[ozmidwifery] routine VE's

[Mary Murphy]

Recently there was a question about the evidence for routine VE’s in labour.  I thought I’d contribute this:     Forms of care unlikely to be beneficial Frequent scheduled vaginal examinations in labor   31 Thought I’d put this in as well. MM Routine directed pushing during the second stage of labor   32 Pushing by sustained bearing down during the second stage of labor   32 Breath holding during the second stage of labor   32 Early bearing down during the second stage of labor   32 Arbitrary limitation of the duration of the second stage of labor   32 'Ironing out' or massaging the perineum during the second stage of labor   32 www.birthpsychology.com/messages/cervical/cervical.html   BMJ 1995;311:469 (19 August) (exerpts) Study criticises protocols for labour A high proportion of the protocols provided by hospitals for women in normal labour are unsatisfactory, according to a new report from the Clinical Standards Advisory Group. The report cites regular vaginal examination during labour as an example of a routine procedure performed "without providing evidence of benefit." All the protocols emphasised that labour should be managed with care and respect for the woman's wishes. But the report says: "Some procedures are apparently recommended almost routinely. The assumption that they are necessary, in the interests of the child and woman, may be questioned. For example regular vaginal examinations (at least every 2 or 4 hours), rupture of the membranes at a cervical dilatation of 3-4 cm and the management of the second stage of labour." Comparison of the expected number of vaginal examinations indicated by the protocols with the number actually performed during labour showed that 71% of women had more vaginal examinations than expected. The Benefits of Using Water for Labour and Birth Extract from “Water Birth” by Janet Balaskas. Midwives who attend water births often have to develop different ways of assessing progress in labour. Instead of routine vaginal examinations to check dilation, the midwife relies on more subtle indicators, such as the woman’s breathing, vocalisations and movements. In fact, many midwives feel that attending labours and births in water has added an extra dimension to their midwifery skills, including an extra sensitivity to changes in the mother without the need for manual confirmation.