How Dilated am I?
As labor begins one of the first questions I hear is, "How dilated am I?" Yes, dilation can be a measuring tool for midwives to assess labor but it does not tell your how close you are to delivering your baby. Did you know that there are many other ways to assess the progress of labor without doing a vaginal exam?
Fundal Height
During labor your uterus swells upward as it pulls the cervix open. At the end of pregnancy as your baby “drops” there will be a span of approximately 5 fingerbreadths distance from your xiphoid (that little V shape where the two bottom ribs meet). As you dilate that distance becomes less. This is measured during the peak of a contraction when the uterus is “swelling”. Each fingerbreadth represents 2 cm. So when there is just 1 fingerbreadth between the top of your uterus and the xiphoid during a contraction you are almost 10 cm. This measurement is most accurate in mom’s who have had a baby previously and if there is not a lot of extra “fluff” on mom’s belly.
Birth Noises, Repetition and Emotions
Most moms will show different emotions, rhythms and sounds during different phases of labor. In early labor I usually see mostly happy moms who don’t make must noise during a contraction and haven’t established a rhythm yet. She can still talk to me during the contraction and is comfortable enough between them. As she approaches 5cm I find more concentration and seriousness during contractions. I might start to hear some light moaning or humming type sound as she works through them. Noises become louder around 5-7cm. I start to notice a rhythm in the way she works through the contraction and there is no longer conversation going on during contractions. She is not so happy anymore and may get irritable with those around her. During the 7-10cm of transition she is quiet between contractions and totally in “Labor Land”. She sometimes feels like she can’t do it any longer and is not sure what she wants. Birth sounds are now deep and moaning as she works through contractions. I usually see a defined ritual in the way she works with each one.
Physical Signs
6-8 cm
Purposeful, rhythmic tapping or shaking of hands or rocking of hips during contraction. She usually starts to feel overheated and her face will flush. Sometimes during the contraction, she will tighten up or curl her toes. At this point most moms will seek out a private place.
9-10 cm
If mom is laboring on land and not in water you will notice that her lower legs become cold as the body directs blood flow to the uterus. At this point you can start to see the tailbone area bow outward as the baby moves down, she may complain of her low back hurting more. You will notice a purple line starting at the anus and reaching all the way to the top of the crack in her bum. (If you pay close attention you can notice this line earlier in labor and see the progression as dilation increases) She will start to feel pressure in her bottom at the peak of the contractions and sometimes pass stool. It is common to feel nauseated, sweaty and shaky. This is a common point for your water to break.
Conclusion
Each labor will be different and unique. I have seen moms at 5 cm who delivered an hour later and moms at 8 cm who did not deliver for 5 hours. Dilation does not always tell us how long it will be until our baby is born. But along with these other observations you will have a better understanding of where you are at in the process of birth. Lean to trust your body and the signals it gives.
