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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Assessing Dilation from External Signs

Well, I don't know about the land of "OZ" but I worked with a Scottish trained midwife who wasn't allowed to do internals, (she was eventually taught, but avoids them, doesn't feel "competent" at it, always had me do them, only when needed of course) and she would use the heartbeat method. In early labour take the heartbeat, mark an "x" where you hear it best. (works best with fetoscope over Doppler) You don't really have to mark the "x" but when first learning it helps. Do this as labour progresses. You will see the "x" marks start at the side, and up, and move down and more central as labour progresses. When we didn't see this happening, do an internal if you can't figure out why this is happening and how to fix it.

       o
x   
  x
     x
       x

When the x is central and well down, she is hitting transition. This method has helped me as I learned to avoid internals. It was easier as I learned more about the differences between multips and primips, and the "look" of a woman in active labour etc. The heartsound moving down gave me the indication that labour was progressing normally, there was no need for internal assessment.

Some more signs we look for:

About six cms -- the contraction pattern often changes, closer, stronger , longer; moms may feel pain lower than before. Look for a flushing over the cheekbones (almost ALWAYS there at six cms -- have no idea of the mechanism).

Near 8 cm -- step up in contractions again, may feel cold/hot, trembly; irritable and cranky, contractions often hang and double, mom may feel as if contraction doesn't leave before the next one begins - may complain of pain even without contractions; may feel nauseated, and may be sweaty.

near full -- more of the above, may say baby feels lower, may vomit breathing may change and become more ragged - sometimes with a "catch" in the middle, or mom may moan with breaths (as if the vocal cords are "getting in her way"), may feel pain or pressure in low back. FHTs are probably midline and very low by now. There may also be a visible "fullness" across the lower sacrum and you can see this grow during contractions. As she progresses, she may be sleepy between contractions and will wake up breathing HARD or hoarsely groaning. , may be a show (second show) or tiny trickle of blood, May say she needs to go the bathroom.(such a good sign!). May feel a little panicky and needs reassurance. ROM usually around now or soon.

beginning of second stage -- there may be a rest after a series of strong contractions; mom may have a long break, might sleep. and when she wakes pushing may come on very gradually with just a bit of breath holding at the peak of contraction, (she will often deny she is pushing) -- but she seems much more comfortable than before. She may continue to just lean on contractions as the pushing urge begins to grow... OR she may have sudden urge to push RIGHT NOW! And I always believe them[Grin]...