Cervical Espionage


Espionage - spying to obtain information that is considered secret or confidential without the permission of the holder of the information.

Not trying to be a rabble rouser or anything, but I hear this all. the. time! A mama comes back from her providers appointment (both OBs and MWs appointments) and I hear about how their provider gave them a cervical check that hurt badly. Sometimes there's bloody show afterwards, sometimes there's mild cramping.

Yes, sometimes that's just how our cervix' feel when we are fully pregnant... When you are around 36 weeks, oftentimes a provider will perform an exam a little different from ones prior. During this exam, they will be feeling for:

  • your ischial spines
  • your cervix (how open it is, how soft it is, and what direction it's pointing)
  • your baby (how low or high they are and if it feels like they're head down

This can, at times, feel more invasive and uncomfortable... But more often than naught, especially if there is 'sharp' discomfort, the provider might be 'helping mom out' by stripping her membranes (also known as sweeping or stretching her membranes) in order to either get some of the dilation out of the way before labor begins, or to try to encourage labor.

A membrane strip/sweep/stretch is when the provider puts a digit (finger) or two inside the cervical opening and sweeps their fingers left and right, around the inside rim of the cervix. This stretches the cervix and breaks the seal that the mucosa has on the amniotic sac adhering it to the cervix. This can cause enough irritation and pressure on the cervix that it might put a woman into labor....

The problem is, both of these are often done without a woman's consent.

When most first time moms think 'cervical check' they're thinking it will be like prior exams... Providers assume the woman knows what will be happening and what to expect. But, when a woman is given a procedure without the provider discussing it or getting her consent, that's assault. There, I said it.

A routine exam can give provider and mom useful information prior to birthing, but it will not tell you how long your labor will be, how soon it will happen, or how short it will be. Some things to consider:

  • It can give you a false sense of discouragement - feeling that your body isn't doing what it needs to, when in fact it's perfectly normal to not make cervical progress until you're in labor.. and it's perfectly normal to go into labor anytime between 38-42 weeks
  • It can give you a false sense of impending labor - feeling that you are going to go into labor any moment can be daunting... a sense of excitement and anticipation, followed by let down if it doesn't happen (see point #1) within your providers projected time frame
  • It can increase your risk for infection
  • Sometimes your water is accidentally broken
  • Sometimes it causes discomfort or bleeding
  • Some women report a feeling of violation when you don't know what to expect

Sometimes a membrane sweep will work to bring on labor beautifully. Other times, it can:

  • cause cramping for 12-24 hours without any dilation or labor starting
  • cause cramping for 12-24 hours with dilation, but then stopping and no labor commencing
  • cause maternal exhaustion (inability to sleep) to occur more commonly because of the 12-24 hours of cramping that occurs prior to labor fully commencing 
  • cause bleeding
  • introduce bacteria, increasing the risk for intrauterine infection
  • accidentally break her water, with or without contractions
  • cause a woman to question her ability to go into labor on her own

A better option: providers, tell the women that you are serving (because that's what you're doing, serving her during her time of pregnancy and birth) what you want to do, hope to find, and the risks and possible benefits - and let her decide what she wants you to do to her body.

Were you given a membrane sweep? Were you asked prior to it being performed? Did it 'work' (within 24 hours of the procedure)?

Additional reading:
Effect of Membrane Sweeping atTerm Pregnancy on Duration of Pregnancy andLabor Induction: A Randomized Trial 
MedScape's Guide To Membrane Sweeping


Entitlement and Luxury

There is an old concept in the doula community that simply won't die... this concept is that, just because a woman deserves a doula, that implies that every woman is entitled to a doula.

And this simply isn't true.

Let's go back to some of my earlier posts...

Much Ado About Gratis
History of Birth Workers

Doulas/godsibs, were always servants and loved ones. Historically they were women who weren't paid for their expertise and assistance during your labor and birth, and historically they had all had birth experience themselves so that they could be considered competent help for the midwife and mama.

Fast forward to today - a doula is now a profession. A profession means that we need to get paid so that we can continue to offer this service to women and don't need to go get a 9-5. We no longer live in an age of indentured servants and a strong local community of women who have experienced normal, natural, physiological labor and birth. So we who have embraced the profession and calling of a doula have had to learn the art of doula work. See here for more information .

I receive around 4 requests a month of women looking for free or reduced cost doula services. Most of them are not because a woman truly cannot afford our services; most of the time it's because they believe that, just because every woman deserves a doula, she is entitled to a doula. That, m'dear, is simply not true.

You're not entitled to a doula any more than you are entitled to a mechanic, or a chiropractor, or a college education. You deserve all of these things, but you are not entitled to them.

Entitlement is to have a right or claim to something, either by virtue of who you are within a certain social or professional network, by law within a given society or organization, or simply being human (i.e. basic human rights).
Deserving is to do something or have or show qualities worthy of a thing deserved. To be worthy of. 
Yes, every woman is worthy of deserving a doula. And every doula is worthy of getting paid for her work.

Now there's also a new concept going around the doula community recently. This concept irks me to no end just as much as the entitlement concept does... it's that our profession is a luxury. This concept stems from the ProDoula campaign to 'elevate the profession of the doula'.

Now, while I commend their vim, and agree that we are professionals and should treat ourselves as such (see earlier posts), we cannot lose sight of what our profession is historically and in terms of the current childbirth climate.

Let's break this bad baby down, shall we?
Luxury is the state of great comfort and extravagant living. Opulence or extravagance. Lavishness.
Profession is a paid occupation, especially one that involves prolonged training and a formal qualification.
To Elevate is to raise something to a higher position. To make it more important or impressive. 
We need to be careful of our words - because our words will exclude or include, promote or reject the heart of our profession and the women we serve...

Yes, a doula is a profession. By merit, so that we can provide this service, it is a paid one, and rightly so. Times have changed and it is a necessity.

No, it was never meant to be elevated. Being a doula isn't about how important and impressive I am... It's about how important and impressive the women we serve are. 

And finally, I am damned well not a luxury item. 

Doulas are a safety measure. It's helpful to look at doulas in terms of value, rather than cost. They put in many hours with each client, doing their best to help them have the healthiest and most positive birth experience possible--keeping you out of surgery and your baby out of special care. It's hard to put a price on that kind of experience. - Improving Birth

As I pointed out in prior posts, and specifically in the history of birth partners, doulas and midwives were not only meant for those women who could afford them. A doula was never a luxury item, although the term we use for our profession is one of luxury.

Doulas and midwives, godsibs and sage femme, historically went to every woman - not only those who could afford one. We trudged through hell and high water to ensure she had a good, supportive birth because we believed in a woman's worthiness to have it - not because of what she could provide us.

I love how Doula Speak puts this:
Well...Depending on what camp you sit in, either could be true. If you narrow your opic to the individual business level you may experience confirmation bias and for your own purposes define doula support as a luxury. With this perspective it makes it easier to be more "hard nosed" about your business model and putting earning before anything philanthropic. After all luxuries should be paid for. But this falls apart when you widen the optic and look at birth outside of your own business goals. The research is clear. Continuous Labour Support is vital to achieving better outcomes for mothers and babies.
Vital. Necessary. Not a luxury. 

So what can we come away with from all of this?

FACT: every woman is not entitled to a doula
FACT: every woman deserves a doula
FACT: the role of a doula is a profession worthy of compensation
FACT: our profession is vital and necessary to achieving better outcomes for health of moms and babies

I love Cassandra Jiminez' response below:
" I think it's a deeper issue of women appreciating their intrinsic value as human beings and we deserve to be taken care of and safe. My safety & well being are worth the cost of a doula and vice versa, my work as a doula is both necessary and valuable and I deserve to be compensated for my services."

What camp do you fall into? Do you consider yourself a Jaguar or a Louis Vuitton handbag; awesome but totally unnecessary?  Do you see your business as something that should be put on a pedestal for women to fawn over because of how great your role is? Or do you feel your work is worthy of compensation, completely important, relevant, and necessary, and have a heart of servitude for the women that you are given the honor of attending?


Rose of Jericho - Symbol and Midwife Medicine

I happened upon this older article from Baraka Birth today. It's beauty was worth sharing.
"Labor begins, and the midwife places a small dry twiggy rosette in a bowl of warm water near the mother. Labor continues, the mother gently perspires, her cervix is softening and opening, and as it does, the ball of twigs begins to soften and expand into a woody flower. She takes a sip of the medicinal water, and, breathing deeply, she watches as the ball fully blossoms. Soon enough, she’s ready to push… 
The Flower of Maryam (Anastatica hierochuntica) is a small shrub collected across North Africa, Saudi Arabia, Iran, and Pakistan, and among its most popular medicinal uses is its application for childbirth. Whether its medicinal properties encourage dilation, or if it’s a powerful visualization tool for mothers, traditional midwives have used the Flower of Maryam with their laboring mothers for hundreds of years. A quick glance at its names (below) suggests its religious significance: it is referred to as the “leaf of Maryam” (mother of Jesus), the “hand of Fatima” (daughter of the Prophet), as well as simply “daughter of the Prophet,” and “resurrection plant.” It is referenced in the Bible in II Kings 19:34-36 and in Psalms 83:13, “make them like tumbleweed,” here referring to the dried twiggy balls of Anastatica that disperse in the wind, scattering its seeds."

According to birth workers and women in the Middle East, the Flower of Maryam (or Flower of Jericho) is a medicinal plant used during childbirth for women in labor. It is steeped as a tea by the midwife, and then taken as birth becomes imminent. 

This powerful image is ingrained into women of every culture regarding birth, every culture but Western culture. This opening, unfolding, spiraling full and wide - unveiling - it's universal. In addition, the tea itself is full of calcium, magnesium, potassium, iron, and alkaloids. 

I found it also interesting that the dried plant looks very much like the vessels of a placenta and umbilical cord. Nature is amazing, isn't it? 

To purchase one for yourself, see here


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