Cervix effacement and dilation

What a GREAT class last night! So much to share...

In the birth junkie world, the cervix-as-budding-rose analogy is nothing new, but yesterday's class brought home one aspect of it to me in the most powerful way. Look at this photo:

How do we get these buds to open up?

We see four beautiful buds on the same stem; one of them has opened and is nicely on its way to full bloom. The other three are being a bit stubborn and are obviously in need of a little assistance, so what can we do to help them? Maybe we could spray some ripening chemicals on them. Or maybe we could use our fingers to peel back those green whachamacallits and dig around the petals, you know, just gently stretching and sweeping in there...

As Gloria was saying this I was feeling sick with the horror of it. Women have these procedures done to them daily. There's this belief going around that the female body needs "help" to do what God designed it to do in His own sweet time. And it's as preposterous as forcing a rosebud to bloom ahead of its natural rhythm. The ongoing impact is far more devastating to the woman, her baby, and to humanity in general than the destruction of a perfectly good rose, however. Urgh. This class kinda triggered my crud again, actually.

Anyway. Here were some of the other little nuggets of information and midwifely wisdom:

Don't get fixated on the cervix. It's a part of the body much better forgotten and left alone.

A non-pregnant cervix feels firm and rubbery like the tip of your nose. A pregnant cervix feels soft like the inside of your lips. (Pout them like Angelina Jolie for best effect.)

It would appear that dilation during the birth process has a healing effect on the cervix. There is some evidence to show that pre-cancerous cells which have been found in pap smear tests disappear after birth. What are the implications of this for women having scheduled caesarean sections? (I'm not in favour of pap smears for various reasons anyway, but I do think this is an interesting point/question.)

Effacement and dilation of the cervix are caused by the fundus (top of the uterus), which is doing all the hard work of labour. As the uterus contracts, the fundus draws up the cervix and lower part of the uterus while simultaneously pushing down on the baby like a piston. Immediately after birth, the fundus is extremely thick while the lower uterus is very thin and the cervix has disappeared. (It's incredible; have I ever mentioned that I love the birth process?)

As a follow-on from that, it's not uncommon for women to hear about the dreaded Paper Thin Uterus, as in, "It's lucky you had the caesarean when you did because five minutes more and your uterus would have ruptured. It was paper thin!" If a doctor says this to a woman they are either ignorant of the normal birth process (which would make sense, particularly if they have a habit of performing caesareans before a woman gets to the fully dilated stage), or deliberately creating drama and fear of the normal birth process.

10 centimetres, that magical point at which dilation is complete and the woman is "allowed" to begin pushing, is symbolic of "I can't feel any more cervix". The woman's cervical opening could actually be 9 cm or 11 cm. I had never heard this before and it was a breath of fresh air. I had always wondered why there was such an obsession with 10 centimetres, when surely every woman is different just like every baby is different and every human being is different. It was also a little bugbear of mine because when I felt the fetal ejection reflex with Cassia, an obstetric nurse who had all along been insisting I wasn't in real labour yet examined me and said I was 9.5 centimetres dilated so I had to get out of the bath, move to another room, climb onto a bed and commence pushing (I feel an odd and rapid fluctuation between meh and wanting to smash things about this nearly four years later).

If a woman says "I have to push!", the appropriate response from the midwife is to ask "where are you feeling it?" If she says it's in her belly, the midwife should say something nice like "That's great, the baby's moving its way down" but NOT encourage the woman to push. If, however, she says it's in her bum and that she feels like she needs to poo (or in fact she does involuntarily poo), then that's a good sign that her cervix is fully dilated and the baby is on its way out. In that case the midwife can say something like "Go with that feeling, then". A midwife should never actively direct a woman to push. She'll push when she's ready -- in fact she won't be able to stop it. I found this insight helpful in understanding a little more of Elliott's birth. I certainly remember that abdominal pushy feeling, but because I had already decided I was not going to actively, consciously do anything during the birth, I just let the feeling come and go. I remember feeling pukey during those moments too, so if anything it was an upwards pushy sensation, not downwards.

I asked for Gloria's comments about cervical lips. This is a reasonably common issue in the medical model, when a woman's cervix is swollen at the front (anterior), preventing adequate descent of the baby. It's usually resolved by someone reaching in and manually pushing it out of the way, although occasionally more "hard core" interventions such as epidurals or even caesareans are used. I already knew that cervical lips are treated with much skepticism and disdain in the normal birth world, but was interested to hear what Gloria had to say. Her reply was that she's very lucky to have a Supreme Court Order preventing her from performing vaginal exams, which means that she never comes across cervical lips. Unless she actually sees a crowning head, she assumes the woman is 2 cm dilated and there's still a way to go. Lisa's comment was (and this is a paraphrase, because I didn't write it down) that the baby's head and the cervix are actually involved in an interplay whereby the head doesn't always apply full and even pressure all around the cervix but rather a little bit on one side, then a little bit on the other, so that the presence of a lip is just the cervix waiting for the baby to take up position. In other words, both of their answers demonstrate that it's normal and there is no reason to pathologise it.