May 28, 2004

Vaginal examinations during labour

Midwifery students often have a hard time when they venture out into the hospital system to undertake the practical components of their education. They learn some exciting things in the University and then discover that the “real world” of practise is very different, creating confusion and in some cases, despondency.

A student contacted me today after she had attended one of my Active Birth workshops. During that program she learned about performing vaginal examinations while women were upright, rather than lying down on a bed. We had talked about the impact of performing this invasive procedure on women and the need to help them feel more in charge of the process and less vulnerable, on those occasions when it is really necessary to check the cervical dilatation.

The student had reflected on this, and changed her practice, receiving positive feedback from the women. Her hospital based clinical supervisor, however, had other ideas and challenged the validity of performing a vaginal exam in this way. She wanted the evidence before she would support this student and also challenged the occupational health and safety issues for the midwife of working like this.

Amazing but not surprising! As I pointed out to this student, it sounded like this midwife was very challenged by the student’s perceptive ideas and felt uncomfortable supporting her (she probably had never tried this technique herself). The crux of this matter is that it is the woman who is central here, not the student nor the supervising midwife. If the woman is happier off the bed, then the midwife must follow her lead and be of service to her in the most appropriate way. Yes, there could be issues for some midwives with bad backs etc, but as I demonstrated at the workshop, these concerns can easily be overcome if the midwife sits down on a low stool, or kneels on one knee. If this is beyond the midwife’s capabilities, then perhaps she should either abandon the procedure (a great idea!) or else find someone who is fitter for the job to take over.

People who feel threatened by new techniques often react by demanding “show me the evidence”. I suggested to the student that she ask her clinical supervisor to find the evidence that performing a vaginal examination on a recumbent woman does not cause distress, discomfort or anxiety. It is a technique that midwives have been undertaking for years, and is a basic skill that hardly needs evidence to support it - just practise!

Posted by andrea at May 28, 2004 05:55 PM

Comments

Hi there,
I am a Midwife in Auckland New Zealand.
We are often challenged about new or different thoughts by people because they feel threatened by our ability to be prepared to practice in a manner that they don't have the confidence or skill to do..... after all we are all vulnerable people now and then and often that vulnerability is expressed in defensiveness....

Posted by: Jane on May 31, 2004 08:32 AM

Comments

I have a question actually and would appreciate it if anyone could email me with an answer. I was 7cm dilated, then arm, then ie then baby turned to transverse lie, does this happen often?

Posted by: sharon on October 27, 2004 03:27 PM