Examination during Labor

September 07, 2008

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Examination during Labor

by Lisa Rodriguez, R.N. and Marjorie Greenfield, M.D.
reviewed by Marjorie Greenfield, M.D.

Near the end of pregnancy, many mothers-to-be wonder about patient-care procedures at their hospital or birth center as they try to imagine what labor will be like. While labor is unique for each woman, there are some relatively standard procedures and events that you are likely to experience, such as having the doctor or nurse perform internal examinations while you are in labor to see how much the cervix has changed.

Here is some information about how labor progress typically is assessed and what you can likely expect from that experience.

Will the exam be uncomfortable?
By the end of pregnancy, most moms-to-be have had at least one cervical exam, so you may already have a good idea of what it will feel like. Exams during labor are usually done with the patient lying on a bed, on her back, with knees bent and legs allowed to drop apart. Although prenatal exams often involve the use of stirrups, a woman who is in labor often can just rest her feet on the bed near her bottom.

As with any internal examination, taking slow deep breaths can help to relax the vaginal muscles. The more a woman is able to relax, the easier it is for her practitioner to reach the cervix, which may be located high up inside the vagina in early labor. Some women find the exam painful, while others find it merely uncomfortable. During labor, many mothers-to-be want to find out about their progress, so they may look forward to the exam in order to acquire this information, even if actually obtaining it is a bit unpleasant.

Common words: what they mean
Following is a list of definitions of some terms you may hear from your practitioner as she reports the changes in your cervical exam:

Cervical ripening. Early in labor, or even at a late prenatal visit, your practitioner may tell you that your cervix is ripe. This means that your cervix has softened (a cervix typically feels similar to a nose) and may be even somewhat dilated. Ripeness is a term sometimes used to indicate that your body is ready for labor.

Dilation is the width that the cervix is open. Dilation can begin before labor actually starts, or in early labor, and is measured in centimeters. For most deliveries, the cervix needs to dilate from zero (not dilated at all) to 10 centimeters (fully dilated) before pushing can begin and the baby delivered. This range is based on the fact that a full-term baby's head is about 10 centimeters across.

Effacement is the shortening, or thinning, of the cervix. Like dilation, it begins before or during early labor. Before effacement takes place, the cervix is like a long bottleneck, usually about 4 centimeters in length. As effacement takes place, the cervix then shortens, or effaces, pulling up into the uterus and becoming part of the lower uterine wall. Effacement may be measured in percentages, from zero percent (not effaced at all) to 100 percent, which describes a paper-thin cervix.

Station refers to how high the baby's head, or other presenting part, is in the pelvis. This information is important because practitioners need to get a sense of how far the baby has descended into the birth canal. Station is determined by feeling where the baby rests in relation to the ischial spines, the parts of the pelvic girdle that protrude slightly in toward the birth canal and can be felt inside the vagina by an experienced examiner.

Station is measured from minus 5 to plus 5. Minus 5 station means the baby is floating above the pelvis. Zero station means the baby has dropped or engaged well into the pelvis and that his head rests right at the level of the ischial spines. And plus 5 means the baby's head not only has come down past the ischial spines, but also is visible at the opening of the vagina (also known as crowning). While the principle is still the same, some practitioners use a scale of minus 3 to plus 3 instead of 5.

The cervix during the latent phase
Near the beginning of labor, cervical exams may be a bit more uncomfortable than they will be as labor progresses, because the practitioner may have to reach fairly high into the vagina to check the cervix. This often happens, in part, because the baby's head has not yet dropped deep into the pelvis, bringing the cervix closer to the vaginal opening. This is normal.

As labor advances, the cervix will move around to the front and become much more accessible, making the exams more comfortable. In the latent phase of labor, the cervix will typically dilate from zero to 4 centimeters so that the opening is about the size of a silver dollar. By the end of this phase, effacement is usually 100 percent.

The cervix during the active phase
Generally, when the cervix has dilated 4 to 5 centimeters, a woman is considered to be in active labor, and faster progress in terms of cervical dilation is typically made for each hour of contractions.

The cervix will continue to dilate to 10 centimeters. During this time, there may be a slight to moderate amount of bleeding from the cervix, called bloody show. The mother may start to feel more pelvic pressure and may even feel the urge to push as the baby moves lower into her pelvis. If she isn't fully dilated, it's important for her to resist the urge to push, because in some instances the cervix will tear.

This phase of labor also includes the transition phase, which typically begins when the cervix is 7 or 8 centimeters dilated and continues until 10 centimeters. When you reach complete dilation in your own labor, it will be time for the real action to begin--when you can begin to bear down and push out the little miracle you've been waiting so long to meet.


RELATED INFORMATION

			Phases of Labor
			The Birth of Your Baby
			Events of Labor
			Birth Procedures

Created October 04, 2001
Reviewed August 14, 2004

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