Saturday, May 4, 2013

Not One

     Claire had been woken up, the morning she turned 37 weeks, by the sensation of her water breaking.  The fluid was clear and the baby was moving well.  At the beginning of her pregnancy she had tested positive for GBS (group beta strep) in her urine, so she and her husband came in for an evaluation and a dose of IV antibiotics.  When they arrived, Claire was not yet having contractions.  Everything checked out good; her waters had definitely ruptured, the fluid was clear, baby and Mama were both doing great.  I started an IV and gave her a dose of penicillin.  Since she was not yet in labor I did not do a vaginal exam.  Claire and her husband then went back home to have some breakfast.  Four hours later, they returned to the birth center.  Again, everything checked out good and I gave Claire her next dose of antibiotics.  Because she was GBS positive, we talked about encouraging her labor to start.  Claire and her husband both agreed that they would like to get proactive.  I sent them home again, this time with some herbs.  I did not do a vaginal exam.

     Another four hours passed, Claire and her husband returned, and they were joined by their 5 year old son and Claire's mother.  It was obvious that things had shifted and Claire was starting to labor.  She was in that sweet foggy stage of early labor, when women seem to be floating above the world, mildly aware of what is going on around them.  I gave her the next dose of medicine and we all settled in.  In a short time Claire shifted again, moving into the active phase of labor.  It was lovely to watch.  She was supported wonderfully by her family and she easily let go to the process.  She moved well, walking around with the contractions and swaying with her husband.  Eventually, she asked to get in the birth pool.  Very shortly after sinking down into the water she began grunting at the top of her contractions and then proceeded to birth her sweet 7lb 2oz. baby boy into the world.

    And all of this without one single vaginal exam!  Of course, I think that is awesome.  A couple hours after the birth, Claire and I were talking about it.  She asked why I never did one and I told her that besides the fact that her waters were ruptured, I didn't need to do one.  It was clear that her labor was progressing and I did not want to disrupt the flow of that progress.  Claire said that during her labor, she briefly wondered why I wasn't checking her cervix but then reasoned that I knew what I was doing and let the thought pass.  It is important to remember that there are so many ways, other than a vaginal exam, to assess labor progression.  Sharp eyes, clear ears and an open heart are just as valuable.  What are some of those other signs to watch for as a woman labors?


  1. I'll try to start a discussion......
    Has anyone had any experience with using the "red line" to assess cervical dilation?.......

  2. Beautiful Aubre! What an ideal kind of birth. It must be so nice to simply employ your wisdom, intuition and 'hawks eye' while interfering as little as possible. Who knows how often strong labors are slowed even when checked by loving midwives in a comfortable birth center. It's a very animalistic experience and it would make that sense that the primal brain can't differentiate between a threat and a cervical check. Not to mention the increased risk for intrapartum fever/infection.

    I have heard many times of this infamous red line, but have never seen it personally. Do you check for one? Have you checked to see if they correspond with cervical dilation?

  3. I saw the red line while supporting my last client while she labored in the tub. I did not measure it, but could tell that she was near full dilation, because it was at the top of her bum. Very cool to see it first hand.

  4. I first heard about the red or sometimes purple line a few years ago, so I started looking for it...and low and behold it is often present. It is not always there and it can be pink, purple, brown or black; it depends on the Mama's skin color and tone. Here is an interesting study that was done in 2010:

  5. Aubre, I've been looking for the line on my clients and I've seen it a few times, it's hard to tell sometimes ;) Another sign is that birthy smell. Smells so unique and earthy! I love when vaginal exams don't happen as well. There are so many other signs. I feel like it's only necessary to do one if there is a decision to be made, ie mom has been laboring for a long time and considering augmentation or drugs, etc. Otherwise it does just interrupt the natural flow of things and get mom focused on numerical/sequential/left-brain stuff.

  6. Xiphoid check can also provide some insight - less comfortable, but more intentional while avoiding the infection risks of an internal exam... During a contraction, see how many finger breadths you can fit between the xiphoid process and the fundus. Each finger is good for about 2cm of dilation (so 5 fingers = 0 cm dilated, 4 fingers = 2cm dilated, 3 fingers = 4 cm dilated, and so on).

  7. Amy, yes the birth smell is deffinitely something to notice! I think that most of midwifery, there is atime and a place for everything. A vaginal exam is just one of the tools in the bag.

    Ellen, I am intrigued by this xiphoid check! I have never heard of it, I will start testing it out for sure. I can imagine that in relation to fetal station, but dilation as well?

    I also think that women have similar facial expressions and looks that correspond to the stages of labor...