When an obstetrician inserts a finger into the vagina of a pregnant woman who is about to give birth, what are they probing or feeling for? Have you ever wondered?
The answer is they feel both the mother’s vagina and the baby’s head. In the vagina of a woman close to giving birth, we insert our fingers all the way in, reaching the baby’s head.
At that point, we touch the cervix. We roughly estimate how wide the cervix is open and its thickness, because for a woman to push the baby out, the cervix must be fully open, which is about 10 centimeters in diameter. Then we feel lower to find the bony protrusions called ischial spines, located around 5 and 7 o’clock on a clock face, to assess the descent of the baby’s head. It must gradually move down from the pelvis into the vagina and finally be ready to emerge at the vaginal opening.
Additionally, we assess the curvature and prominence of the mother’s pelvic bones to determine if they are suitable for vaginal delivery. Even slightly sharp or narrow bones can make delivery difficult.
But believe it, a baby’s skull is not fused like an adult’s. It can move and overlap to reduce the head’s circumference to pass through.
And because the skull is not yet fused, we can feel the sutures of the skull bones.
The human skull consists of several bones, like a jigsaw puzzle.
Have you ever felt the soft spot on a baby’s head? That’s the fontanelle, which is soft and can be pressed. Pressing down reveals the area where the skull hasn’t yet formed.
Well, actually, there is a skull, but it’s not yet fused.
A baby still has a small brain, and it grows every day. That’s why the skull must not be fused from birth, as the space inside needs to expand. Imagine if the skull bones fused too quickly; as the brain grows, it would be cramped, and the brain would push itself out through any available gaps, like the eye sockets. Can you imagine what that would be like?
I’ve been talking for a while now. I’m trying to say that besides when I insert my fingers to feel the anatomy of a pregnant woman’s vagina, I also need to feel the baby’s skull in the vagina. I feel for the sutures between the skull bones, with the key point being the space of the suture above the occiput.
It’s called the occiput. Why feel for it? To assess the rotation of the baby’s head.
Alright, read slowly. I’m about to explain.
When the baby is in the womb, it lies sideways, not on its back or stomach. But when it’s time to be born, as the head encounters the pelvic opening, the mother’s sacrum and pelvic rim force the baby to rotate its head to face the sacrum. Simply put, the baby will face the mother’s backside. As the mother pushes and the vagina opens, the baby’s head will emerge in the position of looking at the mother’s backside. This is the normal vaginal delivery process. If it’s like this, the delivery will be successful.
This is when we need to check how the head is turning and rotating, whether it’s following this process, by feeling the skull sutures and the depression above the occiput.
The person delivering must be able to feel the occiput…
This story happened in a van I was in, listening to the elders talk about childbirth in the past.
The elder I’m about to mention is Dr. Sutham, an expert in vaginal delivery. His internal examinations are extremely accurate.
One evening, he came to deliver a patient under his care, and a medical student came to assist him, or to put it in proper educational terms, to have the doctor teach them how to deliver. The doctor had them perform an internal examination. The patient was pushing, the cervix was fully open, at 10 centimeters, and the baby’s head had descended significantly.
“What time is the occiput at?” the doctor asked.
The question “What time is it?” means where the occiput is positioned compared to the clock face. The best position for delivery is when the baby faces the mother’s backside, meaning the occiput should be at 12 o’clock or under the mother’s pubic bone.
“What time is the occiput at?” This question made the medical student sweat, probably because they couldn’t find the depression. The atmosphere became tense until a delivery room nurse answered, “Six o’clock, doctor.”
“Huh, how do you know? You didn’t examine.” The nurse had to be in the delivery room, helping measure blood pressure and administering medication, not performing an internal examination on the doctor’s patient.
“They posted a notice!” Silence followed, and everyone was puzzled, then the doctor turned to look at her.
“What?” he asked.
“The doctor asked what time the library closes. Today it closes early, doctor. It closes at 6 PM.”
Occiput vs. Library – -“ End of story.
Thanaphan Choobun is definitely not that medical student.
May 17, 67
Source: Asst. Prof. Dr. Thanaphan Choobun https://facebook.com/thanapan.choobun