Tuesday, April 26, 2011

When?

"Everyone wants to know when this baby is going to be born. My mother calls every hour and has been since week 36, now I am 38 weeks and I don't have a clue. No one at the doctor's office will say....."

Her mother wants to know? She wants to know because by thirty-six weeks every day is one day too long to still be pregnant. One feels like a whale, can't stand the thought of buying yet again another size up nursing bra and doesn't really care any more what is involved in getting rid of this very large impediment to walking, sleeping and staying sane.

Pregnant women often request a pelvic exam to determine cervical status. They have already been told that mucous plugs and Braxton-Hicks contractions and eating eggplant is not a sign nor guarantee of impending labor. Providers request pelvic exams to determine if the baby is positioned the way it appears on tummy check and if there is still a question, then that is confirmed with ultrasound. Patients have been told that we never know birth days for sure unless it's a C-Section or an induction.

Pelvic exams for dilation and effacement are subjective measurements that vary from provider to provider. Just like guestimating infant weight. One week Provider A says your cervix is dilated to 3 centimeters and the next week Provider B says two. The cervix hasn't gone backwards in progress, rather the providers have different sized hands.

Pelvic exams are usually uncomfortable in late pregnancy. They cause spotting and increased discharge and then patients have more concerns about impending labor. A pelvic exam may reveal a cervical dilation estimate at 2-3 centimeters, however women can live with a cervix that's partially effaced and dilated for weeks before they deliver.

An exam that reveals a cervix that's soft and beginning to dilate may bring joy to an expectant mother and her family and a whole lot of disappointment when the baby doesn't arrive the next day. Does that rival the disappointment of the thirty-nine weeker who is told that nothing is happening? I don't think so. And it's all meaningless anyway.

"All good things come to those who wait" isn't something that most pregnant women and their families find very informative, or comforting. Waiting patiently for a baby's birth day is not an easy thing. But it is the best way to answer that question: "when is that baby going to come?" You say "patience is as necessary for labor to begin as diapers are for babies." There is no way to predict, by a pelvic exam, anything other than what the cervix is "doing" that hour, that day.