Why just one exam in labor is ordinarily enough
By Doula Delight From Bahama islands info
Ordinarily, the only necessary vaginal exam in labor is the one that determines if the mother is indeed in active labor. It is true, that in cases of arrested labor, additional exams may become necessary, however, since 80-85 % of most labors are uncomplicated and progress as nature intends, one exam will suffice most labors. The essential information obtained from a vaginal exam is the degree of effacement (thinness of the cervix which is important because a thin cervix will dilate more efficiently than does a thick one) and dilation (opening) of the cervix, the place of the baby in the maternal pelvis (how low in the pelvis the baby is) and the position of both the cervix (forward-directed is labor friendly) and the baby (how compactly is the baby coming). The nature of respectful and ethical care requires that any and all vaginal exams be performed only with the mother’s consent. Vaginal exams will not reveal either when labor will begin or how long labor will take.
Repeated and frequent vaginal exams especially by many caregivers cause needless discomfort and ordinarily embarrassment for the mother. Not only are these exams unnecessary but also they are disagreement provoking relative to the status of the labor. Because the assessments of effacement and dilation are subjective, there is frequent disagreement among those examining the mother as to the degree of effacement and dilation that exists as well as with the place and position of the fetus in the pelvis.
It is not as important to know exactly how many centimeters dilated a mother is as it is to know that her labor is progressing. That is unless the labor is being forced to follow the timeline of a labor graph (partogram) or the labor is being driven by pitocin to encourage a more rapid progress of labor because of obstetrical protocols or the active management of labor philosophy (forcing a labor on an artificial course rather than allowing it to progress naturally). The activity of the labor (nature of uterine contractions), maternal response to the labor at a given point in time (extroverted versus introverted or emotions all over the spectrum), physiologic signs (increasing bloody show, a sudden and isolated episode of vomiting, perspiration , feeling hot, and fetal heart rate changes) and maternal intuition are far better indicators of a progressing labor than cervical dilation is. Oxytocin, the contraction maker and natural conductor of labor is a shy hormone. This is to say that, this “mother-maker,” works best in a calm, dimly lit, quiet sanctuary in the presence of unobtrusive trusted companions. Under these conditions, a laboring woman will intuitively move, breathe, make sounds, and do what it takes to birth her baby most easily.
Repeated vaginal exams have the possibility of causing harm physically, mentally and emotionally. With each and every vaginal exam comes the threat of infection because bacteria from the external genitalia is pushed up into the vaginal canal and towards the cervix. There is also the risk of “accidently” rupturing the amnionic sac as dilation progresses. Ruptured membranes further increase a mother’s (and baby’s) likelihood of infection because the protective barrier of the amnionic sac is lost.
Of particular concern, writes midwife Yeshi Neumann, is the possible mental and emotional trauma that can occur because “elements in the pelvic exam can bring up emotions, sensations, images or memories of prior sexual abuse” (p. 336). Given the estimated incidence of childhood sexual abuse (the rates of which are similar in many countries) (pp. 4-5), the need for caution and sensitivity relative to vaginal exams is important. Intrinsic triggers generated by labor (vaginal exams) can evoke negative and traumatizing memories, emotions and physical feelings involving the parts of the body that may have been violated,6 (breasts, vagina, and/or rectum). In summary, it is best that birth attendants “keep their hands to themselves.”
Doula Delight is the premier independent doula service in the Commonwealth of the Bahamas. Doula Delight empowers childbearing families to make educated birth choices that reflect current evidence-based practices to promote healthy and safe birth outcomes as well as breastfeeding success. As professional labor assistants, Doula Delight doulas educate, support and advocate for childbearing families by nurturing them physically, emotionally, and spiritually in the sacred process of birth. We are at your service 24 x 7. Please call 374MUMS or 646-6045 or 351-1697. http://douladelightbahamas.org/
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