The Female Pelvis
I think that most women assume that a Pelvic Exam is am important
part of Obstetrical care, but, some may wonder what type of information a
care giver gets during a Pelvic exam. If this is a first time exam, your caregiver
will, among other things, be assessing the size and shape of your pelvis,
because if you are pregnant, your child will soon be pushed through your pelvis.
Below, the 4 Pelvic shapes.
So, the first thing that your caregiver is going
to do, is to assess which type (Shape) is your Pelvis. The Gynecoid is by
far the most common type of Pelvis that most women have. Even if a women has
one of those 3 much rarer types of pelvises, because most women have very
adequate pelvises, they will still still be able to give birth normally. If
you happen to have a Platypelloid pelvis, chances are that your baby will
enter the world looking at your leg, rather then looking down! Then, the baby
will rotate 90 degrees and then he/she will come out ether looking down or
up! I only had 1 mom in 500 births who birthed that way! Other first time
pelvic assessments, your caregiver will measure or estimate the entrance &
exit front to back space called the Obstetric conjugate (9 Cm. min) and the
Sagittal pelvic outlet diameter (8.5 cm. min). The side to side pelvis space
is called the Transverse diameter (9 Cm. min). Those measurements are rather
conservative, & if your baby measures smaller then average, you should
have an easy delivery.
If the women is in labor, there is a LOT more
things to check!
- Engagement. If the women is in labor & the baby's head
will not Engage (enter) into the pelvic inlet, that's BAD News! You can guess
- Station. The presenting part, most often the baby's head
in relation to it's position in the Pelvis. A + or - according to how much
has entered the Obstetric conjugate (Pelvic inlet)
- Dilation. This refers to how much the Cervix has opened in
Centimeters (Cm.) 0 = No dilation, usually 10 = Full dilation allowing the
baby's head (Or butt if it is a Breech delivery) to pass out of the Uterus
into the Vagina.
- Labor Stage. 0-4 Cm. dilation = Latent Labor. 4 or more Cm.
dilation = Active Labor. If a women enters a hospital in Latent labor and
she is suffering a lot or very emotional, in most hospitals, she will soon
have her baby, but she may regret later that it was born with a knife!
- Effacement. This measurement not many women know about. Effacement
refers to the changes in the thickness of the Cervix. 0%=Very thick, like
when you pucker your lips. 100%=Paper thin! This usually goes with dilation.
- Vaginal discharge. The amount & type of discharge helps
to give an outside indication of labor progress. Blood and Mucus. Those 2
can give clues to how a labor is progressing, in combination with other signs.
- Facial Expressions. Like a discharge, this is another external
clue about how this women is progressing. A few old Midwifes don't do vaginal
checks, they can sit back in a chair and judge a labor very well ONLY with
- Verbal Expressions. Transition & pushing are usually
quite audible! Transition is a time of maximum pain, sometimes nausea, frustration
or just being "Freaked out!". Pushing may have grunting sounds,
because you feel like you are pushing out the biggest Poo you ever had!
- Rotation. Is the baby's head facing the mom's spine? Or looking
left or right? If not severe, it rarely causes a difficult labor.
- Inclination. This refers to the angle of presentation. Is
his/her chin against his/her chest? Or the opposite, Which we call a "Brow"
presentation. An inclined head can really stall or make a very long and difficult
labor, because an inclined head greatly affects the "Fit" through
- Mental state. An unstable in labor women can be a handful
for any hospital, but for a single Midwife, some may be totally unmanageable!
- General Physical condition. Obeast women can have High blood
pressure or Preeclampsia, both dangerous. Very thin women may not have enough
protein reserve to keep her Uterus working through a labor.
So, there it is. A LOT of things for a knowledgeable & responsible
Midwife to be responsible for. And, I did not mention anything about the health
of the baby! If a Midwife accepts to care for a pregnant women, she/he is then
LEGALLY responsible for 2 lives! I have been asked a few times to help a laboring
women by phone or text. Reread the above & you can easily understand how
impossible that is because I will be coaching a women with the possibility of
only one input, Audio! I hope that I have made it super clear about a women
on the phone or texting who after giving me some details asks me "How do
you think I am doing?"