External and Observed Signs of Dilation, Descent and Progress
• Location of FHT (foetal heart tones) with pinard or fetoscope; good for gauging descent. FHT early deceleration pattern will indicate resistance onto pelvic floor and therefore descent.
• 6cm = contraction pattern shifts, flushing over cheekbones.
• 8cm = hot/cold/trembly/irritable/nauseous. Contractions seem to not give her a break.
• Near full = increased pressure, vomits, breathing more ragged, ‘catch’ in breath, deeper, guttural moaning. FHT’s midline and low. Sacrum seems flat and full. Her energy will be acutely aware during contractions but she will retreat just as intensely between them. More show, spotting of fresh blood. Feels like pooing, spontaneous release of membranes.
• Purple line that creeps up like a mercury thermometer from anus to top of bum crease. When it reaches the top, the woman is fully (increase in intrapelvic pressure affects veins in the sacrum).
• Vomiting and ROM (release of membranes) at the same time = 7 cm stretch
• Look at bottom of foot with the toes pointing up. The spot above the heel and in the center will tighten and release as the uterus contracts IF she is at least 5 cm.
• Full = passing stool involuntarily, pouting of anus, instinctive bearing down begins at the beginning of the contraction and not at the height of it.
• The contracting uterus swells upwards as it pulls in the dilating cervix. Before a woman begins to dilate and is about at term, you can get about 5 fingerbreadths of measurement between the fundus and the tip of the breastbone (xyphoid). As she dilates, this measurement decreases at about 2 cms per fingerbreadth. I.e., 1 1/2 fingerbreadths between these two points would be equal to 7-8 cms. dilation. It's an old trick I learned several years ago. This really works but, like vaginal exams, it takes practice. Unlike vaginal exams, it's not out of the scope of practice as a doula to do this type of exam because it's not done internally and not "really" considered a clinical test.
• Abdominal signs: thin line or crease above/parallel to Symphysis Pubis. As baby descends and cervix opens, the line/crease becomes wider from side to side. Near transition = ¾ across. All the way across indicates that pushing is most likely imminent (bulk of baby’s shoulders closer to SP?)
• When she "pushes" spontaneously, does it begin at the very beginning of the sensation or is it just at the peak? If it is just at the peak, it is an indication that there is still some dilating to do. The woman will usually enter a deep trance state at this time (we call this "going to Mars"). She is accessing her most rudimentary brain stem where the ancient knowledge of giving birth is stored. She must have quiet and dark to get to this essential place in the brain. She usually will close her eyes and should not be told to open them.
• Does she "push" (that is, instinctively grunt and bear down) with each sensation or with every other one? If some sensations don't have a pushing urge, there is still some dilating to do. Keep the room dark and quiet as above.
• Are you continuing to see "show"? Red show is a sign that the cervix is still dilating. Once dilation is complete the "show of blood" usually ceases while the head molding takes place. Don’t mistake another gush of blood which may be vaginal wall tears at the point that the head distends the perineum.
• Watch her rectum. The rectum will tell you a good deal about where the baby's forehead is located and how the dilation is going. If there is no rectal flaring or distention with the grunting, there is still more dilating to do. A dark red line extends straight up from the rectum between the bum cheeks when full dilation happens. To observe all this, of course, the mother must be in hands and knees or sidelying position.
Self-Checking of Dilation and Descent From: "Childbirth Quotes from Gloria Lemay"
How to Check Your Own Cervix- "it's not rocket science"
"I think it's a good and empowering thing for a woman to check her own cervix for dilation. This is not rocket science, and you hardly need a medical degree or years of training to do it. Your vagina is a lot like your nose- other people may do harm if they put fingers or instruments up there but you have a greater sensitivity and will not do yourself any harm.
"The best way to do it when hugely pregnant is to sit on the toilet with one foot on the floor and one up on the seat of the toilet. Put two fingers in and go back towards your bum. The cervix in a pregnant woman feels like your lips puckered up into a kiss. On a non-pregnant woman it feels like the end of your nose. When it is dilating, one finger slips into the middle of the cervix easily (just like you could slide your finger into your mouth easily if you are puckered up for a kiss). As the dilation progresses the inside of that hole becomes more like a taught elastic band and by 5 cms dilated (5 finger widths) it is a perfect rubbery circle like one of those Mason jar rings that you use for canning, and about that thick.
"What's in the centre of that opening space is the membranes (bag of waters) that are covering the baby's head and feel like a latex balloon filled with water. If you push on them a bit you'll feel the baby's head like a hard ball (as in baseball). If the waters have released you'll feel the babe's head directly.
"It is time for women to take back ownership of their bodies."
- Gloria Lemay, Vancouver, BC
To follow up this, here is an insightful article by Aussie Midwife, Claire Hall.
Birth and the Male Mindset
I especially like this bit:
" ... all of these external signs are interesting and fascinating - and I watch and observe women, but I do not let the expectations of my observations change my assessment of where she is. I care about how she is and how the baby is. What matters is - how is she? How can I support her best? What does she need? Not "how far is she along the path?" she is either moving toward pushing her baby out or she is pushing her baby out. Who cares how close she is so long as she is listening to her body?"
Well said, Claire!
more here:
Dilation: how to check without checking
The Purple Line as a measure of labour progress
This is a beautiful read: Holistic Stages of Birth
And from Midwife Thinking, Dr Rachel Reed: Understanding and Assessing Labour Progress
The Folly of Fully Dilated - Dr. Sara Wickham
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