Understanding “Labor Lingo”

Sometimes walking into a hospital leaves you feeling like you just landed without warning in a foreign country. So many names and terms used today in hospitals may be unfamiliar to you! Rest assured, this quick glance glossary can help demystify labor and delivery talk and get you fluent in “labor lingo.”

Amniotomy- The artificial rupturing of the amniotic sac. This is done by the care provider with an amniotic hook, which looks like a crochet needle.

APGAR- A quick assessment of the newborn baby. Named after Virginia Apgar. The test is taken at 1 min after birth and then again at 5 min. The care provider is measuring Activity (muscle tone), Pulse (heart rate), Grimace (reflexes), Appearance (skin coloration), and Respiration (breathing rate and effort). These evaluations can all be done with the baby still on the mother’s chest or stomach.

Back Labor- Occurs when the baby’s back is against mother’s back. This leads to longer labors and more pain, especially in the mom’s lower back.

Dilation- The measurement of the opening of the cervix. This is measured in centimeters from 0-10, with zero being completely shut and 10 cm being fully open, thereby completing the first stage of labor. Dilation occurs as the baby’s presenting part presses down onto the cervix as the uterus is contracting and pulling the cervix upwards. It is not unusual for some women to have cervical dilation before the onset of labor.

Effacement- The softening and thinning of the cervix. This is measured on a % scale. 0% means the cervix is still long and hard, 100% means that cervix is completed thinned out. The 100% effacement is often referred to as a “paper thin” cervix.

Episiotomy- The cutting of the perineum (the space between the anus and the vagina) in order to make the vaginal opening larger.
*Side note: There is no evidence that an episiotomy reduces the risk of perineal injury, improves perineal healing, prevents birth injury in babies, or reduces the risk of future incontinence (involuntary loss of urine or feces). In fact, an episiotomy is associated with more pain, sexual problems, and incontinence after birth. Also, there is evidence that episiotomies done to prevent tears that the provider thinks are about to happen actually cause more tears (1).

External Fetal Monitor (EFM)- An external device used to listen to the heart rate of the baby. It is rather non evasive, but does limit the mother’s mobility.
*It should also be noted:
-Routine continuous EFM provides no benefit for babies and increases the risk of cesarean for mothers.
-The American College of Obstetricians and Gynecologists (ACOG) recommends that for healthy, low-risk women (almost all women), fetal heart rate be monitored with a fetoscope or Doppler every 30 minutes in active labor and every 15 minutes during pushing.
-The World Heath Organization (WHO) encourages intermittent manual listening and warns that EFM is often used inappropriately (2).

Fetal Position- The position in which the baby is situated in the pelvis.
-Head down is called vertex.
-Head up is called breech.
-Head down with the baby’s spine facing towards mother’s belly is called Anterior
– Occiput Anterior (OA)
-Right Occiput Anterior (ROA)
-Left Occiput Anterior (LOA)
-Head down with the baby’s spine facing mother’s back is call Posterior
– Occiput Posterior (OP)
– Right Occiput Posterior (ROP)
-Left Occiput Posterior (LOP)

(Photo 2)

Internal Fetal Monitor (IFM)- The internal monitor is used if the mother is high risk or the care provider does not feel like he/she is getting an accurate read from the external monitor. This monitor is more invasive since the amniotic sac has to be ruptured in order to use it. A small fetal scalp electrode is placed in the baby’s scalp to pick up the heart rate.

Meconium- Baby’s first stool. It is blackish, greenish and thick like tar. If the baby passes this stool during labor, the amniotic fluid will be tainted a darkish color. This is recognized as a sign of fetal distress.

Pitocin- The synthetic form of oxytocin. This is used in inductions and if the care providers feels the uterus needs a little help in contracting.

“Ring of Fire”- A burning or stretching sensation experienced as the baby is crowning and the head stretches out the perineum.

Station- The measurement of the baby’s decent through the pelvis. This is done by determining the baby’s presenting part (usually the head) in relation to the mother’s ischial spine. The highest point is -4, 0 would be when the head is in line with the ischial spine and at +4 the baby is on the perineum.

(Photo 3)

Transition- The final part of the first stage of labor as the mother is dilating from 8-10cm. This is the quickest stage and often the most intense with contractions 1 to 3 minutes apart.

Triage- Before you get admitted into the Labor and Delivery Unit, you will stop in “triage” to get checked out. There they will check your dilation and then listen to your baby for about 20 minutes with the external fetal monitors. Your doctor may or may not be there at this time. If your doctor is not in the hospital, a resident or possibly an attendant will perform the exam before notifying your doctor of your status.

Sources
1. “Care Practice Papers” from the Lamaze Institute for Normal Birth.
2. Lamaze International, teaching handout
Photo 2 Doula Momma
Photo 3 Blessed Mom

Internal Exams: When To Get Them

A new mother came back for postnatal yoga last week. She was absolutely glowing and excited to share her birth story with me. The new mama said she really felt good about her birth experience, but with the one exception that she wishes she would have been checked for dilation before receiving the epidural. She arrived at the hospital at 4cm. For several hours she and her husband managed her contractions well. Then she said, all of a sudden they became unmanageable and all she could think about was, “How am I going to do this for much longer!” She immediately requested an epidural and received it quickly. She then explained it was only moments after the pain relief set in that she felt incredible pressure in her pelvis. The doctor then checked her and she was fully dilated and the baby had descended quite low in her pelvis. Low enough that it only took about 10 minutes to push her baby out!!

She explained that in hindsight, she realizes she was probably in transition. However, she or her husband had not experienced labor before and didn’t know what that looked like. She just knew she felt overwhelmed by the contractions, but said that if she had a frame of reference for knowing she was close to the end, she probably would have foregone the pain meds (which was her original intention).

Most importantly is that the new mama felt good about her birth experience. However, there is a lesson to learn for future births and for our readers. If you are considering an epidural, it is not a bad idea to ask for an internal exam to determine where you are in your labor.

The question of when and how often to get an internal exam comes up often in my childbirth education classes. Here is my take on when to get an internal exam.

1. Baseline assessment
When the women first arrives at the hospital or birth center it is useful to get a baseline assessment. Also, if the woman is not particularly far along, this may offer her the opportunity to go home. Most hospitals do not want to admit a woman in very early labor unless she is prepared to take interventions to move her labor along.

2. Concern About Progress or Position
I have encountered several occasions where the mother appears to be in the throngs of intense contractions and those around feel confident that she is fully dilated, or at least well on her way. But upon examination the mother has not dilated much. This would indicate that we need to shift strategies, reconsider the baby’s position, and change activities before the mother gets too exhausted. Dr. Gae Rodke from St. Lukes/Roosevelt adds an internal exam can be very beneficial “When something arouses concern, such as membrane rupture with an unengaged fetus or a Breech, to be sure that cord is not prolapsing, and to confirm the position of the presenting part.”

3. Considering Epidural
Just as discussed in the story above, if you are considering an epidural, you may want to get checked to see where you are in the labor process. Statistics show it is not ideal to get it before active labor- although you don’t need an internal exam to determine you are in early labor. But for those that are looking to do a medication free birth, if you are on the cusp, knowing where you are may help you make that decision.

4. Urge to Push!
Another notable time for an internal exam is if the mother is feeling the urge to push. This topic can bring a bit of controversy. As mentioned before, some birth purists don’t believe that internal exams are necessary or waiting to be fully dilated before starting to push. I do agree that it is important for the mother to follow her instincts. Although, my experience as a doula- working in mostly hospital settings- the care provider wants the mother to be fully dilated before pushing. One reason can be that if the mother pushes and there is still some cervix present, she can actually swell or lacerate the cervix. Dr. Gae Rodke adds, “Pushing before full dilation can cause the cervix to swell, delaying progress. A swollen cervix is more likely to tear, which can cause heavy bleeding and lead to emergency intervention and/or a difficult repair after the baby is born. The possibility of stretching pelvic supports leading to later uterine prolapse is another good reason to wait.” However, if there is still a bit a cervix lip still present, the care provider may help push it back over the baby’s emerging head and help the mother reach full dilation.

Reasons Not To Have Too Many Exams:
Listed above are very valid reasons for the mother to have a vaginal exam. However, it is good to be prudent in the number of exams the mother needs to endure.

1. If the mother’s water broke, multiple vaginal exams it can introduce bacteria and lead to infection

2. Vaginal exams are subjective, so if being performed by multiple people with differing results, this can be discouraging for the mother

3. If the exams don’t show the progression the mother was hoping for, it can be discouraging

4. Vaginal exams are uncomfortable

5. A rough vaginal exam can lead to the woman’s water rupturing

6. Regular internal examines can make the woman feel like she is on a schedule, like she must hit certain marks within a certain time. This is especially true in a crowded hospital where there may be time protocols as to how long a woman can be in labor for before introducing interventions. It would be better to look at the laboring woman for signs of change instead of a clock.

Most importantly, when performing any type of procedure or exam, it is important for there to be a reason behind it. How is this information going to benefit or change the circumstances? As Dr. Rodke pointed out there are legitimate reasons for doing an internal exam that can change the course of action taken from the results of the exam. Doing an internal exam just to try to predict how much longer labor is going to be is not very effective or accurate. Some women can go from 5cm to 10cm in an hour, others it could take 15 hours. It is more important to look at how the mother and the baby are handling labor. Interestingly, some women can have reversal of dilation, especially if they are feeling scared, pushed or threatened.

This is also good advice when it comes to prenatal internal exams. It does not do the mother any good to hear her progress or lack there of before the onset of labor. If anything, this can be discouraging to some women and cause over-excitement for others. I have seen many women walk around partially effaced and dilated for weeks before labor starts. While others see the doctor that morning, hear that nothing is happening and then go into labor that night.

I hope my take on internal vaginal exams has been useful to you. Happy birthing!