How Cervical Dilation Checks Undermine the Imaginal Power of Birthing Women.

in B) Traditional Midwifery, C) Healing Birth Trauma, Popular Articles

Imagination is more important than knowledge.  – Albert Einstein

I recently had an epiphany while explaining to a client why I don’t do Cervical Exams, and why I don’t teach women, or their husbands, to do them either. I started explaining the notion that cervical checks are an unnecessary intervention that don’t actually give us any useful information about labor progress, and that when a woman asks to be checked I prefer to ask her to check in with her inner knowing of how close or far along she is, and go with that over a physical check.

I found myself grappling with what this meant. Am I believing that a woman really knows here cervical dilation in reality, her labor progress, or do I just trust her to know what is important to know? It was then that it occurred to me that it really doesn’t matter.

If she is right in reality then she’s right in reality, and if not, whatever she imagines… well, that’s where the epiphany came in:

It occurred to me that checking cervical dilation interrupts a woman’s psychic feeling into labor.

Of course she imagines that she is further along than she actually is. Her imagination is leading her into the cosmic trance we know is available to birthing women, a trance that transcends all concerns of labor progress. It is full of elemental power and ancestral symbolism.

Birth professionals, in general, think it normal and necessary to be real, to know and measure the reality of labor progress. This includes measuring a particular woman’s labor by some general rule, like you won’t be able to talk to me on the phone when you are really in labor and feeling confident in telling her that she is not really in labor.

My position, in this article, is that a woman’s imagination is part of what leads labor and so, of course, it would be ahead of reality, creating images for the body to live into.

If my epiphany is true, cervical exams are not only useless for measuring reality, they seriously interfere with, and interrupt, a woman’s imagination and inner birthing guide, and represent an unethical and irresponsible intervention, even when performed on oneself.

One mother’s musings:

“I lost my mucus plug on January 23rd and slept through a night of increasingly intense contractions. When I called them in the morning, they said, If you are still walking around and talking, you aren’t really in labor. So, guess what happened? Labor stopped, and I started waiting to be in hard enough labor so that I couldn’t walk or talk. Naturally, this made me really upset emotionally and eager to really be in labor…. What if I had carried on with my inner knowledge that my baby was on her way on January 23rd, and not called anyone and just let it happen? What if the mere suggestion that I wasn’t really in labor was what shut it down?”

Labor Progress

Most midwives are aware that, statistically, cervical dilation is not a good measure of labor progress, and that the stages of labor are far more nuanced than the 3 stages can do justice. I am not going to spend time on this here, but if you question this, please do some research and assess the evidence for yourself.

Midwives often agree to do cervical checks when requested by the mother, and unassisted birthers often learn to do them for themselves (I did). This is giving birth back to mothers right?

I disagree.

I remember asking for a cervical check when I was in labor, but what I really wanted was, HELP me get back in to the present moment where i am connected to the cosmos and my baby and know the answers to my own questions. I also asked, How much longer and got these answers, We don’t know and It’s up to you.

We need to understand what is at root when a woman asks for a cervical check and offer nourishment for the deeper need. In my experience, and in my opinion, women do know one of two things, where they are or where they’re going. Our best contribution to the moment is to help her connect with her own inner knowing and guide. Or if we are birthing unassisted, to have a path back to ourselves prepared and ready.

Imaginal Psychology

“Imaginal psychology is a recent branch of psychology which considers soul to be psychology’s primary concern. Central to this new discipline is the idea that the ‘soul’ expresses itself in images… This approach to psychology draws on a variety of spiritual traditions, the religious beliefs of indigenous peoples, mythology, literature and poetry, Deep Ecology, and social critique.” Wikipedia

It’s easy to talk about the spirituality of birth in the abstract, but more difficult when we want to talk about it concretely. According to Imaginal Psychology, the soul, and its expressions, are of primary concern. We also know that birth complications can stem from external interventions, but also from internal, psychological, obstacles. If in fact the soul speaks in images, we might be better off exploring this language of the soul and lay off all the medical trappings of modern midwifery.

Here is what Henri Corbin, an Imaginal philosopher and mystic, writes:

“[T]he appearance of an Image having the quality of a symbol is a primary phenomena.… the appearance of something that cannot manifest itself otherwise to the world where we are.

The soul speaks to us of our future, it describes things that cannot manifest in the here and now, but that beacon us on and into what might be. The soul speaks the language of myth and symbol, of archetypes, images and visions. When a woman calls her midwife to tell her she is in labor, she is carrying out an archetypal act and she expects to be celebrated and honored. Whether she tells you or not, she does not want to be doubted and she definitely doesn’t want to be told she’s not in labor.

I have heard midwives chuckle about this, and read articles about how to know when you, or she, is really in labor. I am arguing here that if you ask her to tell you the story of what is happening, to describe the image of her sensations, to check in with her baby and her own heart, she will tell you exactly what she needs to hear in order to slip deeper and deeper into the birth trance. She will hear the voice of her own soul speaking its imaginal verses, and they will be her guide. Question her, and you are intervening in a profound and magical process.

Quantum Physics

Quantum Theory simply says: “[B]y the very act of watching, the observer affects the observed reality.” We know from Grantly Dick-Reid and others that labor stalls when a woman is observed in labor. Why would we not consider this fact in the context of cervical checks?

Here is an excerpt from an article in Science Daily:

“Once an observer begins to watch the particles… the picture changes dramatically: if a particle can be seen going through one opening, then it’s clear it didn’t go through another. In other words, when under observation, electrons are being “forced” to behave like particles and not like waves. Thus the mere act of observation affects the experimental findings.” – Science Daily

I can’t resist the image of a woman in labor, and her cervix, likened to the nature of light. She acts like a wave that can penetrate barriers, until she is observed, at which point she begins to act like a mass of particles and gets hung up in obstacles. Perhaps a woman’s cervix is not so different from light while a woman is allowed to labor without intervention in, or observation of, what she imagines.

The Imaginal Power of Birthing Women

The power of imagining is not a foreign concept. We have all heard stories of athletes or performance artists who rehearse in their mind before the actual event. It would be hard to deny the value of this kind of imagining.

However, this is not a create your reality thing. It’s not about wishing something to be true. It’s about the language of our deep inner knowing. It’s not about wishing to see faeries, and hoping to see them. It’s about knowing deeply that there are faeries whether we see them or not.

So how do we address fear when it emerges, as it may in any real rite of passage, if we truly give up the Cervical Exam?

  1. When she asks you to check her dilation do what Jeannine Parvati Baker suggests – ask the mother how far long she is! If she says she doesn’t know try asking this way, If you knew how close you are to birthing your baby, what would you say?
  2. Learn to be in control of your observational field and reign it in. Quantum theory has found that each observer has a field that affects the observed. Get some training in knowing where your field is and how to pull it back.
  3. Develop a soul level connection with your clients so that you are no longer an observer, but a connected piece of her fabric of being.
  4. Learn to read the birth field so you can humbly offer images and ideas that occur to you there.

Even suggesting a position change or rebozo sifting, unless it is a true reading from the sacred birth field, is also an intervention that takes a mother away from responding with her body to her baby and their journey together. And even then, ask her to consider it, and then do what’s right for her…. and it might not be you with the grand idea. It can be anyone.

There is only learning how to truly listen to the birth field and offering, with deepest humility and curiosity, what you find there…this and working prenatally with mothers and families so that they have access to their instinctual and soulful selves.

{ 24 comments… read them below or add one }

Crystal - Prenatal Coach May 30, 2012 at 11:54 am

LOVE THIS! Thank you for sharing your thoughts! :-)

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Laura Shanley May 30, 2012 at 4:53 pm

Wonderful, Krista!!

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Elizabeth May 30, 2012 at 9:23 pm

I agree. This is friggin’ incredible. I love that it delves into science, but it’s a realm of science that becomes so abstract that so many who consider themselves logical will unfortunately not be open to it.

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Erin May 31, 2012 at 9:34 am

Great Article. Should be read by all involved with pregnancy and especially birth.

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Jen May 31, 2012 at 10:31 am

This is great! I was never checked with my 2nd and she came 10 days “early” ;)

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Amy May 31, 2012 at 12:30 pm

I found that when I was scheduled for an induction with my daughter, I went into labor the night before. We had everything ready and our minds were ready. My mind and my body came together and we had a lttle baby girl at 2 am!

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Amy Frank May 31, 2012 at 5:31 pm

This is such an excellent concept, beautifully and accurately described despite its inherent abstractness. My first and only birth thus far was unassisted, with only my husband in attendance, and this really resonated with me, even though I had no managed. medicalized birth experience to compare it to as so many other UCers (sadly) have. When I came to the section on imaginal psychology, I was immediately brought back to vivid memories of my birth experience. One thing that has always stood out to me is all the imagery going through my mind during my birth. As I was reading this section of the post I couldn’t stop thinking about this one part of my birth: as my body started to transition from dilation to fetal ejection, I became distraught and irrational for a time. My husband was encouraging me as I sat on hands and knees in the tub, telling him I didn’t think I could do it and suddenly, I sat upright on my knees, put my hands up on the wall and felt my baby move downward with the most scrumptious pushing sensation I have ever experienced (I’m sure this was my Rhombus of Michaelis opening). I knew something was shifting and changing and in my mind I saw an image of a white horse in a wintery night scene; the horse had been running for some time, it was panting and snorting and there was condensation rising from its nose. It reared up and whinnied loudly just as I placed my hands on the wall and felt my baby begin to move through my cervix. I have always known this was my soul’s voice but you put that thought to words better than I ever could have. Thank you for this post!!!

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Kai May 31, 2012 at 9:36 pm

So inspiration, Sister! Thanks for putting it out there and weaving the threads so eloquently .. . . you are a true craftswoman of your Art! I would love to learn more from you about what you describe as “your observer field” . .. I feel like this is something we don’t learn at school and can be crucial to not standing in the way of the Unfolding. I recognize too that I want to dedicate more time to my prayer practice and connection with Spirit, for that Knowing is a Greater Guide than all the knowledge gained in school. Looking forward to continuing to go Deep with you throughout this journey of learning to Be with Women. xxx

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Tabitha June 1, 2012 at 12:16 am

I love this, and have first hand experience with the negative effects of cervical checks. With my third daughter( second pregnancy, i had a twin homebirth with my first pregnancy) i was checked and found to be at a stretchy 9 cm. I became terrified, Pushing my first had been a horribe experience, directed pupe pushing by a midwife, teing me i couldn’t rest, i was at 10 so i needed to push, so when i was told i was again near pushing i oanicked. when i was checked again an hour later, i had reversed my dilation to a 4. So i had to relabor. I often wonder that if i had never been checked with my first or second births, would i have experienced any of that.i personally don’t find early labor that much easier tha ate labor, so a 3/4 feels as intense to me as a 10, and the numbers just discourage me.

I have a question though. I want to train as a midwife at some point in my life, and i wonder how to broach this with a preceptor or future clients. Do your clients accept your rationale, or do they “NEED” the numbers?

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Kaurina Danu June 1, 2012 at 7:06 am

Totally agree with this article!
For my third child, I went out of my way to find a midwife who was ok with my request for no internal exams at all.
I would like to suggest my experience in response to the idea of “labor stalls when a woman is observed in labor.”
I have found that the mental and emotional state of the observer affects the birthing woman, so labour can be positively or negatively affected by what’s going on in the observers mind. If the observer is bringing a belief of trust in the woman and the process, that enhances the labour, but if the observer is looking at the woman and feeling sorry for her, or looking with the unconscious intention of finding something wrong in the process, well, you know how it goes.

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Rumyana Kudeva June 1, 2012 at 8:21 am

You are magical! Your words were speaking directly to my soul and made such waves within me. I have experienced main stream overmedicated and technologized hospital birth ended up in c-section. Tried for HBAC next time and ended up with the same – not so medicated, but still sectioned me because I never got the support I needed in my home from the midwives. They were really nice women but didn’t know what my soul needed to get through this journey. Now I know that my soul needed this second “failure” to heal itself from the initial trauma that was carved into my heart and body from the first csection. I keep having dreams and imageries about me birthing alone, undisturbed and in peace and I now know I need to listen to my heart and soul. This next pregnancy will be my last one and I want to give myself what I deserve not what others offer me or expect from me. My husband is against homebirth period, but he cannot understand the true meaning of birth for a woman who has been through so much grief and pain. Thank you so much for speaking the words and bringing more light in my heart!

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krista June 1, 2012 at 9:24 am

What amazing company I have here!
Sisters, you make me weep with your words of power, encouragement and wisdom.
I have a full day with clients, but I will return with more considered responses!
Krista

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TheFeministBreeder June 1, 2012 at 8:23 pm

I agree, cervical checks can be utterly useless. All we really need to know is if the baby is out, and well, we can see that! It’s like people who look up the weather instead of walking outside to see how it feels.

I have seen, however, times when it can really help a woman’s confidence. When I was pushing during my home water birth, I got to a place where I was terrified to push anymore because I thought I felt an anterior lip (which I’d had in my previous labor.) When the midwife reached in and said “Nope! Fully dilated, baby’s at +2!” it was exactly what I needed to hear to let go and get the baby out. That wasn’t based on a fear of birth – but a fear of repeating a previous experience. I’ve also seen a mom who wanted drugs say “Oh, I’m at 9! Okay, let’s do this!” instead of accepting the epidural. Of course, that can have the opposite effect if she’s only at 2, but I’ve developed a very certain ability to tell how far a woman is dilated by just being WITH her so I really try to have moms avoid checks when I’m certain the answer will be disappointing to them.

It would be so great if we could all let go and not check the weather.

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krista June 2, 2012 at 9:00 am

@Crystal, Laura, Erin, Jen & Amy. Thank you for your sisterhood in this mission! It is my pleasure to welcome you here!
@ Elizabeth. Yes, many will not understand or appreciate the “pseudo-science” here and that’s ok. I am speaking to all those who DO get it because there just aren’t very many voices speaking to this powerful and often silenced few. I think Einstein would get it though. he he he…..

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krista June 2, 2012 at 9:05 am

@Amy: Wow, that imagery is so poignant and compelling and beautiful…. I am breathless and awakened reading your words. My deepest gratitude for your sharing here! I would love to include your story in a larger write-up (you know in that book I will someday write. smile). Stay in touch!

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krista June 2, 2012 at 10:33 am

Dearest Kai: Our observational field (as I am calling it) can be shifted with our intention. While I was in Peter Levine’s Somatic Experiencing Trauma Resolution training we did a lot of work with this. Especially powerful when an audience can bring their awareness into themselves and leave the stage open and free. I think there is an expectation for “therapists” to be completely focused on and engaged with their clients which can actually inhibit release. I use it all the time now and it’s quite amazing. In being with women in birth it can mean knitting in the corner…. I think though that this doesn’t happen often enough during “pushing” and immediate postpartum. What if our observation interrupts women’s return, bliss and bonding…. Perhaps this observation (even when it’s of ourselves) is at the root of most postpartum bleeding and breastfeeding issues.

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krista June 2, 2012 at 11:45 am

@Tabitha: I wonder too…. about those checks. Most often they are not reassuring to mothers (though this is not always the case). Many many women actually report wishing their midwives/OBs had lied to them! I think this is a sign of the fact that women need to imagine themselves further along than they actually are in order to progress, or live into their own vision.

About your question:
“I want to train as a midwife at some point in my life, and i wonder how to broach this with a preceptor or future clients. Do your clients accept your rationale, or do they “NEED” the numbers?”

This is SUCH a GREAT question and one that I have personally struggled with as well. You might consider looking at prospective preceptors and see where they studied and apprenticed. The Matrona and Ancient Art Midwifery Institute are good examples. Also, find out who they apprenticed with and investigate. In general unlicensed midwives are less bound by mandatory protocol. Ask. You are hiring them as much as they are hiring you so do your research.

In the early days women who wanted to birth at home just started attending each other’s births. I completely support this option even today, though it’s not very popular or supported. Contact me (anyone reading this) and I will send you an essay about one culture’s “dreamtime” midwifery apprenticeship. I am also working on a larger article about the topic of apprenticeship so check back for it.

I have a huge respect and compassion for women who really aren’t ready for something as radical as undisturbed or unassisted birth. That said, I am also a believer in unassisted and undisturbed birth as an ideal. It is my position that, like birth, “traditional midwifery” also belongs to mothers themselves and that motherhood is the truest “midwifery training” around.

As far as working with clients goes. I work exclusively with women who want to claim this level personal power. This doesn’t even mean I think it’s right for everyone. And yet, for those who it’s right for it can be hard to find support. So, I just work with these families and it makes me very very happy. I have found that understanding how to help oneself and others in the birth space “settle” and contact their instinctual selves provides access to the very best reassurance available.

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krista June 2, 2012 at 1:15 pm

@Kaurina: So true!!!

@Rumyana: “They were really nice women but didn’t know what my soul needed to get through this journey.” Most midwives (and OBs for that matter) are really wonderful people, just unacquainted with the paradigm of soulful “care.” We can’t blame anyone. Just call for what we know is true. It’s a revolution of sorts and there is a groundswell of women wanting something different.

I am happy to hear that your dreams are guiding you…. Perhaps a solution will emerge for you from the dreamworld??? Keep me posted!

@Feminist Breeeder: Here is a great article from Midwife Thinking about why cervical lips are not a problem “until they are detected” (because of the way the cervix dilates the anterior portion is always the last to go. ie all women have cervical lips at the tail end of dilation): http://midwifethinking.com/2011/01/22/the-anterior-cervical-lip-how-to-ruin-a-perfectly-good-birth/

That said, a previous birth trauma is likely to present itself in subsequent births and I have the utmost compassion for this. (I myself have experienced it) I wonder, what might have been different if you knew that cervical lips were “normal?” and had worked to resolve that previous trauma ahead of time? (I have no idea, maybe you did work on it. Would love to hear about it!)

In the end, I am not sure I am completely against EVER using physical touch to connect with oneself, one’s baby, or one’s “progress.” I am just calling into question our reliance on them as essential and important protocol in midwifery care. Some women do have an authentic internally generated impulse to feel for their baby. However, from my research and experience this is actually pretty rare. Most women are soaring in the stratosphere and not all that interested in particulars. They often ask questions, but if we wait…. the answer usually emerges in the birth space, like a koan being broken open.

I am also talking about an ideal here, which is important, but also trickier in practice. You make a very good point about the epidural case, but I wasn’t thinking of applying this to a hospital setting. In the hospital I think management does become important. If you intervene in birth you must start “managing emergent complications.”

I am more interested here in how we can avoid complications to begin with.
Best to you!

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melanie good September 20, 2012 at 5:19 am

I totally buy there being a mind-body connection and have given 3 natural births–one at home unassisted with no one to tell me when was time to push ;) , and that was the fastest of all my labors (my second-born, too, so it wasn’t simply a matter of birth order).

BUT as a physicist I must must ask that you PLEASE DON’T INVOKE QUANTUM PHYSICS to explain this. It DOES NOT APPLY to the macroscopic world of which our cervix is a part. Saying things that are blatantly untrue to those trained in science is part of why many obstetricians and other scientist do not support the natural birth movement. They find our reasoning, logic, and evidence to be lacking and when you misapply scientific principles like this, you are adding to that perception in a justified way.

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krista January 20, 2013 at 2:33 pm

“Imagination is more important than knowledge.” – Albert Einstein

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Donna September 20, 2012 at 12:08 pm

Brilliant – makes so much sense!

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Katrina September 21, 2012 at 2:29 am

I was a birth support at a VBAC home birth some years back and at a point in labour my friend became quite fearful and concerned that her scar was going to rupture (as she had been fed a lot of fear from medical people when she said she wanted both VBAC and home birth if possible). I looked in deeply and felt in my own body that her uterus was fine and what was happening was that she had reached the point of dilation that she had got stuck at in her previous birth (no VEs were being done at that point by the way) . But I also knew that it was not for me to tell her this, it was her journey to allow that fear and find her own place of empowerment within it. The midwife attending seemed to be doing the same, asking Helen what she saw, and what she felt was needed. Well within a few contractions Helen was just getting on with it and she moved beyond her fear and proceeded to full dilation shortly after. It showed me so much about the birthing field and how even unspoken fear could have the potential to disturb it. And how subtle the disempowerment could be as well with well meaning friends or attendants telling the woman rather than letting her find the strength and power herself. In the end this woman needed a C/S due to a very short umbilical cord. But she knew at the crucial points herself that she needed to go to hospital, and when she got there an epidural was what she wanted and proceed to C/S rather than rupture membranes and endeavor to give birth vaginally. She did not know what she knew, but she knew and when the baby was born , they discovered a short cord that would not have allowed a vaginal birth. I learned so much at this birth.

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Sarah October 26, 2012 at 7:05 am

I couldn’t agree with you more. I just had my sixth drug-free childbirth and because I knew this would most likely be my last time to experience childbirth (I am 43), I was SO committed to really really being in the moment, letting my fears go, maintaining control and enjoying every moment my getting myself into deep relaxation. Once I got settled in bed (I was in a hospital) I felt like I put myself into complete relaxation mode-I was controlling my mind and feeling my body almost disconnected…it was awesome and I was using visualization, breathing, counting, etc. I had no idea who was in the room and what was going on anywhere but in my body. It was going exactly the way I wanted it to. But when my dr. insisted on checking me (I asked her if we could skip this and she said no) I was thrown off a little…and then she told me I was about 8 and had a little while to go. I didn’t WANT to know and had to work hard to get back to my zen-like state right during the hardest part of labor…she broke that flow by checking me. But what was funny is she walked away with the intention of not coming back for awhile…and I knew because of every contraction I was FEELING, not FEARING, like I had for my previous births, that the baby was going to be born any minute. I told her quickly that the baby was going to be born in one more contraction and she brushed it off. And the next contraction? I pushed out my baby’s head and the doctor had to come running back.

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Margaret Jowitt January 20, 2013 at 2:08 pm

melanie good September 20, 2012 at 5:19 am
I totally buy there being a mind-body connection and have given 3 natural births–one at home unassisted with no one to tell me when was time to push , and that was the fastest of all my labors (my second-born, too, so it wasn’t simply a matter of birth order).

Melanie wrote: “Saying things that are blatantly untrue to those trained in science is part of why many obstetricians and other scientist do not support the natural birth movement. They find our reasoning, logic, and evidence to be lacking and when you misapply scientific principles like this, you are adding to that perception in a justified way.”
Melanie I agree with you in a way, but my main gripe with obstetricians is that they think the only science is randomised controlled trials which can only look at ‘treatments’ and that their understanding of basic birth anatomy and physiology is so poor, I think they misuse science far more than the natural birth movement does, all their talk of science is a con trick to make women do what they want and much is hot air

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