“How to know if someone is fully dilated?” : The Limitations of this Question

Let’s shift that question as many people trying to reduce vaginal exams are already thinking outside of the box.  The cervix-centered approach can sometimes be helpful, but honestly, it usually isn’t about the cervix, it is about the baby.  Let’s be honest with ourselves. Believe it or not, care provider paradigms don’t always strive towards holistic information. 

What are you looking to understand anyways?    

Do you want to know if “you can push”?  Do you want to know “if you are progressing”?  Do you want to know where the baby might be in the pelvis? We may not get information from a cervical-centered paradigm to answer these questions.  We have discussions of tracking dilation but let’s be clear that it isn’t just about dilation. 

If you want to do something different, we can ask different questions.   

The cervix is a doorway.  It is a portal in which people can assess and measure. Until the baby is actually coming through, it may not indicate much at all.  Ok, yes, the door can open, but is the baby coming through.  Don’t blame the cervix if it is not.  See, the door seems to be working in this video.  We can pull it open further as well but my daughter is not encouraged to come faster at the moment. 

This door even when partially closed could open if someone chooses to come into the house. As the baby applies direct contact to the cervix, the door will swing forward and open. 

Actually this could also be the sac against the cervix acting as a dilating wedge and could be reflected in all of the external signs as well. The sac came through the door but then once it popped the baby may or may not be directly behind it.  Once that sac breaks there could be different things that occur: 1) “cervical regression;” 2) application of the head directly on the cervix taking its place and resulting in more pressure.  That purple or many shades of brown or dark pink line we are watching might change and be shorter than it was!  That bum shape might change as well!  The pressure to push might disappear for a short while!  

This is basic physics.  Something bulky or bulging in the pelvis gives pressure from inside and we see those changes externally whether it is the bulging bag of waters or the head of the baby.  

Someone can be fully dilated with an exam and the head can be quite high. There is a bigger picture than just what presents.  As people are trying to reduce exams, lets not stay confined to the hole (cervical centric paradigm), but at least look to the whole baby and the signs of the relationship to the Birthgiver’s body.

So, yes, the list of “if someone is complete” can be an opportunity to refine the question.  How do we know if the baby is coming soon?

  1. Urge to push that doesn’t go away (and have been motivated by someone from inside and not other’s haphazard suggestions).
  2. Heart tones typically have moved to the center above the pubic bone and have gotten quite low.
  3. The sound of the pushes are deeper and sustained naturally (when higher there may be fleeting small pushes followed by none at all). 
  4. The purple or all shades of brown and red line showing that there is fullness behind the butt cheeks spreading them out from the pressure within that comes along with or after the sacrum bulging (rhombus of michaelis). 
  5. Anal flowering with possible poop preceding the baby as it irons its passageway. 
  6. The baby’s head crowns or the water sac crowns, breaks, there is a pause and then another building of pressure soon following. 
  7. There has been an active laboring that has built up over time to someone possibly taking a break with a build up of pressure and intensity and becoming slightly more alert following to the point of undeniable urges to push (with no one asking about if that is what they are feeling).
  8. There could be a full on fetal ejection reflex.
  9. You see the head and the bulging of the perineum. 

The whole instead of the hole is where our inquiries derive.  Anatomy is relationship.  The cervix is connected to other structures.  The baby has a head but it also has shoulders and arms.