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  • Stephanie Flynn

Dilatation - everyone is obsessed!!

Updated: Mar 15, 2019




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Vaginal examinations (VEs) - we are all so obsessed with how many centimetres the cervix is!!


The chances are if you ring family members and say that your partner is in labour one of the first questions asked will be "how many centimetres is she?"


VEs are something you will be offered during labour, but in fact, aren’t a required part of giving birth and like all else, in pregnancy and labour the final decision lies with YOU.


What’s involved?


VEs are often done with you lay on your back (although they are possible in most positions) and a trained health care professional (midwife, doctor) insert two fingers into your vagina and feel for your cervix. This gives them a snapshot of what your cervix is doing at that given time.


They can identify many things, more than just how dilated your cervix is.


The position of the cervix and how it feels


The presentation and position of the baby


If something isn't quite right eg if the vagina is hot and dry it could be a sign of a prolonged or obstructed labour.


But it isn't a predictive tool, for example, it won't tell them what your cervix will be doing in an hours time!!


There are times where a vaginal examination is a helpful tool, and times when it can potentially do more harm than good. Therefore they may be something you want to think about before the birth of your baby.


Three main options


I would prefer to have no vaginal examinations


I am happy to have vaginal examinations when clinically indicated


I am happy to have routine vaginal examinations (usually every 4 hours)


What is important to consider is the impact both the process of being examined and the information gained will have on your labour. For example, if you find laying on your back uncomfortable and the examination itself not very ‘relaxing’ this may trigger adrenalin, which in turn can impact the physiological process of birth. If you are told a number you don't want to hear, what may that do to your emotions? (this can work both ways of course.)


What are the alternatives?


The dilatation of a cervix by any method has limited value, due to the fact that its not a linear rate. There are a number of other possible ways to estimate how labour is progressing.


Watch and wait - whilst every woman labours differently, if watched closely there will be telltale signs of how her labour is progressing.


The purple line - In some women (not all) a purplish line will be visible from her anus up between her buttocks. It is thought that each centimetre of the purple line reflects how many centimetres the cervix is dilated.


Hot legs - as labour advances it is thought that the uterus draws more blood away from the outer extremities ie legs. This can lead to her legs getting progressively colder from the foot to her knee.


Some food for thought?


Something to consider when writing your birth plan?


Further reading


From the AIMS Journal: http://aims.org.uk/Journal/Vol22No1/VEsDiagnostic.htm

http://midwifethinking.com/2011/09/14/the-assessment-of-progress/

https://midwifethinking.com/2015/05/02/vaginal-examinations-a-symptom-of-a-cervix-centric-birth-culture/

https://www.rcm.org.uk/sites/default/files/Assessing%20Progress%20in%20Labour.pdf



Steph x

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