There is some strong correlational evidence to suggest a shortened labour if ARM is performed late second stage or third stage and this may be of benefit for a woman with hypertension who is on the edge of requiring other more invasive intervention. I would find it easier to diagnose breech, do manoeuvres for shoulder dystocia, etc without a bag of forewaters, but of course the risk of ARM must be outweighed by the benefits of doing it. And the indications must be strong. And there is no doubt that on some occasions a baby may be saved by the use of forceps or vacuum extraction, neither of which can be done with intact membranes, and though many of you will point out this is a medical intervention, in some parts of the world they are indeed a life-saving midwifery practice as well.
I agree, Marilyn, we have lost many of our arts because of medical appropriation of them and legal proscription against our performing of them. We may have developed others to overcome this handicap, however, that is not sufficient reason not to reclaim them. I know of centres where midwives are NOT ALLOWED to perform VE, many where they are not allowed to rupture membranes, and only few where they are allowed to suture. In a framework of continuity of midwifery care and the debate over the scope of the midwife, I think this is more a power and control issue than it is one of 'best practice'. We once also turned breeches, performed abortions, verified virginity, baptised babies in danger of death................ the surest way to kill a midwife is to limit her to only those tasks medicine can't be bothered with (like 'support and monitoring' between doctor's visits such as is noted in some medical texts about the role of the midwife). Maralyn is right about this, to limit or draw a ring around midwifery practice causes it to stifle. A very interesting discussion indeed. Trish Marilyn Kleidon wrote: > Hi Trish: > > I love these discussions too! And find myself agreeing with all here! I also > think we need to be aware that some of the skills deemed "medical" or > "obstetric" (VE's and ARM's for example) and indeed at some level are > interventions, became missing from the midwife's tool bag historically > because of legislation instigated by doctors. This was in the period of time > when they were trying to make midwifery illegal in Britain, the USA and > Canada: succeeding in the USA and Canada towards the later part of the 19th > Century and early 20th. Thus midwives who continued to practice learned to > do so without tools that were deemed to be the scope of practice of the > medical profession. This also included attending births without oxytocics or > oxygen as these became available and instead having a pharmacopia of herbs > and other medicinals usually no longer in the medical kit. > > All I am saying is we do need to cautious about drawing boundaries around > what is good midwifery practice. > > As for ARM's I seem to know of no good reason for doing them other than > strong maternal request. I peronally love to have a baby born in the caul, > but also know this freaks some other practitioners out. I have never had an > incident with a baby, and have always been able to simply wipe the caul > away(and save it of course), but do know from comments that it does worry > some (midwives/doctors) regarding the first breath. Has it (being born in > the caul) really ever been associated with delayed respirations, amniotic > fluid aspiration, anything else? > > The only other reason I have heard (but can't bring myself to do) for ARM is > if you are suspecting mec stained liquor: confirming it or not... so as to > decide place of birth: home or hospital perhaps ... for baby resusc purposes > (actually not supported by current research on MAS), just wondering what you > all think? > > marilyn > > ----- Original Message ----- > From: "Trish David" <[EMAIL PROTECTED]> > To: <[EMAIL PROTECTED]> > Sent: Sunday, October 03, 2004 5:24 PM > Subject: Re: [ozmidwifery] VE > > > Mary, Denise, I agree. However, and I risk a minor lashing, I have found > it, on > > occasion, necessary to do a VE on a woman not in labour to reassure her > that she > > will (or will not) go into labour shortly. This has been for a variety of > > reasons ranging from my imminent absence for a few days interstate and her > > desire to have me at her birth, to another's warm-up niggles and her worry > that > > she would be in labour during (1) her partner's trial for burglary or (2) > her > > grandmother's funeral. All wanted reassurance that labour would/not start > within > > a couple of days. A long firm closed posterior cervix is less likely to > preclude > > an imminent labour than one that has started to efface/dilate and which is > > central or anterior (some of the factors in the Bishop Score). On each of > these > > occasions they were 'social VEs' instigated at the woman's request, and > > performed with the best of intentions. An intervention, for sure, but are > all > > interventions necessarily bad? (This question also puts me in mind of > 'natural > > induction' with remedies like cohosh and evening primrose or orange juice > and > > castor oil, or even penetrative sex, none of which are effective when the > cervix > > is long, firm, posterior and closed. It is still an induction or an > attempted > > one, but nevertheless an intervention which seems to be accorded less > censure > > than a 'medical' one.) And in my opinion, to refuse such a request because > of my > > belief that all women should be powerful enough to be accepting of their > body > > and to trust the process would be to impose my ideological position upon > them in > > a context which has not prepared them to accept it. Now was not the time > to > > begin that education process, but perhaps for next time? > > > > I would suggest, and some of my own research informs this notion, that the > > technology that allows 'knowledge' (and I count in this simple > technologies like > > partograms and centile charts for tracking fundal height, right up to VEs > and > > pinards) becomes oppressive when used with an ideological intent that > subsumes > > women's interests to powerful others'. So, ARM by a doctor intent on > getting > > home is 'bad' while ARM by a midwife intent on shortening labour at the > woman's > > request because she is sure she needs it is 'good'? > > > > The converse would be to suggest that women who want to shorten labour are > > somehow ducking their responsibility to take labour at it's natural best, > and > > yet we have absolutely NO idea what this is and have no way of knowing > since we > > can't separate cultural practices of birth from the unadulterated biology > of it. > > > > Therefore, the best we can hope for, I think, is to practice our culture > of > > birth humanely, VE or no VE. > > > > All power to those independent midwives, birth centre and caseload/team > > midwives, and especially to those midwives in very medicalised settings > who do > > this so well. And thanks, Mary, this discussion is exactly what you called > for, > > a rethink on VEs. I love this list, and our students reading these posts > are > > exposed to discussions that we find it difficult to introduce into the > > classrooms, because of the amount of 'fact' we have to impart, and the > lack of > > resources to allow panel discussions of experienced practitioners. So > please, > > keep up the discussions like this, I am sure they are deeply appreciated. > > > > Trish > > > > Mary Murphy wrote: > > > > > Going right back to the beginning, I said that we should "re-think > V.e's" > > > Obviously I realise that they are a valuable tool when caring for > women in > > > labour. Again, we need to learn to diagnose labour correctly without > > > relying on V.E's. Putting ones hand into the vagina and finding a long, > > > thick, cervix means that a woman is not in establsihed labour. This > could > > > have been diagnosed by eyes and ears. I don't mean to prolong the > > > discussion unnecessarily, but it has been a fruitful discussion between > > > midwives of all skill levels and experience. Stacey, keep asking > questions > > > and above all, keep searching for women friendly practices. cheers, MM > > > > > > -- > > > 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. -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
