#32 | Q&A: The Difference Between HypnoBirthing and Bradley, When Formula Might be Needed, What's a Cystocele, When To Allow Family Members at the Birth, Membrane Stripping and Vaginal Exams

June 24, 2020

It's the last Wednesday of the month, which means it’s time to answer your pregnancy, breastfeeding, birth and postpartum questions. Today we're discussing birth support and boundaries, especially when it comes to having a family member, like your own mother, attend your birth. Next, we discuss membrane-stripping for full-term pregnant women. Is it safe? Is it effective? How well does it work? Our breastfeeding topic today is around supplementing with formula--when is it really needed and what can you do to increase your supply? Next we dive into HypnoBirthing and discuss how it differs from the Bradley method.  Cystocele? What's that, and what you can do about it if you have one? Finally, Cynthia asks Trisha some of the most common questions her clients ask: How can a provider tell how many centimeters dilated a laboring woman is, and is it really true that all women get to exactly ten centimeters?

Don't forget to see our chapter markers if you want to look for a specific question.

Thank you to all of our listeners who submitted questions for this month's Q&A - keep them coming. We love to hear from you!

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Between episodes, connect with us on Instagram @DownToBirthShow to see behind-the-scenes production clips and join the conversation by responding to our questions and polls related to pregnancy, childbirth and early motherhood. You can reach us at Contact@DownToBirthShow.com or call (802) 438-3696 (802-GET-DOWN). We are always happy to hear from our listeners and appreciate questions for our monthly Q&A episodes. To join our monthly newsletter, text "downtobirth" to 22828.

You can sign up for Cynthia's HypnoBirthing classes as well as online breastfeeding classes and weekly postpartum support groups run by Cynthia & Trisha at HypnoBirthing of Connecticut

Please remember we don’t provide medical advice, and to speak with your licensed medical provider related to all your healthcare matters. Thanks so much for joining in the conversation, and see you next week!

View Episode Transcript

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast.
Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

All right, Cynthia, we are back. And this question is for you. Alright, let's do it. Hello, ladies. I'm struggling with something and I wanted to get your input. My mother's expecting to be in the birthing room with me and my husband. My husband and I both have a good relationship with my mother, but we aren't sure that we're really comfortable with this idea. First, my husband is worried that she'll interfere or insert herself where he should be. He will ultimately do what I want, but I'm not sure how I feel about this either. My mother and I are very close and a part of me wants to give her the gift of seeing her grandchild's arrival. Do you have any suggestions as to what I can do?

I always find this to be a really interesting question. And I can already envision 95% of our listeners with their jaws dropped like you would have your mother They're in the birthing room. But yeah, for some people, they're in this exact situation. I've even had clients. I've had one client who had her mother in law in the birthing room. I mean, you never know who is right, for whom. But I've even had fathers in birthing rooms, and I've heard sisters in law. So I think there's always an interesting thing about mothers, though, I do think that they're very unique in this as we ponder these options. Well, first, I just want to point out that the language that to the woman who wrote in I just want to point out, the first thing that jumped out was that you said, My mother is expecting to be in the birthing room with me and my husband. I'm so curious about that. Because was she expecting to be in the birthing room just by virtue of your being pregnant and you're going to have a baby and she's expecting it because she's assuming that she will be there or is she expecting it because you've already invited her and now you're considering removing that invitation. I think of it's the Former, and she is just expecting it without having had a discussion with you. I think that's worth paying attention to because one of the next things I want to talk about is boundaries. How well does your mother respect your boundaries and your husband's boundaries, your husband already seems to be a little bit concerned about a boundary issue or he wouldn't have said that she'll somehow insert herself. And I do want to share a very interesting anecdote with you. I had a client who was very close with her own mother. And she had her mother come to the birthing room in the hospital, and she ended up having a very, very prolonged, but what turned out to be natural vaginal birth, no epidural nothing, and having a natural birth was of the utmost importance to this woman. And her mother knew that. And when the labor became prolonged, there was a period in which the mother was pulling the midwives into the hallway of the hospital saying I want you to put her on pitocin right now and speed this up.

Yeah, it's shocking, but I can understand you kind of can't blame the mother, she's mothers are always going to be thinking that they know what's best for their child, even though we know as grown adults that they certainly don't always know what is best for us. But to do that is certainly a crossing of boundaries. And I'm a little bit curious to see how the provider responded to that.

Oh, they came and told the birthing mother this is you know, if they couldn't control the mother, I don't think that's one of the cases in my opinion, like you can't blame the mother because I'm thinking, you know, this is this is this is a communication thing. But you know, when your daughter is a grown woman, you need to start respecting her as your emotional equal, and now this is your daughter's birth. This is her life event. And it's a privilege even for the mother to be there. It really is a privilege. She doesn't have to be there. She knew her daughter wanted a natural birth. She was taking the providers aside and trying to manipulate the situation against her daughter's own wishes. I thought that was just a great example of how severe this can go when you come from that generous place of but my mother wants to be there. Now, I don't know if I'll ever hear a story like that. Again, I think that was so extreme and shocking. I don't think I would. But what you can consider is, how would your mother handle it? If you're uncomfortable, if you do have a medical situation going on, I had to make this own decision with my mother who is by far the closest female to me. And I just recognized that our mother's love us in a way our partners do not. And if I had any indication of being uncomfortable or anything other than completely happy and relaxed, that worried look would show up on my mother's face in an instant. And then that worried look would mess with me because I'm so tied to how she feels emotionally. It's a very intense bond mother and daughter. I think some women can handle this together. And they think others cannot. My mother and I both recognized, why don't you stay a few feet away behind the closed door and be there the moment this baby is out, but let's protect you from whatever you think I'm experiencing and protects me from worrying about how you're doing, like me worried about my mother during my labor would have been a reality.

Yes, that is definitely not what a laboring woman needs to be worried about.

So this is the big question to ask, would your mother be in that room? For her sake? Or for your sake? That's it, you have your answer. Now, if she would be there for her sake, you really need to reconsider this. If she would be there for your sake because you're comforted by her because you feel better with her there because she'll take care of you in a way that you need her to. Then absolutely have your mother there. Once you make that decision to have your mother there, or by the way, a sister, a sibling, another parent and in law, a friend. It is extremely important, in my opinion, to go through your expectations of them. What are the boundaries going to look like? Right? Are they going to be quiet? Are they going to be talkative? Are they going to be vocal, your advocate Are they just going to physically touch you? Are they just going to run errands and get you things? It really has to be hammered out. And then I think it can be the best of all worlds. And I have to say, I would not discount your husband's reservations. This is his birth and his baby too. So it's very lovely of him to say, you're gonna make the ultimate decision. I think everyone around you should be saying that, that you make the ultimate decision. But if he has reservations, I would, I would really give that a lot of thought. Well, good luck with that.

I sometimes I feel I think it's really that's one of those things that like the answer truly is already there. Like it's, it's you know, you know, she she knows this this woman feeling like so many times people are thinking Oh, good. I have someone I can ask. They'll tell me what to do. And we're just like, yeah, luck to you. Because it's it's a very personal decision. How could we possibly know it? Write for some people as it is wrong for others. And none of these decisions have anything to do with how much you love your mother. You know, it's just it has nothing to do with your love for your mother. It has to do with what your needs are during the birth. So, yeah. All right, what's our next one? Let me look at this. Trisha, I've got one here. Are you ready for ready for me to write? I'm ready. This one says I'm past my due date. I hope that came in this week. And she's still pregnant. I was I passed my due date and my doctor suggested that she could strip my membranes. Is this an effective strategy for getting labor going? So let me just begin by explaining what stripping the membranes means. The membranes are the amniotic sac, and a provider can go into the vagina and actually into the cervix. If the cervix is already slightly dilated, and can use their fingers to gently pull the amniotic sac away from its attachment to the lower uterine segment. And in doing that, the body will actually release prostaglandins. And prostaglandins are one of the mechanisms that help our body get into labor. This technique can reduce the length of pregnancy by about two to five days. Just because it will generally shorten the duration of pregnancy, it doesn't mean that it will always put a woman into labor. So I know that sounds a little bit confusing, but basically, it means that your body must be already very near Yeah, into labor for this technique to work. And overall, it does seem to shorten pregnancies by a few days. There's a 20% increase in the likelihood of going into labor. That's it. So for some women, it's not going to have an impact because if the baby isn't anywhere close to ready, nothing will happen. But if she is close, it looks like it can kind of trip the process into happening and it shakes out to be about 20% At a time apparently, it's really a good technique for that woman whose provider is saying, it's time to get you on the induction schedule, and they're going to ask them to come in for our chemical induction, but the woman would like to try an alternative first. It is a very quick process. It's just a few swipes of the fingers. But those few swipes can be uncomfortable for women. And then sometimes it does cause uterine irritability for hours, sometimes even days afterwards. There are a few contraindications for it. But for the most part, it is a good option for women who are close to term and hoping to avoid a chemical induction.

So just one more note on this that if you're going to have your membranes stripped, you should be consenting to it. And if you are consenting to a vaginal exam, you may inadvertently be opening up that possibility that they just might go strip your membranes without your knowledge. So just be aware that that is a conversation out there.

That's a really good point about informed consent because it is really all too easy when you go in for a visit to your provider and they do a digital vaginal exam. And they suggest, well, we could just rip your membranes but premature rupture of the membranes does potentially put you at risk of other complications in the labor process.

Yeah, this always comes down to consent. We have one here that is a postpartum question related to the baby. It says my baby is 14 days old and losing weight. His pediatrician told me that I need to start supplementing with formula. I've been exclusively breastfeeding since he was born and really don't want to use formula. What can I do? And what if he refuses to take my breasts meaning after the formula is introduced, I assume?

Yes, I think that's the concern that after giving the baby formula in a bottle that the baby will then refuse the breast. So this is always a tough situation. I've seen it a lot of times and It is very difficult for mothers who are fully committed to breastfeeding to even consider the use of formula. But I will say this, if the baby is 14 days old and losing weight, then the breastfeeding relationship is already compromised and introducing formula or any form of supplemental milk, whether that's donated milk or if you have happened to have pumped milk for some reason. That is what you are going to need to introduce to your baby in order to catch them up on their weight, I say.

And the reason I say catch your baby up on their weight is that in order for a breastfeeding relationship to work, supply and demand have to be in sync. And if a baby is underweight, that means that they're under feeding. And if they're under feeding, that means that they are actually sending the message to your breast into your body that says I don't need as much milk as you can make right And therefore they're going to under feed and grow more slowly. And that process if it goes unchecked and goes on for too long can actually be the reason and often is the reason that women end up not being able to breastfeed for the long term. Right. So the reason that the pediatrician is recommending formula is because most likely This is a supply issue. Now there are cases where it could be some other reason that the baby's just not feeding frequently enough, but the milk supply is still plenty adequate. So if you feel that you can pump enough milk to sufficiently supplement the baby with the additional the additional answers that your baby needs then then that would work too. But generally this happens in an under supply situation, and we need to catch the baby up with supplemental or donated milk while we stimulate the breast to increase the milk volume and get supply and demand back contract, and then we can go back to just regular breastfeed. So then like, what do you do you just have to focus on pumping a little extra or getting the baby to the breast more often to get supply and demand back and sink or is it just a done deal by then?

So no, it is definitely not a done deal. This is a situation where I would strongly recommend getting a lactation consultant involved because it is cumbersome and it can feel complicated and overwhelming and it can feel very discouraging and sometimes, you know, emotionally draining. So having the support of a professional lactation consultant who can help coach you through and guide you. And regular weight checks will also be really important. Yeah, this plan is all about preserving the breastfeeding relationship with your baby and trying to get back to that as quickly as possible through the ketchup weight process. And while you're on this plan, you are definitely still breastfeeding and spending as much time skin to skin as possible.

Can you respond to the last part of her question where she says What if he refuses to take my breast? Yes, absolutely. Thank you for bring me back to that part of the question. It can happen, but I will tell you that it is almost always about flow.

So the reality is that your baby definitely prefers your breast and the warmth of your body and the texture of your skin over the silicone nipple. However, when they are underweight, they will prefer to feed wherever the flow is faster. And if your milk supply is compromised in your and your flow is slower because you are producing less milk, then they're going to prefer the bottle for a period of time. As soon as your baby's weight is caught up and your breast milk supply is also caught up and your flow increases at your breast. At that point, you should be able to go back and forth between bottle and breast without any difficulty.

So I really encourage women to think about this as not a preference for a breast or bottle but simply a flow preference. So once you get that flow back up to speed, you should be able to get the baby back to the breast the weight will be cut up and hopefully everything will be a lot easier from then on and your breastfeeding relationship with your baby will be able to last for a very long time. So I'm glad you brought it on this question and I hope that you get started right away on a plan and it is most definitely not too late.

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I am preparing for my second child this fall and I am interested in taking the HypnoBirthing series for the first time, I took the Bradley method classes for my first birth, and I found them helpful and was able to have an unmedicated vaginal birth. How can HypnoBirthing  build upon my existing knowledge and further prepare me to have another good experience the second time around?

I always crack up at the word unmedicated because it makes medicated the default rather than natural and it's like the word uncircumcised rather than using the word intact. It's like as if circumcised is the default how we're all born and then it's like, this one is uncircumcised. Right. So I think the whole episode on language this is a great example of that. Yeah, I can speak to this. I get this question a lot. And I hope I do right by Bradley, in my response. I think I will, and I certainly hope to. So first, I am a certified HypnoBirthing instructor and I have I'm an expert in this method. I've taught thousands of people and I, I've been doing this for many years, and I've studied it far beyond my basic credentials. So I have a lot of experience and knowledge with HypnoBirthing. With the Bradley method, my experience is only as follows basically, a when I was pregnant with my son before I read and took the HypnoBirthing class, I read the complete Bradley method book, and then be in all these years that I've been serving clients. I have had many women exactly like this one who said they took the Before the first baby had a natural birth in most cases, and then wanted to take HypnoBirthing for the second, I have never heard anything negative about Bradley, I think all of these methods are doing a wonderful job. We're all interested in evidence based birth. We're all here to tell women their rights.

We're all here to serve women and to make them the focus of this experience. So I'm thrilled with all of the methods that are out there. HypnoBirthing is unique. And I think it is currently getting so much press and attention in the media because of just the way that it seems humans are evolving in their interests these days when it comes to mind body and everything like that, because HypnoBirthing is very Mind Body centric, but let me give a few distinctions between the two that I'm aware of. One is that the Bradley class is significantly longer. It is a 12 week class. HypnoBirthing is a 12 hour class. It's about four weeks. Another distinction is that the Bradley method Has homework in the program. HypnoBirthing by definition will never include homework because what mammal out there roaming the earth is preparing for childbirth by studying or learning anything on a conscious level. So HypnoBirthing is about getting in tune with what we know you already have and no, on an unconscious level, just like you unconsciously from the moment you were born, we're going to be perfectly capable of going to the bathroom and having sex and, and having babies like all the things that humans do. So we don't want to keep you in your conscious mind. We want to get you away from that. And imagine if you had a homework assignment and didn't do well on it, and then God forbid, concluded you're not ready to give birth when that has absolutely nothing to do with giving birth. So the duration of the course is different. The fact that HypnoBirthing does not ever have homework is different. And now let's talk for a moment about your Partners, Bradley has historically been referred to as husband coached childbirth, I think that started in the 70s. I don't know if they're, they've modified it lately, I would imagine hopefully they have, but husband to coach. So let's just set aside the word husband, first of all, which already is not appropriate for so many couples. Coach is, is a big difference between the philosophies. In HypnoBirthing, no one is going to coach you through childbirth. It is a mother led class. Imagine holding a yoga pose and someone coming up next to you and telling you how to breathe and how distracting that might be when you're in your flow. When you're just in your body. You're in your breath, and you're focusing. So in HypnoBirthing, no one is there to coach you, your partner. If you have a partner, you're fine if you don't have a partner in HypnoBirthing, but if you have a partner, their job is to take care of everything outside of you to make sure that room is treating you with respect that it's peaceful. It's quiet, that you are allowed to go within and birth your baby. But it is not about the partner ever telling you to breathe, telling you how to breathe, timing things and asking you questions or, or yelling, push or saying push or telling you how to push. So that approach is also very different. This is a program that emphasizes, I think the intention is emphasize a deep self trust. That said, I think Bradley accomplishes that very well. Also just in a in a different way. And then the only other distinction that I'm aware of, is that Bradley talked a lot about pain management. And that doesn't resonate for everyone and some people feel comforted by that. But in HypnoBirthing, we don't even talk about pain. We don't use the word pain. Whatever we feel in childbirth, we can learn to interpret in a different way like oh, I had such a crappy feeling or I had this this backache with every single surge. surge right there. That's a word that's that's HypnoBirthing we don't say contraction, we say surge lifting arising. So the language between the two programs is different as well. But Honest to God, I don't think you can go wrong. I think they're both excellent programs. I think it's a matter of just finding a good instructor, whatever you do, and making sure the philosophy of the approach resonates with you. There is not a bad decision to be made here. And kudos to you to even be educating yourself and preparing because that is the bottom line, and that's definitely going to benefit you.

That is an excellent explanation of the differences between the courses. But I am curious about the bookwork aspect in Bradley, I feel that there's a lot of sort of the basics of pregnancy, the stages of pregnancy, what to expect. Do you do a whole lot of that in HypnoBirthing as well?

Nope, that is exactly what we're trying to get away from in HypnoBirthing. But it's very much about how do you focus how to use your mind how to use your breath. And your physiology to get through any difficult moment in life or whether it's difficult or easy how to get through any moment in life. So what do you learn to visualize what language is going to be used around you? there That said, it's a very practical class as well, like there's a detailed walking through all of the options in your birth plan and all of the ways to like, you know, we talked about induction and membranes releasing and what if it's Group B strep? And what if it's preeclampsia, right, educating yourself on how to make informed choices, as opposed to just getting the basic nitty gritty of pregnancy stages and things of that nature?

Absolutely. Yeah, there's absolutely none of that in HypnoBirthing. And I challenge my clients a lot because I think I mentioned this in one of our podcast episodes, but I like to play around with them a little bit, too, because, you know, we all hear the comedian's telling their jokes about like, Oh, well, you don't have to give birth to something the size of a watermelon and everyone likes to laugh about these things. But then it scares women into thinking well, how does something this big Come out of something this tiny and sometimes I explain it to people like well this is what happens the baby touches the parent em and there's a surge of relax and then the parent am suddenly yield. It's been waiting its whole life, its whole life. It's its whole life to yield when there was a baby's head there and the vast majority of women absolutely did not tear when they choose their own position for birthing. But after I explained it to my clients, I like to say, Did you really need to know now? Like, could you have just trusted that we're here? after hundreds of thousands of years like we're here for a reason. This has always been meant to be safe. It's always been meant to be with the intention of your survival and your baby survival. Like it's nice and comforting to be like, oh, cool, so Okay, so that's why my parents mom can yield to something the size of a head but did we have to know or could we have just simply trusted could we had just trust it.

Unfortunately, we've been taught that it is not safe and that it is unnatural, and that it does require intervention or that it may not go the way it's supposed to. So it's really almost like we have to go through this unlearning process.

That's exactly right. The language I usually use is where restoring you to what you already do know on a cellular level. But it is an unlearning. And I'm this is why it's changed my life. I'm a classic person who loves an explanation for things I love to study. I would have loved homework and a childbirth class that was like right up my alley, like give me the homework. I'll provide beautiful homework assignments every week if you want me to. But there was some, I think, inner wisdom in me that was practicing yoga for years that kind of recognized, maybe I need to get away from this part of me and just trust that it will go well and now that I'm going to trust it, how do I facilitate it and then the challenge and for me, the emotional growth was in the trust in the letting go, not which is count which is like counter to everything I had ever done in my life up until then, which is all about studying and tests and learning, and this is like, no, you're gonna let go of your, your need to do that. And you're gonna just trust that this is how the process goes. And yes, fortunately, there's the component of the class that teaches like, well, what if this does go off course? What if this doesn't go? Well? What do we do then? What questions you asked, what are your rights? When do you really need medical intervention? As opposed to when you probably don't? So that that does get addressed Of course, as well. So, yeah, all right, Trisha, I can't even pronounce this word Cisco seal. Exactly. Yes, that is it.

All right. The question is, I don't have any issues related to sex, but my midwife did tell me that I do have a sister seal, which I guess is bladder prolapse. I definitely don't notice it unless I jog or jump and I have trouble with holding in my piece. Sometimes. My midwife recommended that I try keigo weights so I bought a set that came with great reviews. But I have no trouble with even the heaviest weight. So I'm wondering if you have a recommendation on what I should do next. So the fact that you're experiencing some amount of urine leaking with jogging, jumping, or probably even when you sneeze is definitely not uncommon for women after having had childbirth. However, it is something that should resolve on its own as the pelvic floor muscles regain their strength, so if it hasn't, and I don't know exactly how far out postpartum you are, but I would say that that is something that would require a pelvic floor therapist to discuss with you and see if there's some additional things that you can do. As far as the system seal goes, assisted seal is a basically a protrusion or a pushing of the bladder into the anterior vaginal wall. There are degrees of severity of it so you can have a very, very mild Cecile that you know you sometimes have just after birth and itself resolved Or you can have much larger degrees of it that can become much more complicating, but a lot of it has to do with pelvic floor. laxity, meaning weak muscles in the pelvic floor. So everything about improving it is related to strengthening the pelvic floor. And what if it's just really severe.

In the more severe cases of assisted seal, sometimes you have to actually have surgery or take hormones or use something called a pessary. But none of that sounds like what we're dealing with here. This just sounds like a case of mild Cecile related to childbirth. And as those pelvic floor muscles get worked on and strengthened, it should resolve if other symptoms develop. Or this isn't resolving with the Kiko weight exercises. As I said, pelvic floor therapy is definitely the next best step.

Okay. Trisha, I told you I wanted to surprise you with the question that I get all the time that only a midwife for obstetrician can answer. But how can you tell what a woman How can you tell how dilated a woman is?

You mean without doing a vaginal exam?

No, I don't mean that. Oh, it's all art. Right? Okay. Well, sure. There's a little bit of science to it. But yes, a lot of art to it. But the reason I said without doing a vaginal exam is because there are actually ways that you can gauge cervical dilation without doing a vaginal exam, that purplish line that appears on the lower back.

Yeah, so it's not really always very accurate. But yes, the line on the low back can give you a little bit of a gauge. And also, in the, you know, after you've watched enough women go through waiver, you can get a pretty good sense of where a woman is in labor just by her behavior, especially if they're in transition, which is the eight to 10 centimeter timeframe. There are some very clear signs that women exhibit when they're in this stage of labor, but as
far as it goes for measuring the cervix digitally. It's done with two fingers inserted into the vagina and you reach your fingers all the way up into the cervix using your pointer finger and your middle finger. For most practitioners the the 10 centimeter mark is basically about as far apart as you can spread those two fingers for people with smaller hands they may only be able to get to nine centimeters so you know that your tendency in 10 centimeters if you go past the width that you can actually spread your fingers so digital not meaning technology yes

yes exactly digital meeting your finger definitely not technology actually it's surprising that nobody's come up with that kind of tool yet.

Yeah, everyone please don't try to use your iPhones for this. I mean, it really is a skill that you develop over time. I can recall in school, measuring a woman's cervix and thinking she was like five centimeters in my Professor or preceptor would come in and be like, nope, try seven, seven and a half. And, you know, you just you learn I think probably most providers would agree with me that the the distance between like four and seven centimeters is the hardest under four, especially under three easy peasy. And you know, after eight to 10, that's easy. Like everybody can kind of get that that right. One thing that blows people's minds apparently is how can it be that all women of all shapes and sizes around the world all get to 10? Are there women I've always heard nine and a half or 10. But are there women who like get to eight and a half and they're ready to have the baby and women who go to 11 not to make a spinal tap reference.

Cervical dilation is not just about the opening of the cervix, it also has to thin out and a face. So there are actually three variables that we're looking at in cervical dilation. So you have the openness, the thickness, and the length. the cervix. Now before it can be really opening, you have to the thickness has to go away and the length has to shorten. So you're looking at all those things when you're assessing where a woman is in labor, but the most important piece of it is that full dilation is the absence of the cervix is fully open to silly bend, and fully shortened and measuring it is an art based so yes, it definitely is an art but it also has a methodology and very, you know, clear measurements to evaluating it.

And it all makes you wonder like, why are we even up inside of there anyway? Who are we serving?

Well, you're exactly right about that.

But only do we need to be measuring the cervix if we're having the expectation that a woman is supposed to dilate a certain amount in a certain amount of time. Otherwise, we can simply go based on signs of transition and urge to push and you know, baby's head being visible. With the parent I am  the questions only a midwife comm answer. Thank you Trisha. That was great information and thank you to everyone who wrote into us this week. We appreciate it so much. We always love to hear from you at down to earth show on Instagram. Call us 802-438-3696 and we will see you next time.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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