Re: [ozmidwifery] any benefit to teaching women self examination?

Thu, 06 Apr 2006 05:27:31 -0700

Just arrived home from such a birth in our unit, 2-3 cm to birth in 1 hour.
 
The woman I cared for birthed less quickly (5hrs) and I almost managed not to disturb her birth with a VE , but after 30 min of almost second stage behaviour, thought I should do a quick check. But was only quick and on the birthstool, she had a lip, was still there when i checked again half hour later but disappeared with just a little pressure kept on during the surge.
A bit disappointed in myself, I know it would have gone in time by itself and I was just being impatient I suppose.
Cheers,
Di
----- Original Message -----
Sent: Thursday, April 06, 2006 9:44 AM
Subject: Re: [ozmidwifery] any benefit to teaching women self examination?

Hi Sue,
 
I too have seen many transitional women at 3 or 4cm who birthed within in the hour!
 
Melissa
----- Original Message -----
Sent: Wednesday, April 05, 2006 8:10 PM
Subject: Re: [ozmidwifery] any benefit to teaching women self examination?

I have long thought that transition phase has nothing to do with how many centimetres dilated a woman is, have been laughed at several times for suggesting that a woman was transitional at only 3cms, only to have a birth within 1/2 hour. I have known even very experienced midwives get VE's wrong - one memorable one was a woman who was supposed to be 'fully' and in reality had a posterior closed os, which had not been reached - the midwife was feeling the head stretching the anterior vag wall and had not felt back far enough to reach the os. Mistook the bulging anterior wall for an open cervix.  Another who self-examined and got the stage correct (5cms) but entirely missed the fact that it was an undiagnosed breech!  She just thought the baby was bald :-)
Melissa - I agree that your own assessment at home was probably correct and can only assume that the admitting midwife made an error, but you own behaviour at that time was surely transitional!  (still, a good story to dine out on !! :-))
For myself I found self examination quite easy but did not do it prior to going in- was most disappointed to be told I was only 5cms and not thinking that my labour was strong and that I was transitional - delivered 1 hour later, after self-checking and finding an anterior lip.
I don't know how women not used to feeling their own bodies would fare - as student midwives we all found this to be one of the hardest skills to learn and it took many VE's before it clicked for me.
Ina May Gaskin, and others also speak of cervix's actually 'going backwards' and I have seen this occasionally.
Interesting thoughts
Sue
"The only thing necessary for the triumph of evil is for good men to do nothing"
Edmund Burke
----- Original Message -----
Sent: Tuesday, April 04, 2006 12:35 PM
Subject: RE: [ozmidwifery] any benefit to teaching women self examination?

Oh – what a stressful experience – I had something similar happen for my first vaginal birth (and labour) when I was examined I was only 3 but I thought I must have been 8 and felt really panicky and then within about 20 mins I was pushing and 15 minutes later my baby was born.  But it was very disheartening thinking I didn’t know where my body was at.  I believe my VE was correct – I was just having transitional type contractions with my cervix not far behind!  It just reinforces the question of how useful is a VE? 

 

Maxine

From: owner-[email protected] [mailto:owner-[email protected]] On Behalf Of Melissa Singer
Sent: Tuesday, 4 April 2006 2:04 PM
To: [email protected]
Subject: Re: [ozmidwifery] any benefit to teaching women self examination?

 

Hi Maxine,

 

This is my own personal experience with self examination.

 

I'm a midwife of ten years working in a hospital setting (ie have done plenty of V.E's!!) and when I had my first baby just over a year ago I laboured at home from 11am until midnight when I did my own examination and I could have sworn I felt a 5 cm dilated cervix with bulging membranes.  From there I decided to go to the birth centre which was 45min away.  I had strong regular contractions but coping fairly well at home in the shower.  My husband was asleep - typical!   When I arrived the midwife examined me (I didn't tell her I had performed my own) and she said I had a posterior closed and uneffaced cervix.  I was baffled about the discrepancy and absolutely mortified I, as a midwife, had arrived to the birth centre sooooo early.  She suggested we go home so I did.  I screamed all the way home, stayed there for 1/2hr and decided if I had to go another 12hrs with this intense pain I needed drugs and drove the 45 mins back fighting the urge to go to the loo for a poo.  Arrived and jumped in the bath a screamed out a baby girl.  Much to the midwife's surprise!  My husband told her the head was out.

 

Anyway, I'm still not convinced her examination was right looking at the time line of events, but I was coping so well at home  and when I was told I hadn't even started to efface yet I lost the plot!  When I arrived back the midwife must have thought I still had ages to go because I didn't received one word from her, let alone reassuring, that it was all O.K and I was nearing the end.

 

Melissa

----- Original Message -----

Sent: Tuesday, April 04, 2006 8:00 AM

Subject: RE: [ozmidwifery] any benefit to teaching women self examination?

 

Hi Julie – an interesting concept and I have actually had this discussion before-  Was it with you? I think as a student midwife that vaginal exams were one of the most difficult clinical skills to learn, because initially everything felt the same – soft and squishy and it took a bit of experience to start to discern the different textures and landmarks.  This may be different for other midwives though – I may have been a slow learner!!  Though it did seem pretty universal at the time I trained for it to be a skill that took some practice for us students ( oh poor women in teaching hospitals).  Maybe teaching methods are different/better now.  So my initial response is it may be hard for a woman to feel how dilated she is but the descent of the head may be easier for her to feel but not necessarily relevant if she was in early labour.

I was a support person at a client’s birth the other night and she spontaneously (ie noone suggested it) put her finger inside her vagina to feel where her baby was, she was in a bath and had slow progress when pushing so actually checked her own progress (descent of the head) and gave the midwife feedback.

I am interested to see what others think.

 

Maxine

 

 

From: owner-[email protected] [mailto:owner-[email protected]] On Behalf Of Julie Clarke
Sent: Tuesday, 4 April 2006 6:51 AM
To: [email protected]
Subject: [ozmidwifery] any benefit to teaching women self examination?

 

Hello. It seems that women admitted to labour wards in the latent phase of labour are more likely to have interventions, and up to 80% of women presenting can have admission delayed (Lauzon & Hodnett 2001).  I have sought information on how to determine the transition from latent to active phase and it seems that the main physiological marker used in diagnosis is the dilatation of the cervix.  I am wondering if there would be any benefit to teaching women self examination as a method of delaying admission.  I would appreciate any feedback, comments, opinions, experiences. Thank you, Julie

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