OK- this is pasted from something on ICAN and I got it from the UC birth list. Enjoy! The references to pasta really made me laugh, since we own an Italian restaurant. I'm going to cross post this in November and December, because so many people are asking this question.
__________________________________________________ ___________
Learning Your Cervix
Interestingly, women who want no one else to check their cervices
(plural
for
cervix), invariably ask me how to check their own. I have described
it for
years, but finally wrote the process out for one of my on-line groups
and it
was well-received and understood for something that is 100% tactile as
opposed
to intellectual. I hope the information is helpful to those that want
to
know.
Note #1: I utilize several food analogies below that might offend
some who
feel I am not seeing the woman for her Self. Please know that isn't
so at
all,
but I am trying to find common items we can touch and experience. I
am not
objectifying the woman. I promise.
Note #2: When I speak of "we" throughout, I am speaking as a midwife.
As a
mom, I never did self vaginal exams because I was too fat to reach, so
reading over this, it sounds like midwives have exclusive domain over
these
learned skills. I don't imply that at all and am actually writing
this so
folks not only know what we are doing (when they are done), but so
they can
do them themselves if they want to.
Learning to do vaginal exams 101/201/301. No test given, ask any
questions
when they come up!
IMPORTANT NOTE FOR PARTNERS: When putting fingers inside the vagina,
washing
hands is a given, but we have found that the index and middle finger
are
easiest to maneuver inside a vagina. Just watch that thumb! It, all
too
often, finds the clitoris... please be aware of your thumb and keep
it to
the
side.
DILATION:
We (midwives, I can't speak for docs) start by measuring our
forefingers and
middle fingers as they are stretched apart. Mine are 8 centimeters
(cm)
apart.
Then, we begin guess-timating objects: drinking glasses, soda cans,
salt
shaker's bottoms; anything in a circle, small and large. We guess,
then
measure; first with the tape measure, then our fingers to verify,
then, when
we are guessing correctly more than not, we switch that order...
fingers,
guess, then measure.
When I first went into a vagina to find a cervix, it was mush. I was
lost in
the terrain. Mind you, I had been lesbian for many years and had
assisted
Certified Nurse-Midwives and Labor & Delivery nurses for a long time
so knew
what cervices looked like with speculums, but finding one with my
fingers
was
a whole 'nother story! Non-pregnant cervices feel like the tip of
your nose.
Pregnant cervices feel like your soft, gooshy lips. Being slow and
gentle
and
patient helps you or your partner find your cervix (and can be
foreplay for
some).
I can tell when someone looking for a cervix finds it. They get an Ah-
HA
lightbulb over their head because, even in the gooshy terrain, there
is a
distinct difference once the cervix is felt.
Many descriptions abound: a soft, full donut is the most common... the
"hole"
of the donut (the "os" of the cervix) closed and tight when not
dilated...
warm and open and varying in size as dilation begins and progresses.
EFFACEMENT:
The length of the cervix is now actually measured when women are
having
pre-term labor issues... their finding that the length of the cervix
can be
indicative of early labor (along with the fetal fibronectin test, but
that
is
another story).
From http://www.babycentre.co.uk/expert/557301.html:
A vaginal scan is the best way to measure your cervix because it can
be seen
much more clearly this way. The cervix looks like a tube on the scan,
between
3 and 5 cms in length, with one end at the top of the vagina (the
external
os)
,and the other end inside the womb (the internal os). It is the
internal os
that can begin to open first, and this will look like a V shape on
the scan.
As the os opens further it becomes U shaped. This is called
funneling. (2)
If
the closed part of the cervix measures less than 2.5 cms, a stitch
will be
put in to stop the cervix opening further. <my note: that is cerclage>
<end quote>
But, in normal labors, cervical effacement (as the shortening is
called) can
occur weeks ahead (not uncommon) or not until labor begins (not
usual).
Judging effacement again begins with measuring your (or your
partner's)
middle finger and finding where 4 cm is... touch that... feel where
that is
on your finger. 4 cm is a bit long to me, especially as we move
closer to
birth, so maybe finding where 4 cm and below would be better.
What is measured during that early ultrasound (if one is performed)
is the
distance from external os to internal os. Measuring with fingers is
different
since we aren't putting a finger inside the os, so instead, we feel
the
cervix
from the outside... feeling the os, and then running our finger up
the outer
portion… up to the upper vaginal wall and guess there. And it is a
guess.
Of course, to make things more confusing, we don't guess in
centimeters, we
guess in percentages effaced (gone/shortened).
And, with practice, we needn't have felt a woman's cervix at all in
pregnancy
to know what the effacement is in labor; either... it is an
intuition... a
"feeling" of where that cervix was/is.
So, remembering that the cervix is the uterus can help with
visualizing what
you are feeling. The uterus uses her muscles to pull up in
preparation for
pushing down of second stage. The cervix (the actual donut part if we
go
back
to that analogy) thins as the uterus pulls those muscles up. From
thick like
rigatoni (10% effaced)... gooshier than rigatoni... like rigatoni
filled
with
jello or pudding, maybe... to thin like over-cooked fettuccini (80%
effaced),
but wider... not as wide as lasagna noodles, though, and no more
pudding...
just flat and soft.
When the cervix is 100% effaced, then it is unable to be felt at
all...
called "paper thin" because the cervix is flush with the baby's
head...
barely a perception of change between vaginal wall and baby's head...
a
fraction of an elevation... like when you put your hand on a sheet of
paper
lying on your desk and slide your finger off the paper onto the desk
with
your eyes closed... like that.
The rigatoni to fettuccini stages are subjective since they are done
in
percentages... and I don't put too much stock in effacement since it
happens
with dilation anyway. If the cervix is 1-2 cm long, that's about 50%
effaced.
Less than that, 75%-100%... not usually 100% until 10 cm (and without
a
cervical lip!). However, women do have 100% effacement pre-labor. I
know to
run to their home (or have them run to the birth center/hospital if
that is
where they are delivering) when labor begins... 100% effacement is a
pretty
darn good gauge of a quick labor in the making.
STATION:
Station is measured in -4, -3, -2, -1, 0, +1, +2, +3, +4. Minus 4 is
high,
high (some texts discuss minus 5 and plus 5, but not all)... the head
floating... ballotable (bounce-able... pronounced buh-LOT-able). Even
a
minus
2 or 1 is generally ballotable. Once the baby gets down deeper in the
pelvis,
it can no longer ballot (buh-lot).
How do we make the baby ballot? With fingers inside the vagina, we can
actually touch the baby's head, even with a closed cervix...
alongside the
upper vaginal wall... we can feel a head about minus 2 (longer
fingers can
reach minus 3s and 4s). Touching the baby's head, we put pressure
there and
if it bounces out of the pelvis, it is ballotable. It's best not to
ballot
too hard lest the umbilical cord fall below the head. A gentle tap to
feel
ballotability is sufficient when wanting/needing that information. It
is
possible to ballot externally, but they (those that judge) wouldn't
consider
that accurate. When there is a question about head/pelvic
compatibility,
docs
and midwives have been known to push the baby into the pelvis to see
if the
baby fits. We can actually feel the head above the pelvic bone (pubic
symphasis) if it does not go into the pelvis.
Of course, for goodness sake, that is zero indication of being able
to fit
through the pelvis and is nearly absurd to even put a mom emotionally
through
the experience. The baby's head isn't in the position of its own
choosing,
the woman is lying down, the pelvis isn't open to its full capacity,
the
baby's head hasn't molded... la la la.
What does a baby's ballotability mean for me? It gives me warning
about cord
prolapse... that is about it. While I share about cord prolapse with
each
client, if I find a baby high during prenatals (even externally), I
have the
woman look me in the eye so she understands what to do if her water
breaks
before I see her again to see where that baby is. (A midwife is the
product
of the sum of her experiences... and I have had 2 cord prolapses in my
hands.)
The head being high is an avenue for a cord to slip around the head
as the
membranes release, the head possibly following, compressing the
cord – a life-threatening emergency for the baby.
So, what does it feel like when your fingers are in the vagina and
you touch
the baby's head? Hard compared to the soft and gooshy vagina and
cervix...
even through the vagina as opposed to inside and through an open
cervix, the
head can be felt. If you are able to reach in and feel the baby easily
without reaching far, the baby could be at zero station or less. If
the baby
feels really close (5-6 cm in) to the introitus of your vagina, s/he
could
be
at a plus 1 or 2 station (what you might find in good active labor).
The
baby's head able to be seen with pushes, and not in-between
contractions/surges? Plus 3. Able to be seen between contractions and
continues birthing? Plus 4. Plus 5 is crowning if a plus 5 is used.
Now, I know that stations typically are described as the widest
diameter of
the baby's head being aligned with the ischial spines of the mom (zero
station if it is even with the spines). That is an obscure
description for
many people and I hope that how I described it is easier to be "seen."
Stations, like effacement, mean virtually nothing in the grand scheme
of
things unless progress is an issue during active labor. Station can
give us
a
heads up on what might be happening with a baby's head position...
with
inability to mold easily... or if mom has pelvic issues (a former
accident
or
severe anorexia as a teen). Otherwise, it is just another measurement
midwives are taught to do as a matter of course.
CERVICAL LIP:
Since I mentioned this above, I feel I should talk about it for a
moment.
Lips can be anywhere, but almost always called "anterior lips" mostly
because
when a head is entering the vagina during 8-10 cm dilation, feeling
behind
to
find a posterior lip is nearly impossible. We usually will
mention/chart
where it is... the most common locations are between 11:00 and 2:00.
What might cause a cervical lip? After talking to hundreds of folks
who have
felt and know cervices, there seems to be an agreement that cervices
do not
dilate in a symmetrical manner. It probably doesn't dilate in an oval
path,
either, but most likely, in a fluid pattern whereby some parts are
more
dilated and effaced than others, yet those same parts could seem to
lag
behind another portion of the cervix ten minutes later. I believe
that if
there were a way to accurately and continuously measure the diameter
of
cervices during labor, it would be shown how asymmetrical dilation
really is
(and I do not advocate creating or utilizing such a tool!).
Therefore, I
believe that a cervical lip is nothing more than the asymmetrical
cervix
finishing her job dilating and that so many women have cervical lips
because
so many people put their fingers in to find them. I believe that if
there
was
a realization (or acknowledgement) of this asymmetry surrounding the
entire
dilation process, amazing amounts of hysteria from the medical
establishment
could result – and, conversely, women could use the information
towards
their
own empowerment and refusal to allow the arbitrariness of a cervical
exam
affect the emotional and spiritual progress of their labors.
However, most don't acknowledge or accept this theory and feel they
need to
do something with a cervical lip. There is a lot of discussion in
midwifery
and medical communities about what to do and this is certainly a case
of
experience dictating what the care provider does, but I have really
come to
believe if your hands aren't in your vagina (or someone else's hands
in your
vagina), you won't know you have a lip! But, for those that really do
want
to know what is taught and done during lips in labor, here goes.
Most midwives agree to not put pressure on the swollen lip... rest it
by
lying on the opposite side of the lip (unless it is truly anterior,
then
switching sides can be beneficial). If the lip is more on one side
than the
other, after resting, flip sides to put pressure on the cervix and
see if
that helps. Some midwives use ice to take the swelling down, putting
the ice
in a sterile glove if possible. Some midwives lift the floppy cervix
over
the
babe's head. Some midwives shove "stubborn" (thick) lips out of the
way.
Some
midwives manually dilate their client's cervices (for a number of
reasons
including selfishness [being tired], or when a baby needs to get out
fast).
It helps to let a woman do what feels right and if it hurts, don't
push! If
it feels good, then push.
The common belief is if a woman pushes before she is fully dilated
(the
excuse for vaginal exams to see if it is "time to push"), she will
tear her
cervix. In 23 years and over 800 births, I have seen a torn cervix
one time
(with a non-instrumental [forceps] birth) and the woman delivered her
6th
baby so fast that baby just fell out, no exams at all. All those women
pushing on lips, pushing before they were ready, pushing when told
not to...
no tears at all. I have felt cervices swell closed (a couple three
centimeters more closed) with pushing, but not torn. Listening to the
body
cannot be stressed enough and, when upright, the body rarely forgets
what to
do.
I hope this information has helped those that want or need this
information
for themselves. Even women who have care providers and allow those
providers
to do vaginal exams have found the descriptions helpful as they
visualize
what is happening inside their own bodies.
Remembering that vaginal exams, even by the same midwife, doctor,
partner,
or yourself is subjective and what might be felt by one caregiver
would
register a totally different description by another a few minutes
later.
Our bodies are fluids, not solids. Change is normal. Being with our
bodies
during those changes can be delightful!
Barbara E. Herrera strives to be a low-profile midwife and share as
much
information with women as she is asked, believing the information
belongs to
the women, not only in the proprietary hands of doctors, nurses, or
midwives
__________________________________________________ ___________
Learning Your Cervix
Interestingly, women who want no one else to check their cervices
(plural
for
cervix), invariably ask me how to check their own. I have described
it for
years, but finally wrote the process out for one of my on-line groups
and it
was well-received and understood for something that is 100% tactile as
opposed
to intellectual. I hope the information is helpful to those that want
to
know.
Note #1: I utilize several food analogies below that might offend
some who
feel I am not seeing the woman for her Self. Please know that isn't
so at
all,
but I am trying to find common items we can touch and experience. I
am not
objectifying the woman. I promise.
Note #2: When I speak of "we" throughout, I am speaking as a midwife.
As a
mom, I never did self vaginal exams because I was too fat to reach, so
reading over this, it sounds like midwives have exclusive domain over
these
learned skills. I don't imply that at all and am actually writing
this so
folks not only know what we are doing (when they are done), but so
they can
do them themselves if they want to.
Learning to do vaginal exams 101/201/301. No test given, ask any
questions
when they come up!
IMPORTANT NOTE FOR PARTNERS: When putting fingers inside the vagina,
washing
hands is a given, but we have found that the index and middle finger
are
easiest to maneuver inside a vagina. Just watch that thumb! It, all
too
often, finds the clitoris... please be aware of your thumb and keep
it to
the
side.
DILATION:
We (midwives, I can't speak for docs) start by measuring our
forefingers and
middle fingers as they are stretched apart. Mine are 8 centimeters
(cm)
apart.
Then, we begin guess-timating objects: drinking glasses, soda cans,
salt
shaker's bottoms; anything in a circle, small and large. We guess,
then
measure; first with the tape measure, then our fingers to verify,
then, when
we are guessing correctly more than not, we switch that order...
fingers,
guess, then measure.
When I first went into a vagina to find a cervix, it was mush. I was
lost in
the terrain. Mind you, I had been lesbian for many years and had
assisted
Certified Nurse-Midwives and Labor & Delivery nurses for a long time
so knew
what cervices looked like with speculums, but finding one with my
fingers
was
a whole 'nother story! Non-pregnant cervices feel like the tip of
your nose.
Pregnant cervices feel like your soft, gooshy lips. Being slow and
gentle
and
patient helps you or your partner find your cervix (and can be
foreplay for
some).
I can tell when someone looking for a cervix finds it. They get an Ah-
HA
lightbulb over their head because, even in the gooshy terrain, there
is a
distinct difference once the cervix is felt.
Many descriptions abound: a soft, full donut is the most common... the
"hole"
of the donut (the "os" of the cervix) closed and tight when not
dilated...
warm and open and varying in size as dilation begins and progresses.
EFFACEMENT:
The length of the cervix is now actually measured when women are
having
pre-term labor issues... their finding that the length of the cervix
can be
indicative of early labor (along with the fetal fibronectin test, but
that
is
another story).
From http://www.babycentre.co.uk/expert/557301.html:
A vaginal scan is the best way to measure your cervix because it can
be seen
much more clearly this way. The cervix looks like a tube on the scan,
between
3 and 5 cms in length, with one end at the top of the vagina (the
external
os)
,and the other end inside the womb (the internal os). It is the
internal os
that can begin to open first, and this will look like a V shape on
the scan.
As the os opens further it becomes U shaped. This is called
funneling. (2)
If
the closed part of the cervix measures less than 2.5 cms, a stitch
will be
put in to stop the cervix opening further. <my note: that is cerclage>
<end quote>
But, in normal labors, cervical effacement (as the shortening is
called) can
occur weeks ahead (not uncommon) or not until labor begins (not
usual).
Judging effacement again begins with measuring your (or your
partner's)
middle finger and finding where 4 cm is... touch that... feel where
that is
on your finger. 4 cm is a bit long to me, especially as we move
closer to
birth, so maybe finding where 4 cm and below would be better.
What is measured during that early ultrasound (if one is performed)
is the
distance from external os to internal os. Measuring with fingers is
different
since we aren't putting a finger inside the os, so instead, we feel
the
cervix
from the outside... feeling the os, and then running our finger up
the outer
portion… up to the upper vaginal wall and guess there. And it is a
guess.
Of course, to make things more confusing, we don't guess in
centimeters, we
guess in percentages effaced (gone/shortened).
And, with practice, we needn't have felt a woman's cervix at all in
pregnancy
to know what the effacement is in labor; either... it is an
intuition... a
"feeling" of where that cervix was/is.
So, remembering that the cervix is the uterus can help with
visualizing what
you are feeling. The uterus uses her muscles to pull up in
preparation for
pushing down of second stage. The cervix (the actual donut part if we
go
back
to that analogy) thins as the uterus pulls those muscles up. From
thick like
rigatoni (10% effaced)... gooshier than rigatoni... like rigatoni
filled
with
jello or pudding, maybe... to thin like over-cooked fettuccini (80%
effaced),
but wider... not as wide as lasagna noodles, though, and no more
pudding...
just flat and soft.
When the cervix is 100% effaced, then it is unable to be felt at
all...
called "paper thin" because the cervix is flush with the baby's
head...
barely a perception of change between vaginal wall and baby's head...
a
fraction of an elevation... like when you put your hand on a sheet of
paper
lying on your desk and slide your finger off the paper onto the desk
with
your eyes closed... like that.
The rigatoni to fettuccini stages are subjective since they are done
in
percentages... and I don't put too much stock in effacement since it
happens
with dilation anyway. If the cervix is 1-2 cm long, that's about 50%
effaced.
Less than that, 75%-100%... not usually 100% until 10 cm (and without
a
cervical lip!). However, women do have 100% effacement pre-labor. I
know to
run to their home (or have them run to the birth center/hospital if
that is
where they are delivering) when labor begins... 100% effacement is a
pretty
darn good gauge of a quick labor in the making.
STATION:
Station is measured in -4, -3, -2, -1, 0, +1, +2, +3, +4. Minus 4 is
high,
high (some texts discuss minus 5 and plus 5, but not all)... the head
floating... ballotable (bounce-able... pronounced buh-LOT-able). Even
a
minus
2 or 1 is generally ballotable. Once the baby gets down deeper in the
pelvis,
it can no longer ballot (buh-lot).
How do we make the baby ballot? With fingers inside the vagina, we can
actually touch the baby's head, even with a closed cervix...
alongside the
upper vaginal wall... we can feel a head about minus 2 (longer
fingers can
reach minus 3s and 4s). Touching the baby's head, we put pressure
there and
if it bounces out of the pelvis, it is ballotable. It's best not to
ballot
too hard lest the umbilical cord fall below the head. A gentle tap to
feel
ballotability is sufficient when wanting/needing that information. It
is
possible to ballot externally, but they (those that judge) wouldn't
consider
that accurate. When there is a question about head/pelvic
compatibility,
docs
and midwives have been known to push the baby into the pelvis to see
if the
baby fits. We can actually feel the head above the pelvic bone (pubic
symphasis) if it does not go into the pelvis.
Of course, for goodness sake, that is zero indication of being able
to fit
through the pelvis and is nearly absurd to even put a mom emotionally
through
the experience. The baby's head isn't in the position of its own
choosing,
the woman is lying down, the pelvis isn't open to its full capacity,
the
baby's head hasn't molded... la la la.
What does a baby's ballotability mean for me? It gives me warning
about cord
prolapse... that is about it. While I share about cord prolapse with
each
client, if I find a baby high during prenatals (even externally), I
have the
woman look me in the eye so she understands what to do if her water
breaks
before I see her again to see where that baby is. (A midwife is the
product
of the sum of her experiences... and I have had 2 cord prolapses in my
hands.)
The head being high is an avenue for a cord to slip around the head
as the
membranes release, the head possibly following, compressing the
cord – a life-threatening emergency for the baby.
So, what does it feel like when your fingers are in the vagina and
you touch
the baby's head? Hard compared to the soft and gooshy vagina and
cervix...
even through the vagina as opposed to inside and through an open
cervix, the
head can be felt. If you are able to reach in and feel the baby easily
without reaching far, the baby could be at zero station or less. If
the baby
feels really close (5-6 cm in) to the introitus of your vagina, s/he
could
be
at a plus 1 or 2 station (what you might find in good active labor).
The
baby's head able to be seen with pushes, and not in-between
contractions/surges? Plus 3. Able to be seen between contractions and
continues birthing? Plus 4. Plus 5 is crowning if a plus 5 is used.
Now, I know that stations typically are described as the widest
diameter of
the baby's head being aligned with the ischial spines of the mom (zero
station if it is even with the spines). That is an obscure
description for
many people and I hope that how I described it is easier to be "seen."
Stations, like effacement, mean virtually nothing in the grand scheme
of
things unless progress is an issue during active labor. Station can
give us
a
heads up on what might be happening with a baby's head position...
with
inability to mold easily... or if mom has pelvic issues (a former
accident
or
severe anorexia as a teen). Otherwise, it is just another measurement
midwives are taught to do as a matter of course.
CERVICAL LIP:
Since I mentioned this above, I feel I should talk about it for a
moment.
Lips can be anywhere, but almost always called "anterior lips" mostly
because
when a head is entering the vagina during 8-10 cm dilation, feeling
behind
to
find a posterior lip is nearly impossible. We usually will
mention/chart
where it is... the most common locations are between 11:00 and 2:00.
What might cause a cervical lip? After talking to hundreds of folks
who have
felt and know cervices, there seems to be an agreement that cervices
do not
dilate in a symmetrical manner. It probably doesn't dilate in an oval
path,
either, but most likely, in a fluid pattern whereby some parts are
more
dilated and effaced than others, yet those same parts could seem to
lag
behind another portion of the cervix ten minutes later. I believe
that if
there were a way to accurately and continuously measure the diameter
of
cervices during labor, it would be shown how asymmetrical dilation
really is
(and I do not advocate creating or utilizing such a tool!).
Therefore, I
believe that a cervical lip is nothing more than the asymmetrical
cervix
finishing her job dilating and that so many women have cervical lips
because
so many people put their fingers in to find them. I believe that if
there
was
a realization (or acknowledgement) of this asymmetry surrounding the
entire
dilation process, amazing amounts of hysteria from the medical
establishment
could result – and, conversely, women could use the information
towards
their
own empowerment and refusal to allow the arbitrariness of a cervical
exam
affect the emotional and spiritual progress of their labors.
However, most don't acknowledge or accept this theory and feel they
need to
do something with a cervical lip. There is a lot of discussion in
midwifery
and medical communities about what to do and this is certainly a case
of
experience dictating what the care provider does, but I have really
come to
believe if your hands aren't in your vagina (or someone else's hands
in your
vagina), you won't know you have a lip! But, for those that really do
want
to know what is taught and done during lips in labor, here goes.
Most midwives agree to not put pressure on the swollen lip... rest it
by
lying on the opposite side of the lip (unless it is truly anterior,
then
switching sides can be beneficial). If the lip is more on one side
than the
other, after resting, flip sides to put pressure on the cervix and
see if
that helps. Some midwives use ice to take the swelling down, putting
the ice
in a sterile glove if possible. Some midwives lift the floppy cervix
over
the
babe's head. Some midwives shove "stubborn" (thick) lips out of the
way.
Some
midwives manually dilate their client's cervices (for a number of
reasons
including selfishness [being tired], or when a baby needs to get out
fast).
It helps to let a woman do what feels right and if it hurts, don't
push! If
it feels good, then push.
The common belief is if a woman pushes before she is fully dilated
(the
excuse for vaginal exams to see if it is "time to push"), she will
tear her
cervix. In 23 years and over 800 births, I have seen a torn cervix
one time
(with a non-instrumental [forceps] birth) and the woman delivered her
6th
baby so fast that baby just fell out, no exams at all. All those women
pushing on lips, pushing before they were ready, pushing when told
not to...
no tears at all. I have felt cervices swell closed (a couple three
centimeters more closed) with pushing, but not torn. Listening to the
body
cannot be stressed enough and, when upright, the body rarely forgets
what to
do.
I hope this information has helped those that want or need this
information
for themselves. Even women who have care providers and allow those
providers
to do vaginal exams have found the descriptions helpful as they
visualize
what is happening inside their own bodies.
Remembering that vaginal exams, even by the same midwife, doctor,
partner,
or yourself is subjective and what might be felt by one caregiver
would
register a totally different description by another a few minutes
later.
Our bodies are fluids, not solids. Change is normal. Being with our
bodies
during those changes can be delightful!
Barbara E. Herrera strives to be a low-profile midwife and share as
much
information with women as she is asked, believing the information
belongs to
the women, not only in the proprietary hands of doctors, nurses, or
midwives
