Engagement: the last time that word was on your lips, it was probably cropping up alongside terms like diamond ring, champagne and bended knee. Not these days, though. The only engagement youre interested in right now concerns the relationship between your unborn babys head and your pelvis.
Your baby is said to be engaged when the widest diameter of his or her head has descended into your pelvis; in other words, when most of it is down behind your pubic bone, ready to make the short journey through the cervix and vagina and out into the world. Your midwife will probably start checking for signs of engagement from about 36 weeks. Shell feel for the babys head, and then quite firmly try to palpate both sides of the head to assess how much of it is still up above the pubic bone, and how much has disappeared below.
In their training midwives are taught to mentally divide the babys head into fifths: they then judge how many fifths are inside the pelvis, and how many are above. This is why, if you listen in on conversations outside any pre-natal clinic, youll hear women saying how theyre two-fifths or four-fifths engaged.
One slight hiccup, though, seems to be that different midwives have different ways of looking at the engagement issue when it comes to writing it all down in your notes. What youll find is that some will record you as being three-fifths engaged, meaning three-fifths of the babys head is in your pelvis, and others will write the same thing meaning three-fifths are still palpable above.
All very confusing but, says Sue Jacob of the Royal College of Midwives, the main message you need to take away with you is that what you want is for four-fifths, or indeed all five-fifths, to be safely down behind your pelvic bone, and youll know youre in business for the birth.
Or will you? Well, its certainly a good sign but its not, on the other hand, a total clincher. If you go ordering your champagne supper for two days time, or planning your mothers trip down from Manchester for next weekend assuming your little bundle will definitely be out by then, youre being much too hasty. The fact is, babies heads can sometimes engage a couple of weeks, or even more, before you have any signs whatsoever of going into labour.
Its important to be clear, at this point, that what happens vis ? vis engagement with a first baby is very different from what happens when youre pregnant for a second or subsequent time. Basically, toned muscles and a uterus thats never been so stretched before means things are all a bit OK, a lot tighter on your insides when youre having your first baby, and as a result first babies tend to nestle down into their mums hip area, and then stay there, a lot sooner.
Second, third and fourth time around, babies tend to be in no hurry at all. Why should they, really: your now nicely pre-stretched uterus can accommodate them comfortably for longer, so they just dont feel the need to be squeezed down into the pelvis until labour is already well under way.
Thus your babys head being engaged means something quite different depending on whether its your first or second child: no need at all to worry, if youve had one or more babies before, about whether this one is engaged or not, because a perfectly straightforward labour could be just around the corner even if your little one shows no signs at all of heading south.
With a first, although its by no means a cast-iron guarantee of everything going swimmingly, midwives do tend to greet the discovery that the babys head is engaged with a certain jubilation. The reason is that, having got down into the pelvis, the baby has more or less proved he or she will, probably, fit through the gap.
Where a first baby hasnt engaged at 38 or 39 weeks, says Jacob, the question has to be asked: why not? Is the baby too big, or the pelvis too small, for the head to fit? And if so, what are the implications for the delivery? If youre nearing your due date and your babys head isnt engaged, do talk it through with your midwife or obstetrician: it used to be fashionable among the childbirth community not to set too much store by whether engagement had happened or not but, says Jacob, the tide is turning and its once again seen as a significant event.
Nor is it just about size and whether your babys head will fit through your birth canal. Once the babys head is engaged its pressing down onto the cervix, and there it has an important job to do in helping to ripen and prepare the neck of the womb for labour.
From a comfort point of view, too, engagement is definitely a good thing. Once the head is down in the pelvis youll probably feel a lot less squashed in the upper part of your body if youve suffered from heartburn, you may well feel it ease a lot. Known as lightening or dropping, the feeling of the babys head moving down for the birth is greeted the world over as a sign that things are quite literally moving in the right direction. You might feel you can get a lung-full of air for the first time in months and while sitting down may prove a distinctly odd sensation now theres a babys head wedged into your pelvis, the general verdict among pregnant women seems to be that the last few days and weeks of pregnancy are eased, slightly, by a babys descent towards the world outside l
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