Midwife Matters

Pregnancy preparations, women's health, and care options

“Every Mother Needs A Midwife, And Some Women Need A Doctor, Too!”

An article from the Boston Globe “Call (Back) The Midwife” looks at midwifery today in the U.S. and how we need a cultural change to make birth normal and not high risk.  Read the article HERE.

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Be Like a Princess and Call the Midwife!!

130723150642-03-royal-baby-0723-horizontal-galleryPrincess Kate used midwives for the birth of the new little royal Princess Charlotte.  Read more about it here.

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Midwifery Benefits? Improved Outcomes For Moms Who See Midwives, Review Finds

A review that was just published by the Cochrane Library finds that regular midwifery care for the duration of pregnancy is associated with better outcomes for moms and their babies.

Read more here.


Is There A Natural Way to Induce Labor??

That is a good question!  Link here to see if any of the ideas you have heard really work.

Karin Marshall, CNM

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Take A Virtual Tour Of The Mother Baby Center At Abbott

Don’t have time for the real thing?  center_slideshow4

Now you can take a virtual tour of The Mother Baby Center at Abbott Northwestern Hospital.

Of course you can do both.  They offer tours every week.

Sign up for a free tour on-line or call 866-904-9962.


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Is My Cervix Ripe?

As providers we often refer to a cervix as ripe or not at the end of pregnancy.  To many women this can be confusing and frustrating.  What exactly do we mean when we say your cervix is not ripe?  Here is what we are checking for:

  • Typically a cervix is 3 to 5 centimeters long throughout a pregnancy.  As you get closer to the end of your pregnancy the cervix can start to thin out, or efface.  When we check your cervix we can feel how long it is from an exam.  If a cervix starts out at 4cm and is now 2cm that is called 50% effaced.  When the cx is completely thinned out, then it is 100% effaced.  How do we know exactly what your cervix was before…3cm, 4cm or 5cm?  We don’t, we make our best estimate.  That is often why you will get different numbers from different midwives.  Don’t worry, you are not going backwards like it may sound sometimes!
  • Next we check the position of your cervix.  It can be posterior (meaning far back in the vagina), mid position or anterior (easy to reach, close).   Everyone is different, but most women tend to be posterior or mid during pregnancy.  As the cervix effaces and gets more ready for labor it will ordinarily be easier to reach or more anterior than it had been.
  • A cervix during pregnancy is firm.  It should feel somewhat like touching the end of your nose.  A sign that your cervix is changing can be that it has gotten softer.  As pregnancy/labor advances the cervix usually becomes softer, sometimes almost mushy feeling.
  • We also check where the head of your baby is, more commonly referred to as the station.  If it is engaged in the pelvis that is a 0 station, its head is at the ischial spines of your pelvis, which is the narrowest part of your pelvic structure.  Above the spines means the head is not engaged in the pelvis and is measured in centimeters but with a negative sign in front of it.  If the fetal head is 2cm above the spines, then the station would be -2.  As you move closer to the pushing stage of labor the fetal head advances past the ischial spines and it is again measured in centimeters but with positive numbers.  An example would be the fetal head is at a +1 station.  At a +5-6 station you can see the head at the entrance (introitus) of the vagina.  Up until the end of pregnancy the baby should not be engaged in the pelvis.  When we refer to the baby as ballotable, it means we can move the baby up and down in the uterus.
  • Lastly we check the cervix for dilation.  During pregnancy the cervix is normally closed.  The last few weeks of pregnancy, especially if you have been pregnant before, the cervix can start to open or dilate.  This is not necessarily an indication that you will labor early.  Some women are dilated several centimeters weeks before they go into labor.

We put all of these assessments into a score called a Bishop score.  Each one of the above parameters is scored and then we add them up and come up with how ripe or ready your cervix is for labor.  If you are a first time mom a ripe cervix is a score of 8 or above.  For moms who have had a baby before it is 6 or above.  The higher the score the more ripe or ready your cervix is for labor.

Women often want their cervix checked at the end of the pregnancy during their prenatal appointments.  This is where you will hear the report if your cervix is ripe or not.  I have seen many women with an unripe cervix go into labor over the next few days and vice versa – a woman with a very ripe cervix go for many more weeks until labor begins.  In other words it doesn’t really mean much, so you shouldn’t worry about it.

The one time an unripe cervix does matter is if you need to be induced.  In that case we would start the induction with a cervical ripening agent and get your cervix more ready for labor.  This however doesn’t happen very often.  We try to induce only women who have a medical indication for inducing labor.  In my next blog I will discuss cervical ripening and how that is done.

Karin Marshall, CNM


Want to be Like a Princess? Use Midwives!!

Duchess of Cambridge Kate Middleton just gave birth to her first child using Midwives!!130723150642-03-royal-baby-0723-horizontal-gallery

She had an unmedicated, 11 hour labor that was attended by a team of 4 Midwives.

To find out more click here.


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Labor Companions: The Power of Supporting Mother and Baby

Cultural, ethnic and family systems seem to influence who is present for the momentous and sacred experience of giving birth.  As midwives we have seen that birth is a powerful experience that is often marked as one of the most important life experiences for a woman.  Birth can have a deep impact on her sense of  how she views herself and ongoing  future challenges in life.

Picture 012Your birth is always YOUR unique birth.  Most likely you will not birth like your neighbor, your sister or your mother.  Embrace that you will have YOUR birth.  Go with the flow, trust you will know what is best for you.  I think it is best that labor companions be companions, not  “coaches”.  They are your companions to offer loving presence, gentle reassurance, offering suggestions (not directives) and a spirit of believing in you.  Their presence should empower you.  A Doula can be very valuable as a companion.  The Mother’s partner often needs support also so do not hesitate inviting someone in addition to your partner.  Midwives are present to support and protect the normal physiological process of birth. We are also present to identify deviations of  normal and provide evidence based interventions that are specific to your labor.   There are no routine interventions done by midwives.  They are always in response to the individual needs of the Mother and baby.

Sometimes I have witnessed labor become a spectator event, people want to watch.  Now I personally think every woman is unique and may have different needs and wishes.  But I also think there should be careful consideration by the Mother as to who will offer:  a loving presence, gentle reassurance, the spirit of believing in you and  releasing you to your unique birth experience.  Do not underestimate the cost of emotional power taken from the mother when there are people present who are not the choice of the Mother.  It does influence the unfolding of labor and progress in the birth.

What to do if there are individuals who want to be present but you have not  invited them?

Here are a couple of suggestions:

  • Have a conversation with your “group”.  Share that you welcome their thoughts and prayers for you during labor.  Maybe suggest they light a tea candle in honor of the work you are doing.
  • Reassure them they are welcome to come celebrate with you after you and the baby have met.
  •  Limit phone calls into your room.  You need to be present to your labor, not all the inquiries of “what is happening”.   Technology is wonderful , but can also interrupt a significant moment.
  • Have a pre-birth celebration in which you invite your family and friends to offer  a “Rite of Passage to Motherhood “party.  Ask for blessings.    As women share their birth stories take what is helpful and remember you are safe, loved and supported.
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