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What Does My Midwife Mean?
Q: I am in my 36th week of pregnancy. I have been having some contractions, and my midwife checked me. She said that I am station -1 and high, and 50 percent effaced, 2+ centimeters dilated. What does this mean? Is it possible I may be having my baby early? And if I do, what are the chances for a healthy baby?
A: It sounds like you are having some pre-term labor, which is defined as uterine contractions that cause cervical change before 37 weeks of gestation. This is not unusual for many women.
When your midwife said that you are station -1 and high, she was referring to the engagement of the baby's head inside the pelvis. The baby will become engaged when the baby's head has reached the ischial spines (bony structures that are felt inside the pelvis outlet during an internal exam) or lower towards the entrance to the vagina. The ischial spines are located in mid-pelvis and referred to as station 0 (zero). The numbers given from -4 (pelvic brim) to +4 (pelvic outlet) are centimeters plus or minus from the station 0 at the ischial spines. The station numbers after engagement will be referred to as +1, +2, +3, +4 and will be felt during an internal exam (station +4 usually means that the baby's head will be seen at the entrance to the vagina).
"High" is a general term used to designate the position, or station, of the fetal head within the pelvis. If the midwife said the head was high, she meant that the head was not yet engaged in the pelvis. During a tummy check, this usually means that she can still hold on to the head above the pubic bone and gently move it back and forth, side to side. As the baby becomes more fixed and engaged and is lower inside the pelvis, the head will no longer be able to be moved, becoming much harder to grasp during a tummy check.
Effacement refers to the thinning, also called effacement of the cervix. In preparation for labor, and throughout labor, the cervix becomes progressively thinner. 50 percent effacement simply means that the cervix is about 1/2 the thickness of a normal, non-laboring cervix.
The 2+ refers to the dilation of your cervix. This is a measurement in centimeters of how much the cervix has opened in preparation for childbirth. 2+ would mean greater than 2 cm, but not quite 3 cm. Active, irreversible labor usually occurs at 4 to 5 cm of dilatation. Although these terms indicate that there has been some change in the status of your cervix, this does not necessarily mean that you will deliver prior to 37 weeks.
In most cases, no one knows what causes pre-term labor. The biggest risk factor for pre-term labor is a history of pre-term labor in a previous pregnancy. Other things that are associated with pre-term labor include multiple gestation (twins or more), fetal abnormalities, and maternal infections or other conditions. In the absence of an obvious cause of the pre-term labor, there are several measures which could be taken. Bed rest is the simplest measure which is known to decrease uterine activity. Relaxation and meditation exercises can help. Dehydration can lead to contractions, so every pregnant woman should drink lots of water, at least 2 liters per day, more when outside in the heat. Try relaxing in a warm tub of water or taking a nap. Ask your midwife about herbal or holistic suggestions she may have to help you decrease contractions.
Medically speaking, there are several medications which are used in pregnancy and decrease contractions. These include brethine, procardia, and magnesium. Steroids are often given prior to 34 weeks to aid in fetal lung maturity, but would not be indicated for you. Studies have shown no benefits from steroid use after 34 weeks gestation. Home uterine monitoring can be helpful. This is when a pregnant woman wears a monitor twice a day, then sends the transmission over the phone lines to be interpreted by a nurse. The patient's health care provider orders limits of the number of contractions that are acceptable for a particular gestational age. At 34 weeks of gestation, the threshold is usually 5 to 6 contractions in an hour. The health care provider is called when the threshold is exceeded. Unfortunately, not every insurance company allows for medical home uterine monitoring and it is a costly procedure.
If you and your midwife choose not to have a medically monitored pregnancy, you can keep track of your own contractions by writing them down when they occur with the time of day, the length of the contraction from beginning to end, how often they are occurring from the beginning of one to the beginning of another, their intensity (if you can breathe through them without conscious effort and are able to focus elsewhere or if you have to concentrate on them and consciously breathe). Note where you are feeling them (in the back, the abdomen, upper or lower, above the pubic bone, etc.). Also note if they are regular and are coming at even intervals or if they are simply occurring here and there whenever they decide to appear. It is good to write down what activity you were engaged in when you had the contractions. Change your activity and see if the contractions stop.
Use your stop and go contractions as a chance to practice your breathing and relaxation techniques. However, do not wear yourself out. If you are tired, try to sleep as much as possible. If you use all your energy prior to strong labor, you will not have much energy reserves for the birth itself. Keep a record of all your contractions and report it to your midwife. Most likely she will ask if you are having any vaginal discharge or mucus spotting. If you are, this may mean you are losing your mucus plug that seals off the cervix and uterus from the vagina.
It is impossible to predict whether or not you will deliver early. Often, we struggle and struggle to control pre-term contractions, only to have to induce the patient/client after her due date. Fetal lung maturity usually occurs between 36 and 37 weeks. If the baby is born before the lungs are mature, a stay in the neonatal intensive care unit will be required. The baby may need oxygen or to be on a ventilator. Over 90 percent of babies born at or beyond 34 weeks will do fine in the long run, with no permanent problems or developmental delays. If due dates are reliable, a homebirth is possible at 37 weeks.
If you have any questions about your pregnancy or pending labor, discuss it with your midwife and have her explain to you what your body is doing and what to expect. Knowledge helps to erase fears when you are able to understand the normal processes of your body. Meanwhile, relax and try not to worry. Your labor will start when you and your baby are ready to go through it.
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