Ready to give birth? - vaginal examination (VE), effacing, dilation, station & presentation

Vaginal exam

These cervical changes can be measured by the caregiver doing an internal vaginal examination with their gloved fingers during labour, often referred to as a VE or vaginal examination, or perhaps an 'internal'. During labour, vaginal examinations are usually carried out after a contraction finishes and when the woman says she is ready.

An internal examination procedure involves the caregiver putting on a sterile glove and often using an antiseptic cream, applied to the first and second fingertips.Their 2 fingers are then gently inserted into the woman's vagina, so the caregiver can examine her cervix. The woman's cervix is checked for the following:

Dilation

When her cervix is opening it is called dilating. Or how open the cervix is. This is measured from 1 to 10 centimetres (10 cm being fully open or fully dilated).

The consistency of the cervix. Is it soft, stretchy and yielding - often referred to as ripe or favourable. Or is it firm and tight rimmed often called unripe during late pregnancy.

The position of the cervix. During pregnancy the cervix leans towards the back (or posterior) behind the baby's head. This often makes it difficult for the caregiver to reach. As the cervix ripens (and during labour) it moves forward towards the front, making it more accessible for the caregiver and indicating progress is being made.

Station

The estimation of how far the baby's head has come down into the pelvis. This is called the station and is measured from minus 3 (- 3), meaning the baby's head is high and not engaged, to plus 3 (+3), where the baby's head can be seen at birth. Most babies' heads are at minus 2 at the beginning of labour and 0 to +1 when the pushing starts.

Effacement

When a woman's cervix thins during labour it is referred to as effacing. This is how thin the cervix feels and is measured in percentages from 0% to 100%. 0 % is when the cervix is long and thick, 100 % is when the cervix is paper thin, when most of it has been pulled up and absorbed into the lower segment of the uterine wall.

Presentation

How well the baby's head is sitting on the cervix. The part of the baby 'leading the way' during labour is called the 'presenting part', which may be their bottom if in a breech position. The caregiver tries to estimate how 'well applied' the baby's head or presenting part is to the cervix. A well applied head is regarded as being more efficient at dilating the cervix during labour.

The position the baby is lying in (i.e. posterior or anterior). This can be felt if the cervix is more than 4 cms dilated but can sometimes be difficult to accurately determine.

Source: http://www.kidspot.co.nz/article+3301+119+Internal-examination-and-cervical-dilation.htm

RIP MH370

I cannot imagine the anguish of those who knew the passengers on board MH370 especially the family members. The loss of a husband, a wife, a father, a mother, a sister, a brother, a grandmother, a grandfather, a son, a daughter... :'(

Flight MH370 ended in the Southern Indian Ocean. A good choice of word. A mark of respect for those directly affected by this tragedy...

*all images cilok-ed from google images

36 weeks

2 more days and I will be in my 37 weeks.  

3 more weeks to go (but based on my past track record is always 40 weeks + 2 extra weeks and that will set back my timeline to 5 more weeks).

Back pain getting worst.

Crotch pain getting worst.

Can't sleep (refer previous post and pic). And mr hubbs can't sleep too because his wife keeps tossing and turning all nite long.

Heartburn is a killer. I get that nasty hot sensation on top of my lungs just below my neck even after a few hours after the last meal. And especially cruel when I lie down.

My puffy feet getting puffier all the way to the shine. And now even my hands are puffy and taking off my wedding ring is near impossible at this point in time.

Brixton contraction is getting regular especially at nite while I'm about to lie down to try and sleep but not painful.

Walking means pressure on the bladder and thus more frequent loo visits all day long.

Baby still moves inside and his favourite position now is stretching and pushing my lungs into my throat. Damn painful that one.

Did I mention the back pain? Oh the back pain!!!

Bag has been packed and is ready by the door.

Matresses, pillows, sheets, towels have been washed. Other baby clothes have not though.

Baby cot is still in the box. Bedroom is still not baby-fied yet.

I'm torn between wanting to have him in my arms as soon as possible and letting him bake properly in the oven (if you know what I mean) and for him to decide when he wants to greet the world.

but... 3 more weeks (or possibly 5 more weeks)...and the pain!!! sigh...



***
updates: 25.03.2014

went for 36 check up yesterday at Klinik Pakar HUKM. Registered at 1pm and finally went into see Prof Zainul at 9.30pm. Yup... we waited 8 hours at the hospital. Prof Zainul is an excellent Dr. I feel very comfortable with him and while in labour pain I need to ensure that I am as comfortable as possible and that would include the person who will be prodding me inside out while I pant in extreme pain. However, for those who are thinking about seeing him for pre-natal check up, please do bear in mind the waiting time. It can really be exhausting especially when you are in your 3rd trimester. For those who stays nearby you can always come early to register (some came as early as 8am to register and goes to work and comes back after 2pm (he is at the clinic from 2pm onwards every Monday and Thursday but rarely comes on time. The earliest usually would be around 3pm. Yesterday he started at 5pm hence the late nites. He is known to see patients right up until 12 midnite according to the nurses there).

Reached home around 11. Had burger tepi jalan for our lunch and dinner before heading back to go straight to bed. And now I am extremely exhausted that I can't think properly and therefore work is suspended until I can think properly again today. My back pain is acting up again. Even with a pillow behind my back the office chair still feels uncomfortable.

OK, the result of yesterday's check up?

Had CTG to check baby's heart rate and uterine contraction. Result - baby is active and very minor uterine contraction.

Baby is now approximately 3.5kg (he was 2kg last month). The calculation of head circumference estimates him to be at 39 weeks. So is the calculation of the circumference of his stomach. Asked Prof if this means the due date has shifted and he said to stick to the current week which is 36 weeks. He is going to be 1 big baby. If he goes to 40 weeks, his weight could possibly reach up to 4kg @_@. Atte, kalau sebulan naik 1.5kg. Another month another 1.5kg.... whoaaaa...

I am 87.9kg from 85.3kg last month. But since baby gained 1.5kg, I guess I didn't gain any more weight (mind you there is the weight of placenta and extra blood to consider as well).

Amniotic fluid still ok. Placenta is healthy. Baby is still quite high and not yet engaged.

Since Prof will not be around next 2 weeks, I need to prep my honey bun to please stay inside until the next check up... but the idea of waiting another 2 weeks and enduring the pain for another 2 weeks... aiyoh.

Oh well...

The tower of pillows

For when sleep eludes me...