Dear Trish Whilst I agree with your first sentiment <They are a tool in the professional midwife's kit that should be used with caution, judgement, humanity and great respect. They should only be practised by skillfull practitioners who know the theory behind what they are doing, the evidence basis for them, and the ramifications of not doing as well as of doing them
I have not heard any one say or suggest < you will never have to use them, so therefore should never learn them. I likened it to using a thermeometer to confirm what a midwife would suspect or know from being "with woman" And I know when student's learn about taking using a thermometer they learn about the factor's that can influence the reading and no measurement is infallible and uncontaminated by context the latter is particularly true for VE's though not recognised or reflected by medical facilities and practitioner's which I and many other midwives have known and been constrainted by! It was these influences to which I was ineptly refereing. Denise Hynd "Never believe that a few caring people can't change the world. For, indeed, they are the only ones who ever have." Margaret Mead ----- Original Message ----- From: "Trish David" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Sunday, October 03, 2004 12:22 PM Subject: Re: [ozmidwifery] VE > VEs are like perineal suturing and rupturing of membranes. They are a tool in > the professional midwife's kit that should be used with caution, judgement, > humanity and great respect. They should only be practised by skillfull > practitioners who know the theory behind what they are doing, the evidence basis > for them, and the ramifications of not doing as well as of doing them. To think > you will never have to use them, so therefore should never learn them (like > resuscitation) puts women at risk of a bungle. Therefore, as skills that have > been part of the midwife's kit bag for millennia, I would suggest ALL midwives > should be competent (not merely manually able) to perform VE, ARM, suturing, > emergency procedures, waterbirth and so on and so on. We can teach skills, we > can encourage learning, but we can only mentor and role-model compassion, > judgement and a woman-centred philosophy. > > Trish > > Belinda Maier wrote: > > > I think that Stacey needs to learn ves because regardless of what we ideally > > want for birth at present times ves are a major aspect in the care of women > > in labour wards. I would rather a caring midwife do them than anyone else so > > if you know how to do them then you can maintain your care without a doctor > > or other midwife coming in to your room. With the high use of synto and > > epidurals listening is often not enough because they both change everything. > > This is the reality Stacey will have to face until the perspective of birth > > changes and women also seek change. I agree with most of the comments that > > you can manage birth without ves but for the majority of women who at > > present birth in labour wards it is a rare time for them not to have one. > > That is not to say we always have to do one but it is also the case that > > women are taught to expect ves and to worry about their dilation. Ves can > > sometimes reassure them they are doing okay. In my practice I avoid ves and > > do believe that you can hear what dilation women are at, but I had an > > experience when my friend was having a fast third labour after two horrible > > labours. She did not believe she was in good labour and while I reassured > > her and explained why I didn't need to do a ves she didn't enjoy this birth > > and I regret not doing a ve to tell her her dilation. When Stacey is > > confident with ves then she will be confident in defining her own practice > > (and defending it). > > Stacey try holding your hand into a fist fingers curled feeling across the > > bottom of your fist (little finger end) that is roughly the thickness and > > note your cant get your finger inwhere your little finger is curled. going > > up the side is the length both roughly 3cm and 3cm. > > Women in long or in labour but not active yet often are effacing that is the > > thickness is going but not dilating and when they do start to dilate often > > then move quickly. Also just because a woman is maybe 1cm dilated and still > > long and posterior doesn't mean she wont be birthing in the next hour or so. > > This is where listening to her is vital especially if she has birthed before > > and she is telling you she is in good labour or will have it soon etc > > For positions get a doll and a pelvis and practice heaps as well as figuring > > out what you would feel on palpation, you can pick up delflexed heads etc by > > palp but it takes confidence in your palp skills - and time is needed for > > that. > > Good luck and dont forget we all started with more queastions than answers - > > you will get there > > Belinda > > > > -- > > This mailing list is sponsored by ACE Graphics. > > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
