in order to help assess how dilated the cervix is, as well as assessing for the other features too. It’s these ‘other features’ that I really wanted to focus on today, because it’s these that are often forgotten about, despite being vitally important. Here goes:
1)      Effacement- “What’s that?!” I hear you say. Effacement is how thick or thin the cervix is. During pregnancy, the cervix is long, up to 4cm. The closer your baby is to being born the thinner the cervix will become. It gets as thin as a few millimetres. For first time mums, the process of thinning out generally happens before the cervix can really start to dilate and open. For mums that have had babies before, the thinning of the cervix can happen simultaneously to the dilatation. This is often what your body is achieving in the early parts of birth. The time when you might be experiencing surges that don’t form a regular pattern, when some are strong, some are weak, some are long, some are short. This process can take time, which is why it is normal to be feeling these irregular surges for up to a few days before the strong, regular ones arrive. 
 
2)      Consistency- This is how soft or firm the cervix feels. The closer the baby is to being born the softer the cervix will feel. One way of comparing the changes that cervix goes through is comparing the feel of the end of your nose (pretty firm) to the texture of your lips (much softer). This change in texture is all part of the process of birth. Once the cervix is soft it is much more likely to thin out, dilate and open. It can become soft towards the end of pregnancy, without any surges or the softening up may happen as the surges begin.
 
3)      Position- Throughout pregnancy the cervix sits at the very top of the vagina, pointing backwards. This is for very obvious reasons- it is in protective mode. It’s as far away from the outside world as it can get, keeping your baby as tucked up and as safe as possible. The closer your baby is to being born the further forward the cervix will move. It goes from a ‘posterior’ position, to a ‘mid’ position, to an ‘anterior’ position. Again, this movement of the cervix often happens when those irregular surges begin, as the birth gets closer and closer the cervix moves further and further forward.
 
4)      Descent of the baby’s head- I guess this one is obvious but it’s still overlooked so many times. The lower the baby’s head is the closer she is to being born. This is measured from -3 (meaning the head is very high up) all the way to +3 (meaning the baby’s head can be seen at the entrance to the vagina). This can also be measured by feeling your tummy- your midwife probably does this whenever you have an antenatal appointment- it is written in your notes as 0-5/5 palpable. If the baby’s head is very low it will be 0/5 palpable and if it is very high it will be 5/5 palpable (also, sometimes called free). It is common for labour to start when the baby’s head is around -2 or -3 and then for baby’s head to move lower and lower as the birth progresses.
 
Each of these features is really important and can show just how much your body has achieved before the cervix begins to dilate. Try and remember this when you find yourself in triage or when the midwife is coming to see you at home, if you are having a home birth. You’ll probably only make the journey to the hospital or call the midwife if you think that birth is getting close and it can be so disheartening to hear that it isn’t as close as you thought. So, ask your midwife to explain everything to you. If you find out that your cervix is 2cm dilated but it is now only 1cm thick, it’s in a mid-position and it’s soft plus your baby’s head has moved downwards- then think of all the work your body has done to get you to that point. It’s thinned your cervix by 3cm, it’s moved your cervix forward, it’s softened it up and it’s moved your baby’s head into your pelvis.
Isn’t that amazing? It’s done incredible things already and it’s about to do a whole lot more. Listen to your body, it knows what it’s doing. Plus, this is only a moment in time- things can and will change and you will meet your baby.
www.doitlikeamother.co.uk Chloe is a working midwife and mother of one, and teaches our hypnobirthing courses in Upminster #doitlikeamother #hypnobirthingworks #positiveimperfectbirth

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