With Halloween last week a picture of a pumpkin display in a maternity unit supposedly showing varying cervical dilation sizes went viral. It was meant to be a laugh, but a woman commented under one ‘This is scary.’ And I don’t blame her, especially as the picture of 10cm aperture looked much bigger than 10cm.
Over the years there have been various depictions of progress of dilation of the cervix from 1cm to 10cm: as fruit, flowers, and food stuffs. But do you need to know this? Are these pictures helpful? Or do they feed the fear, and fantasy, of our modern Western portrayal of birth as mechanistic and difficult?
1. Talking about labour and birth in terms of centimetres dilated is a patriarchal, mechanistic approach, which puts the value of measuring birth from the outside, and therefore the knowledge of the care provider, over the internal knowledge of the woman in labour. It detracts from, and diminishes what is going on inside.
2. Dilation is only a small part of what happens in labour. However, as this is one of the few elements of birth that can be measured, its importance has been elevated above other elements, and beyond its actual relevance.
3. Women don’t dilate in equal increments. Showing dilation in incremental stages adds to the misconception that dilation is linear and even. Women can be in labour for twelve hours and be 4cm, and yet 30 minutes later be 10cm, or still take another day or two. The idea that women ‘should’ dilate 1cm per hour has been totally debunked. However many obstetric units still have a fixation on linear progress, even if this has now been stretched to 0.5cm per hour. Often this fixation on measuring labour progress by dilation, is not matched by any action to support increasing dilation, such as dimming the lights, offering reassurance, aromatherapy, or recommending getting in water. (Interestingly, while many UK hospital trusts have guidelines recommending women should not use a birth pool if labour progess is slow, Michel Odent actually introduced birth pools as an intervention to help stalled labours.)
4. Measuring dilation is not an exact science. No one puts a ruler next to your cervix. Midwives and doctors get better by practise but there is room for error, especially between practitioners.
5. Not all cervixes are the same, obviously. Not all baby’s heads are the same size. The idea that you need to get to 10cm is an approximation. A nice round number.
6. Knowing how dilated you are at any one time is no indication of what will happen next. The cervix is not a crystal ball! And dilation can decrease as well as increase.
7. You don’t need to know what 10cm looks like to dilate. Dilating is an involuntary bodily function. If you like to visualise your body opening up, that’s fab, but no need to imagine a certain size or number.
8. Measurement leads to feelings of failure. Showing gradations of size, is like a sliding scale of progress, that can leave women feeling like they failed to make the grade, rather than their body just needed help, or that they were failed by a system that is not set up to provide an environment to meet the basic needs of a woman in labour: dark, private, and full of love and reassurance.
9. Talking about 10cm can be fear provoking. It encourages women to look at their bodies from the outside, rather than reassuring them that their body carries within it knowledge from thousands of years of human evolution. It can and does stretch as much as it needs to, and the baby’s head is designed to mould and shape to fit through the cervix, the vagina, and the perineum.
10. Ten centimetres isn’t that big, certainly not as big as the hole in the pumpkin in the viral picture. Ten centimetre is the length of a very short charging cable (see my picture). Oh no, now I’m doing it! See how easy it is to start comparing and sharing.
I loved reading an article about a midwife on placement in an African country. The women at the rural hospital laboured outside, only going into the labour ward when pushing. The midwife asked them how the midwives know the women is actually in established labour. ‘When we can see the baby’s head.’, was the reply she received. (I’m looking for the link to reference and will add it when I do.)
There is no research to show that having regular routine vaginal examinations in labour improves outcomes. More on this in another blog post!
So I urge birth workers to refrain from sharing posts showing dilation increments, no matter how funny, and women to tune out any they come across. Tune into your inherited knowledge of what to do, just like cats, dogs and elephants. The human race would not be here today if our bodies didn’t stretch and do what is needed most of the time. Learn about the hormones of labour and what you can do to put yourself in the best position for labour to go as well as possible, which includes considering turning down routine vaginal examinations. Practise listening to your instincts. What do you need right now? Drink? Toilet? Move about? Release tension in your jaw?
In our modern Western culture birth is generally talked about in terms of what can be measured from the outside (centimetres dilated, length and timing of contractions), but this is a very limited knowledge base. By using this language we limit knowledge and education of birthing women/men, partners, midwives, and doctors. Giving birth is so much more than this. Women in labour have a far greater access to information about what is going on, and what they need for labour to move on.
So forget about the measurements, and listen to your body.