Midwife Matters

Pregnancy preparations, women's health, and care options

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


National Midwifery Week!!

This is National Midwifery Week 2013!  555942_676791132331463_2142164159_n

 Find out more about midwives and how they provide satisfying, safe and evidence based care.  Are midwives right for you?  Read more HERE.

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.


1 Comment »

Delayed Cord Clamping is a Good Idea!

Research has shown that by delaying cord clamping for 1-5 minutes after birth, your baby will have multiple benefits. The blood in the placenta will transfer to the baby during  that delay of clamping the cord. This delay of cord clamping has benefits  beyond the first few days. Studies have shown the following:

1.  Iron stores in the blood that are given to the baby  dramatically reduce newborn and infant anemia.  This improves your baby’s nervous system development for as long as 24 months of age.

2.   The baby’s oxygen levels are improved.

3.   The best news it that it gives your baby a store of Stem Cells.   Stem cells provide long term benefits to prevent age related disease.

Babies benefit from these three simple actions:

  1. Placing your baby on the mothers abdomen after birth
  2. Keep the cord intact for the first few minutes of life
  3. Breastfeed your baby within the first hour of life


Leave a comment »

Tdap Vaccine. Is It Really Safe To Get Vaccines During Pregnancy?

Tdap is tetanus, diphtheria, pertussis (whooping cough) vaccine.  In 2012 there were 4125 cases in Minnesota. There were so many it was classified as an epidemic.  The Center for Disease Control and the Minnesota Department of Health recommends every pregnant woman get a Tdap every pregnancy.arm-shot


1. Because of the Pertussis epidemic.

2. Because it offers the best protection for your baby.

3. Because giving the vaccine during pregnancy gets antibodies to your baby.

A recent letter from nine organizations in Minnesota including:  MN Department of Health, MN College of OB/GYN, MN Assoc of Pediatrics, MN Perinatal Organization, MN Nurse Midwives, MN OB and Neonatal Nurses and the MN Medical
Association state the following:

Women should receive Tdap vaccine during every pregnancy. 

Ninety percent of pertussis deaths are in infants younger than four months. Giving Tdap vaccine during pregnancy prompts prenatal transfer of pertussis antibodies, protecting the newborn during his or her first months of life. It also prevents post-partum transmission of maternal pertussis. Tdap is considered safe to give during pregnancy, regardless of the interval since the patient’s last tetanus booster or previous Tdap vaccination. The optimal window for administration is between 27 and 36 weeks’ gestation.

If a woman does not get the vaccine during pregnancy, the postpartum vaccine will offer some protection by not exposing the baby to Pertussis. The post partum vaccine will not offer the baby the important antibodies given through the vaccine during pregnancy.

Fathers, daycare providers, grandparents and other family who will be in close contact need one Tdap as an adult.  This is to prevent transmission to the baby.  They do not need one every pregnancy because they do not pass antibodies to the baby.

Please ask your provider about this important vaccine!

For more information please visit The Center for Disease Control and Prevention website.


Leave a comment »

Constipation in Pregnancy

Constipation is a common occurrence in pregnancy, especially early on.  It is caused by changes in your hormones that slow down your digestive tract causing things to move at a slower pace. Nausea may have also changed your eating habits in early pregnancy and this can also play a role in constipation. Ultimately you feel bloated and can have abdominal pain as well as difficulty passing stool. Thankfully there are some easy things to try to remedy this.

1.  Drink at least 8-10 glasses of water a day. Sometimes a glass of warm water (flavor it with lemons) in the morning can help you to have a bowel movement.

2. Try to add fiber to your diet by eating fresh vegetables and fruit, beans and whole grains daily. You may also try fiber bars or fiber supplements but be sure to drink plenty of water with these.

3. Pick up some whole flax seeds or whole millet and sprinkle these onto your food. It is tasteless and adds bulk easily to your diet.

4. Get some exercise every day, this will often stimulate your bowels into action.

5. If constipation continues you may try a stool softener such as colace that helps moisten the stool for easier passage.

If you continue to have problems or have not had a bowel movement for more that 3 days you should talk to your provider for further assistance.


Leave a comment »

Early Childhood and Family Education (ECFE)

ECFE is a Minnesota Department of Education program that offers joint parent/child classes for children from newborn to kindergarten in every school district in Minnesota.  It is a wonderful way to connect with other parents in your neighborhood, engage in fun activities with your children and talk about family and parenting.

I took my first ECFE class when my oldest son was 6 weeks old.  It was a new parent class so everyone in the class was a first-time parent of a newborn.  Parenting a newborn is an intense experience and having a group of people who are going through that same experience at the same time was an invaluable source of support.   Several of the mothers I met in that class are still some of my closest friends.

I took several more ECFE classes in the next few years.  The classes felt like a moms group, preschool class, social hour and resource for all my burning child-related questions wrapped in one.  I looked forward to them every week.

Even though my kids are in elementary school now I still refer back to things I learned from ECFE.

Check out the ECFE website for more information and classes.



Leave a comment »

Nausea and Vomiting in Pregnancy

Pregnant_purpleYou could hardly wait to become pregnant and now it has finally happened!  As thrilled as you are, you soon realize that morning sickness can be an incredibly uncomfortable problem during pregnancy.  Morning sickness, or nausea in pregnancy can interfere with your daily life.  Each woman and each pregnancy can be different.  That sick feeling usually begins around the 6th week of pregnancy and for many women ends around the 16th week. Fortunately, for a lot of women the vomiting and queasiness go away at some point during the day so they can begin feeling hungry again and keeping some food down.  These kinds of episodes can occur at any time during the day, not just the morning and typically are not harmful to you or your tiny baby.

Nobody knows exactly why so many women get morning sickness during pregnancy.  However, there are helpful tips that you can try to alleviate your chances of nausea, these include:

  •  Eating a few crackers in the morning before you get out of bed.  Set them next to your bed the night before. Lay in bed  for about 15 minutes, relax and let your stomach settle before getting up in the morning.  Always get up slowly.  Try to eat small snacks during the day between meals and don’t let your stomach become empty.  Skipping meals is never a good idea.
  •  Eat what you feel like eating when you feel like eating it.  Everybody has the story of wanting ice cream at midnight. I wanted a McDonald’s hamburger like crazy once and I wouldn’t normally even consider eating such a thing!
  • It is usually best to avoid spicy, fatty or fried foods. Also, try not to lie down right after eating a larger meal.  If smells bother you that can be a part of pregnancy as well.  Try to keep windows open and fresh air flowing.
  • Definitely feel free to ask other people to help you with cooking or walk away from smells that can be irritating.     Sometimes eating cold foods can be easier than hot items since they tend to have less of a smell. In addition they can actually be soothing on an irritated stomach.  I loved chocolate shakes during pregnancy
  • Trying ginger, lemons or peppermint has been found to relieve nausea.  Make sure that you are using real ginger, not artificial. Ginger root tea, ginger gum or snaps and fresh ginger or syrup added to water are all safe. Peppermint oil on a cotton ball, which is safety pinned to your clothing may help control nausea associated with odors. For some women salty chips, crackers, or pickles can settle the stomach enough to eat a larger meal.
  • Staying hydrated is important so continue drinking small amounts of fluids frequently during the day. Although something may have been your favorite drink before pregnancy, you might have to try new things.  I found 7up worked far better for my nausea than Sprite.
  • Always try to get plenty of rest because nausea can worsen when you get tired.  This is a time in your life to nap and pregnant women in their first trimester tend to need more sleep anyway.  You may miss some work or other activities might have to wait, so try to rely more on family and friends until things improve.
  • If you’re able, try taking your prenatal vitamins with food or just before bed.  Also, a vitamin lower in iron may alleviate this side effect. If the multivitamin worsens your nausea, you could consider just taking the folic acid 400 mcg alone on a daily basis until your nausea resolves.
  • For many women acupressure bands, called Seabands, can also provide relief from nausea.  The small plastic button on the bracelet pushes against an acupuncture point.  They are reasonably priced and available over the counter.
  • Doxylamine has been used to reduce vomiting and is found in over-the-counter products such as Unisom.  In addition, Benadryl 25-50mg, before bedtime can help alleviate nausea and promote a good night’s sleep.  These are both considered well-tested and safe medications to take in pregnancy. Finally, Vitamin B6 10-25 milligrams taken 3 times daily has been found to help with nausea, although may be less effective with vomiting.

However, if none of these things seem to be helping then it might be time to visit your Midwife.   There are other prescription medications available which may provide you with some much needed relief.  Additionally, for about 1-2% of the population, pregnancy results in a condition involving excessive vomiting call Hyperemesis Gravidarum.  The condition can be difficult to manage and may require IV fluids and medications.  Maintaining contact with your health care provider allows earlier recognition and treatment, which can be so helpful to both you and your unborn baby.


1 Comment »

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.
Leave a comment »