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You will have several internal vaginal examinations and your abdomen will be palpated to assess the baby's position. If your doctor is assessing if amniotic fluid is leaking, a speculum examination may be done, but in most cases this isn't necessary. Usually, the doctor uses her fingers to assess the baby and the progress of labor. She will try to check you often enough to make sure that your labor is progressing, but not so often that it causes you extra discomfort or increases your risk of infection. The following are assessed during a vaginal examination.
The doctor will check how far the head has descended into the pelvis (see The "station").
The doctor will assess how your cervix is shortening, known as effacement (see Effacement). Once the cervix is sufficiently shortened, it begins to dilate, or open.
The doctor assesses how dilated, or open, your cervix is (see Dilation). Active labor is established at 3 to 4 cm dilation and full dilation occurs at around 10 cm. You can't push your baby out until you're fully dilated.
Fetal presentation refers to the part of your baby that is coming out first. Babies can be born head first or bottom first (breech). Your doctor will also assess which way your baby is facing in the birth canal. The easiest way for a baby to be born is head down with the back of the baby's head (occiput) and spine toward the front (anterior) of your uterus, known as an occiput anterior position. Your baby can also be born vaginally from an occiput posterior position (back of baby's head and spine toward the back of your uterus), but this can take longer and be more painful. Vaginal tears are more common when babies are born in the occiput posterior position. A final position is when your baby faces your side, known as occiput transverse. Full-term babies can't be born in the transverse position since the head is too big to fit this way. However it's not uncommon for babies to rotate around during labor, although this would need to happen before you start to push. If this doesn't happen, labor may need to be assisted with forceps or a vacuum and suction cup (see Methods of assisting birth).
Although most of the time your doctor will try to examine you inbetween contractions, sometimes it helps to see how much the baby's head comes down in the pelvis during a contraction, referred to as the descent. If there is a good descent during contractions this means that the baby is fitting well into your pelvis and that your contractions are efficient.
The reality of a hospital birth is that medical interventions may be suggested, some of which may be more helpful than others. Procedures that can be done include artificially breaking the water; inserting a catheter or an IV line; and speeding up labor with drugs.
Artificially breaking the bag of water, known as amniotomy or ARM (see Breaking the water) is offered routinely in some hospitals in labor. This is a painless, low-risk procedure that is thought to shorten the time of labor by one to two hours, reduce the chance of a low early APGAR score in your baby (see Apgar score), and significantly decrease the chance that you'll need drugs to speed up labor. ARM is usually optional. The one time it is necessary is if a fetal scalp electrode needs to be put on the baby's head (see Internal Monitoring) since this cannot be done without breaking the water. It may also be done as part of the induction process (see Breaking the water).
A slow labor may be speeded up with the medication oxytocin, a procedure known as augmentation. Oxytocin is naturally released from your pituitary gland in labor. Synthetic oxytocin can be given via an intravenous (IV) line to strengthen contractions. When this is done, it's usual to have continuous fetal monitoring (see Electronic fetal monitoring) since, if the contractions become too strong, your baby may show signs of distress. Since oxytocin is quickly cleared from your system once the IV is turned off, contractions that are too strong can be weakened quickly. Oxytocin is also given during an induction of labor.
Excerpted from Pregnancy Day by Day.
Copyright © 2008 Dorling Kindersley Limited.
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