labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Wednesday, July 11, 2007

Childbirth Ed Series Redux

The following is a Life and Times original. I am reposting the original posts of the Childbirth Education Series. Enjoy!

Childbirth Education, Labor Nurse Style: The Introduction

I have several different types of readers: mom's, moms-to-be, nurses, lurkers of undetermined classification, and my family (I think my biggest fans). Oh, and let's not forget the enema crowd. My plan is to gear this childbirth education series to everyone. My purpose is to help the moms-to-be make educated choices regarding their pregnancy, childbirth, and postpartum periods as well as help everyone else understand the process. There is a lot to cover but I will break it down into small chunks of info so that it is not quite as overwhelming. I hope to post weekly on this series, but don't hold me to it. I have shitloads of school work that requires a lot of my time.
So why should you bother being one of my childbirth ed students? Because I am going to tell you how it is straight up. No bull shit. No hospital agenda, not what your doctor wants you to know (ie, how to be a good patient, essentially). Because the majority of women give birth in hospitals I am focusing on that type of birth but much of what I discuss can be applied to out of hospital births. And besides, I have been in this type of nursing for a while now.
And so to begin, I am going to give you the terminology you will be reading throughout this series. I realize that many already know or have a general idea of these words, but I can't assume that every one does. So here we go....

Terminology, Part One

Uterus: this is a large muscle that houses the fetus and the placenta. Before pregnancy the uterus is approximately 2 inches big and weighs about 2 ounces. It sits just behind and below the pubic bone. The uterus typically tilts towards the front of the abdomen, so in other words the top portion leans a bit forward. Some women have normal variations in how the uterus sits within the pelvic cavity, none of which I have seen as being a problem for getting pregnant or with fetal growth. Common variations are retroverted (tipped towards the butt) and retroflexed (tipped towards the butt and slightly folded over). I have read in obstetrical textbooks that a non-anteverted uterus may become stuck in the pelvic cavity, but I have not personally encountered this in practice.

Photo Sharing and Video Hosting at Photobucket

The uterus has several parts. The part you will hear discussed the most is the fundus. The fundus is the top of the uterus. It is the strongest part of the uterus and contractions originate in this section. During labor the nurse, nurse midwife, and/or physician will place their hand on your abdomen where the fundus lies beneath. It helps them assess the strength of the labor contractions, and after birth it helps to assess the tone of the uterus. The muscle tone of the uterus after birth is important because a contracted uterus keeps the mom from bleeding too heavily. You'll hear your fundus being called either "firm" (this is good) or "boggy" (not good). When a uterus is boggy, the nurse or other provider at your delivery will give constant uterus massage... and no, it isn't like getting a back massage.
The body of the uterus is the area that houses the fetus and placenta. Just below the body of a pregnant uterus is the lower uterine segment where c-section incisions are made. Then follows the cervix.
Oh, and by the end of your pregnancy the uterus will weigh several pounds and be almost 16 inches long (40 centimeters) which reaches just below the rib cage.

Cervix: this is the doorway from the uterus into the vagina. The cervix must do two things in order for a baby to leave the uterus for the big bad world on the other side. But more on that in a second.
Almost as soon as conception occurs, the mucous plug is formed. The mucous plug in the cervix provides protection against any bacteria, virus, other other forgein substance from getting into the uterus. We'll talk more about the infamous mucous plug later...of which provides no indication for when labor occurs when it "falls out". And no, it doesn't come out looking like a cork.
So the two things will happen to your cervix during labor: dilation (sometimes called/written as dilatation) and effacement. Dilation is the opening of the cervix that is measured in centimeters. Pushing begins at 10 centimeters. Effacement is the thinning of the cervix. This is measured in percentage. Effacement is probably one of the more difficult concepts for one to understand, but I will try my best to explain.
Prior to labor, the cervix measures approximately 3-4 centimeters in length. So during labor that length is shortened. So if you are told that you are 50% effaced that means the cervix is about 1.5 - 2 centimeters long. 100% effaced means the cervix has no length left to it at all... it's like looking at the edge of a piece of paper.

Photo Sharing and Video Hosting at Photobucket

In a women having her first child, effacement is completed before complete dilation (10 cm). In a woman having subsequent children the dilation and effacement occur almost simultaneously.

Perineum: this is an area that is steeped in controversy. How so, you ask? Because this is the area an episiotomy is performed, and the area some like to massage during labor. I will get into that stuff later.
Photo Sharing and Video Hosting at Photobucket

Literally, it is the space between the vaginal and anal openings.
If you have any questions, ask me in the comments section. That way I can provide an answer for all to see.


Gatxan said...

I'm one of your every day lurkers and, with luck, a future mom to be... So, thanks a lot for these series! They are truly informative!

Tfny said...

How can I prepare this area before birth (perineum). I am due in 2 months and just read abou this tonite and kind of worried. Thanks

Labor Nurse said...

tfny, here is a link on how to perform perineal massage:

Perineal Massage in Pregnancy

Brandi said...

Hi! My name is Brandi and I am a student midwife and doula. I have a blog "The Belly Button Connection" and I was going to do an entry on dilation and came across your blog. From what I've read it's very good and informative. Good luck to you! :) Let me know where you teach. Maybe I can visit your "keep it real" classes one day.