Checking dilation without a vaginal exam

Yeah, this piqued my interest, too.

First, there are many reasons why it would be beneficial or helpful or preferable to be able to check your progress without having a vaginal exam. The most obvious is the discomfort of having someone (as I read on another blog) “search for my tonsils via my lady parts.” Also, vaginal exams increase the risk of infection if the water has broken — even when sterile gloves are used, there are bacteria on your body that get on the sterile gloves and then are given a free ride up to your cervix. Before sanitation (even simple hand-washing) was practiced by birth attendants, it was common for women to die of “childbed fever” due to germs being introduced directly into the uterus this way.

[As an aside, when you hear people decry modern homebirth because "women used to die all the time before they started having their babies in the hospital," you now know that the high maternal death rate was at least partially attributable to doctors' dirty hands infecting scores of women. It was common practice to teach medical students how to do vaginal exams by using cadavers -- dead women (who frequently were victims of childbed fever) -- and then to go down the hall to where women were laboring and without washing their hands, perform vaginal exams on them, directly introducing the germs from a dead person into the body of a living person.]

But another reason would be to assess where you are in your dilation so that you know when to go to the hospital (if you’re planning a hospital birth). A frequent concern of women is that they’ll go to the hospital (or call the midwife) too soon…. or else too late. In the first case, they may be turned away until they are dilated more; and in the second case, they may have a harrowing ride to the hospital with a white-knuckled husband fighting his way through traffic while she tries not to push.

On this thread at Midwifery and More, there are a few different ways mentioned, but the one I want to talk about most is one that Anne Frye wrote about in Holistic Midwifery, Vol. II, p. 376. Sarah Wallbaum mentioned it on our childbirth educators email list, and it intrigued me. Here’s how it works:

During a contraction and with mom on her back, determine how many fingerbreadths of space are between the fundus [top of the uterus] and xiphoid process [the triangular tip of the breastbone] at the height of a contraction.

5 fb = no dilation
4 fb = 2 cm
3 fb = 4 cm
2 fb = 6 cm
1 fb = 8 cm
0 fb = complete

She said that she has practiced this for accuracy with a midwife, and has both found it to be fairly accurate, but that if a mom is very obese, it would be difficult to use. Even if it just gives a “ballpark figure” it just feels empowering to me to be able to know this information without having somebody else’s hand stuck up inside me. Remember also, that the World Health Organization’s guidelines for Safe Motherhood says that vaginal exams should be kept to a strict minimum, and in the first stage of labor once every four hours should be enough (3.3).

Update: Here is another blog post that has other ways of checking dilation.

Updated again to add this link to an image of the xiphoid process method of estimating dilation.

And yet another update (7/27/10) for this link

Updated again to add this abstract (9/24/10): a study on the colored line that usually appears between a woman’s buttocks as she dilates

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26 Responses

  1. I told one of my doula clients about this, she was intrigued so we tried it during her birth. She had a vaginal exam and then we checked this way and it was accurate! Pretty cool. :)

  2. [...] mystery but it’s really not any more mysterious than picking your own nose! Have a look here and here The way that midwives measure dilatation is to insert two fingers and spread them apart so that [...]

  3. I have not used this method but I would love to try. I do not do many if any vaginal exams for my clients. I use another couple of signs. 1) as the woman progress the pigmentation of the labia changes along with the coloring between her bootom cheeks. When it becomes very dark she is complete. 2) I watch for the scoop of her back to disappear. As the baby secends the sacrum will push out.

    • Miriam,

      Thanks for the alternative methods — I’ve not heard of those before. Is this change in coloring the same for women of all ethnicities? — that even dark-skinned women will get darker?

  4. Have you heard about the method using the red line that extends on a woman’s back, upwards? I read about it in Davis’s “Heart and Hands” and am going to ask DH to check for it next time.

  5. Diana,

    I think the “red line” was mentioned in the “Midwifery and More” thread I linked to above. It sounds very familiar; although it’s been so long since I’ve read the original thread I can’t remember for sure. There were several different “external signs” on that thread, and I thought they were very interesting.

  6. That is so cool. My body tells me what’s going on, and the only reason for a VE is to confirm what you’re wondering. To have it be done without risking the closure of dilations is fantastic.
    I love my midwife, but not that way…

  7. Here are some more ways of checking dilation without a vaginal exam.

  8. there is a point on a womans heel that you can tell dilation from , i believe it is in polly blocks book , obstetrics for the home. i have used this trick for years and it is amazingly accurate.

  9. also , as soon as a finish this weeks work ill reply here also ,,, night work kills me lol lol

  10. [...] May 30, 2010 by Brandy Astwood Over at Woman to Woman CBE, Kathy Petersen has once again written a great post, this time on Checking dilation without a vaginal exam [...]

  11. [...] –oh there are a couple of awesome posts on checking dilation during labor without a vaginal exam.  lovely. this one… [...]

  12. kathy, did you find out about the heel technique? :)

    • No, I need to follow up with her. I think I had emailed her, but she said she was busy and would email me later. Guess I need to email her again. :-)

  13. let us know when you find out. i am curious :)

  14. [...] For the most part, I feel I “got” this – I think I was checked 3. Had things not been moving so fast, I would have asked about using other, less invasive, methods to check my progress. [...]

  15. My 2nd labour, I was 9cm dilated but baby wasn’t engaged. Would that affect the stomach reading?

  16. Hi, Kathy,

    I wanted to let you know that the link you have posted for me isn’t working. Since I am still being contacted about this post (amazing!), maybe you you could check it. This is the correct link: http://mamasara.com/Mamasara_Midwifery/Welcome.html
    Thank you! It’s wonderful to see how far reaching your blog is 3 years later!

  17. [...] is…. http://www.gentlebirth.org/archives/novagxms.html Finger breadth method (external): http://womantowomancbe.wordpress.com…-vaginal-exam/ (^ ^ ^ I can't wait to try that one next time! ) Check your own cervix? [...]

  18. [...] Dont know if this is much use but I just googled checking dilation without internals http://womantowomancbe.wordpress.com…-vaginal-exam/ [...]

  19. [...] are by seeing how many fingers fit between the bottom of the breastbone and the top of the uterus, http://womantowomancbe.wordpress.com…-vaginal-exam/ This lists external signs of established labour: [...]

  20. The source of this information is Molly Caliger. She’s an American midwife who ran The Russian Birth Project for many years and taught this and other Russian midwifery skills to midwifery students in Iowa. It appears in Anne Frye’s book but is incorrectly cited to someone else. I always meant to write Anne Frye about that, but wanted to share it here too. I learned it from the “master” herself and can attest that it’s a great tool to have especially with situations such as a ruptured bag. Thanks Molly, for sharing your wealth of knowledge and experience!

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