Yes Trish: If you need to do one of these interventions, with good indication, the BOW must be broken. But not just to avoid a mess.
marilyn ----- Original Message ----- From: "Trish David" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Sunday, October 03, 2004 7:17 PM Subject: Re: [ozmidwifery] VE, ARM etc.. > 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. > -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
