The Real Paradigm of Cervical Dilation Part 1: Language
I'd like to start this blog with a recent scenario:
Mom's in labor and things are moving forward. We stayed home some hours, made it to the hospital safely and comfortably. Mom is going unmediated and dad has a normal amount of anxiety mixed with excitement.
In triage, we are met with a very common occurrence, the measurement of the the dilation of the cervix. The effacement and baby's position are measured too but it is always the widening of cervix that gets the unfortunate spotlight.
Sleepy Nurse #1 let's us know that mom is 6 cm dilated. According to ACOG's recent report, we have entered active labor. This is great news for all, and mom feels proud of her body's ability to get her this far. Dad, while reasonably more excited than before, is still feeling nervous.
We get settled in the delivery room and approximately 6 hours go by. Yes it is a miracle that we have been left alone for 6 hours. Well-Meaning But Uninformed Resident Doctor enters our room and it is time for another check.
Here's where the situation gets sticky: After the cervical exam, the doctor looks over to the nurse (not my client) and says, "She's only at 7 cm."
Let that sink in for a second. Better yet, pretend you are an athlete, running the marathon of your life. A marathon that will test every ounce of your endurance because it goes on for miles and miles. You are tired, nervous, anxious and excited all at once. You run past a mile marker that says "You are ONLY at mile 3." What does that do for your confidence?
That's the language many doctors and nurses use in delivery rooms. There is an attitude of mom's body not doing enough. There's no account for how quickly things can change and little consideration for the reality that labor can take time and patience (not just for mom and dad, but patience of the medical staff too).
Why must we change the way we measure dilation? Because it can be defeating for mom to hear that she is ONLY at 7 cm. Because it makes dads or partners nervous that this much time has gone by with seemingly little change. Because it can lead to medically unnecessary c-sections.
Let's edit the above scenario:
The beginning is the same until we get to the second check.
After the cervical exam, the doctor looks over to the mommy-to-be and says, "You've made it all the way to 7 cm! Great work!"
The medical information is still the same, right? It is just the delivery that has changed.
Why must we change the way we measure dilation? Because it is just one tiny piece of the magical labor puzzle. Because if framed correctly (without other congruent medical complications) we can use words that are kind and compassionate to moms who are working so hard to labor their babies. Because this minor change in awareness can propel mommy forward and help her deliver that baby.
I'm going to let you in on a secret here: There are other ways to figure out dilation (yes doulas, you can provide hope and encouragement without performing a cervical)! I think I'll wait until next month to write the continuation of this blog because I am always practicing patience and because language as a framework around labor and birth is important enough of a topic for this blog.
So, I'll see you at the next phase of this blog, otherwise known as Part 2: Figuring out Dilation Without a Vaginal Exam. In the meanwhile, Happy Birthing!