Self-Help: Key to Understanding the Changes Our Bodies Go Through During Pregnancy

Excerpt from Chapter 1 of Woman-Centered Pregnancy and Birth by Ginny Cassidy-Brinn, R.N., Francie Hornstein, and Carol Downer
Federation of Feminist Women's Health Centers
Illustrations by Suzann Gage

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To actually see your cervix and the opening to the uterus-the opening that will dilate to allow the baby's head to come out-can be one of the most exciting moments in your pregnancy. Suddenly, all of the diagrams and drawings that you have been looking at to try to understand what is happening, make perfect sense. And, just as when a woman is not pregnant, being able to look at the cervix makes it easier to ward off or alleviate common problems such as vaginal infections or urinary tract infections.

It is not essential to do vaginal self-examination in order to understand the processes of pregnancy and birth or in order to stay healthy. Any woman can carry out all of the suggestions in this book without ever seeing her cervix. Self-examination of the vagina and cervix using a plastic vaginal speculum is, however, very simple to learn, requires a minimum of equipment and is a common-sense health routine equivalent to standing in front of a mirror, opening your mouth and saying, "Ah."

Self-examination can be done by yourself or in a self-help group. The Self-Help Clinic started out in April, 1971, as a type of consciousness-raising group. The Self-Help Clinic is a meeting where women learn to do self-examination of the vagina, the cervix and discuss their health experiences. Depending on the age, sexual orientation, and wishes of the participants, the topic may be birth control, menopause, sexuality, childbirth, vaginal infections or feelings about our bodies.

The equipment needed for self-examination is a vaginal speculum, a light and mirror. Most women prefer a semi-sitting position on a bed, table or the floor, usually with a pillow behind them. Water soluble jelly can be used to moisten the bills of the speculum. The speculum is inserted with the bills closed, handle up. Many women are pleasantly surprised to find that, since they are in control, the procedure is not painful. You open the speculum by pushing down the front of the handle while simultaneously pulling up on the back. As the speculum opens, you will hear three clicks. You can lock the speculum into place at whichever notch is comfortable. Speculum's come in three sizes, narrow, medium and long. Most women use a medium. Many women who usually used a narrow speculum found it was easier to insert a medium size speculum during pregnancy. Many women have noticed that their cervixes moved further back in the vagina during pregnancy and found it necessary to switch from their usual medium size speculum to a long one.

The light, generally a flashlight or a high-intensity lamp, is reflected off the mirror so that the vaginal walls and cervix are illuminated. Magnifying mirrors can help you to see details.

Often, women need several attempts to bring the cervix into view. But, with practice it becomes much easier. No one who has tried persistently has failed to use the speculum successfully. As your abdomen gets larger with pregnancy it becomes more difficult to see your cervix. By lying flat, self-examination can be made easier with the help of one other person holding a large mirror over your cervix. As pregnancy progresses, the cervix grows along with the rest of the uterus. Some women's cervices get so large that it is possible to see only a portion of the cervix at any one time. By pointing the speculum in different directions, you can eventually see the entire cervix.

You can safely do vaginal self-examination throughout pregnancy as long as the bag of waters hasn't broken and you are having no signs of miscarriage. These guidelines are the same as the guidelines for deciding when it is safe to have coitus (see p. 61)

Two customs are observed in the Self-Help Clinic. A woman does self-examination if and when she feels comfortable doing so, and she gets to look at her cervix fist. Many women want to do self-examination at the first meeting; others take their speculum's home to have their first look in privacy. Initially, a woman may feel reluctant to do self-examination if she is menstruating of has a bad-smelling vaginal infection. When she finds out that the other women are eager to learn about menstruation or vaginal infections, she is generally happy to give them a chance to learn. Embarrassment is replaced by curiosity; some have called it "show and tell time."

The distinctive sounds of a Self-Help Clinic are the clicking of speculums, the buzzing of several conversations and intermittent choruses of laughter. An air of discovery and adventure exhilarate most women in the Self-Help Clinic.

Another important part of the Self-Help Clinic is the uterine size check. A member of the group can feel your uterus by inserting two fingers of a gloved hand into the vagina pressing with the flat of the fingers of the other hand just above the pubic mound. After the first three months of pregnancy it is not necessary to insert the fingers into the vagina. While lying flat, the uterus can be felt by pressing down under the ribs, with the flat of the fingers, and gradually moving the fingers down toward the pelvis until a hard muscular ball is felt. This is the top of the uterus which get approximately one inch higher per month during pregnancy. The purpose of the uterine size check is to learn the size, shape and position of the uterus. Its growth can be recorded by periodically measuring the distance from the top of the uterus to the pubic bone with a tape measure laid flat on the uterus. A uterine size check can also be done to see if the uterus is larger or softer than usual, indicating pregnancy.

At the first Self-Help Clinic we learned to do self-examination of the cervix and vagina. As woman after woman inserted her speculum, looked at her cervix, then passed around the flashlight so that others could look, we exclaimed over the different characteristics of each women. It soon became obvious that the so-called "disease" of yeast overgrowth is a common and generally harmless condition. In an era of tight jeans, nylon pantyhose, the Pill, and high sugar diets, we have varying amounts of yeast in our vaginas. We were struck by the absurdity of having made numerous trips to the doctor to deal with this everyday common problem. All but one of us had "tipped uterus," which merely means that is was angled wither toward the back or front instead of the classic, textbook angle. One women recalled that her doctor said her tipped uterus accounted for her problems in getting pregnant. Another said that her doctor had blamed her tipped uterus for her many pregnancies. Just by talking to each other and comparing notes, we could see how we had been made to feel like there was something wrong when, in fact, we were quite healthy.

That very first evening of self-help, like all those that have followed, liberated us from many of the myths and notions that had driven us to the gynecologist. We found that irregular menstrual cycles are not uncommon; very few of us fit the 28-day cycle model. Our normal secretions varied throughout our cycle, becoming very heavy around the time of ovulation. This "discharge" had caused many of us great concern.

Menstrual Extraction is an early accomplishment of the Self-Help movement. Lorraine Rothman invented the Del-Em, a device used by groups of women to suction out the uterine contents on or near to the time of the expected menstrual period. This technique, which shortens the menstrual period, lightens the flow, or terminates an early pregnancy, has been used by women for ten years with outstanding safety and success. If this technology were widely available to women, the dark ages of state control of women's reproduction would be over. We would cease to worry about what the predominately male Supreme Court or legislature dictate.

The concepts of Self-Help have had a tremendous impact on the women's health movement. Lorraine Rothman and Carol Downer, members of the first Self-Help Clinic, travelled around the country in the fall of 1971, visiting women's groups to lecture on abortion and to hold Self-Help Clinics. Many women's health groups had reached an impasse at that time. They were counseling and referring women to abortion facilities on the East and West coasts and they had read Women and Their Bodies, the predecessor to Our Bodies, Ourselves. But they felt unable to proceed further due to lack of funds and the lack of cooperation of the medical profession in their communities. Self-Help gave them the ability to directly learn well-woman health care. They were able to do independent research, to compile information and finally, to set up women-controlled clinics.

The women in a Self-Help group in Santa Cruz, California taught themselves to be midwives and later formed the United States' first birth center, the Santa Cruz Birth Center. The concept of a community center where women having home births could come for prenatal care and meet other pregnant women has since become very popular. One of the midwives in this group, Raven Lang, wrote the first and for several years the only book on home birth, The Birth Book. This book inspired many mothers to have home births and many women to become midwives.

Woman-Centered Pregnancy and Birth focuses on information that enables you to make important decisions about your pregnancy and birth. Learning self-examination is an important first step, and a self-help group is the best setting in which to learn it.

You can order a plastic speculum from the Feminist Women's Health Center or the Women's Health Specialists

Also, visit "Our Anatomy" webpage for further information.

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Woman-Centered Pregnancy and Birth published in 1984 - we encourage comments, insights and suggestions; please write whwh@womenshealthinwomenshands.org