Inital physical exam? - Page 2

[sevenkids]

Originally Posted by BetsyS

In my experiences when I was working, this was my patient population. We did exams to pick up on things because, other than pregnancy, our population used the ER as primary care.

I guess, to me and my colleagues, it felt like part of caring for the whole woman, and not just her pregnancy.

Yes, I see it as offering holistic care....there's more to a pregnant woman than her pregnancy and what's going on in other parts of her body is going to have an effect on her pregnancy, even if it's simply her comfort and general well-being. If I find a TMJ out of whack, I think she's going to feel a whole lot better if she gets it worked on. If I see an uneven gait or a curved spine, I'd want her to see a chiropractor before she gets big and starts feeling pelvic, hip and back pain. If I feel an enlarged thyroid, I'd want that followed up on. A lot of my clients have never been taught how to do a breast self-exam.

Besides, I may be being totally egocentric, but I think I do a more sensitive, compassionate and personal exam than an MD with 60 other patients to see that day. The disparities in health care are very apparent in my area and among my clients, so it's very important to me to close that gap as much as I can.

[sevenkids]

Oh, and I was gonna ask, does anybody even do pelvimetry outside of the classroom anymore?

[CarolynnMarilynn]

I don't offer breast exams to examine breasts for potential breastfeeding issues as there is nothing I would *do* about flat nipples or inverted nipples. In my experience almost all babies do just fine at the breast, although sometimes it may take extra time. I am happy to assess when the woman is actually breastfeeding. I offer breast exams specifically for breast lumps and bumps, and to proactively discuss breast self exams as an option women, or their partners, may want to start doing on a regular basis.

[Charmie981]

Really? Given my experience with my own flat nipples, I recommend shells in pregnancy and if mom has flat or inverted nipples, I'd want her to know it might take a little more work to get baby latched on so she doesn't get frustrated.

Nope, I don't do pelvimetry and wasn't ever really taught it, aside from "if you can touch bone in the posterior side of the pelvis during a vaginal exam, it's unlikely a baby will fit through there" I don't even know if that qualifies as pelvimetry!

[Jane]

Are people using different terms here? I wouldn't think a "initial physical exam" would include a pap/pelvimetry. Although I do offer that, if desired and indicated.

[Reha]

Well, according the the NARM PEP material, the physical exam includes:
general appearance
baseline weight and height
vital signs
HEENT (hair and scalp, eyes, thyroid, enlarged lymph glands of neck, chest, under arms, mouth, teeth, mucous membrane, tongue)
Breast condition, by examination
torso, extremities for bruising, abrasions, moles, unusual growths
baseline reflexes
heart and lungs
the abdomen, by palpation and observation for scars
kidney pain (CVAT)
the spine
pelvic landmarks
pelvic measurement
the condition of the uterus, ovaries, cervix (by speculum): performs a Pap, obtains gynecological cultures
the size of the uterus and fetal age (by bimanual exam), the condition of the vulva, vagina, cervix, perineum, and anus

[Jane]

Yeah, so I did that for the NARM, but I wouldn't do all that for every person, only what's indicated. If dating is good, I don't do dating by pelvic size on 'real' clients. I only do CVA thumping if the person is complaining of back pain or has UTI s/sx, for another example.

[bobandjess99]

My midwife (cnm) offers a a full range of services, including full physical exam and labs, etc, but is okay if you decline. She's never touched me except to palpate my belly a bit and tell me what position the baby is in, take my blood pressure, and measure my fundus, all with my consent. She also, with my consent (not implied either, even though I had asked for the visit, and obviously wanted her help, she still very specifically asked my permission to touch my breast right before actually started touching me), did some touching of my breasts during a postpartum lactation visit, because dd was having latch issues.

[rnchrista]

Originally Posted by Apricot

Are people using different terms here? I wouldn't think a "initial physical exam" would include a pap/pelvimetry. Although I do offer that, if desired and indicated.

I think so. I should clarify, we don't actually get them undressed for their physical, unnless they ask for a pap and breast exam. But otherwide we go through the whole body system (i.e. look at their pupils, look inside thier mouth, etc), again, just to get ready for NARM

[Gilby]

I've had a PE each time and our practice does one unless it is declined by the client.

[Jane]

I do think it's good to practice for the NARM - It might be nice to do one each week until it's routine. Between learning it and taking the exam, I lost some of my smoothness in going from one thing to another. In clinicals I never pick through someone's hair, and even though I know how to do it, it felt so funny at the exam.

[kltroy]

My first pregnancy CNM did an initial physical exam, which I thought was fine. This pregnancy, a different CNM did not do one. Also fine. I really don't have a problem with it either way and think it's probably not a bad idea to do one so that your MW has a "starting place" to know how things are on you. After all, the MW is supposed to care for you as a WOMAN, not just for your baby and pregnancy. In that context, having a PE every year or two seems reasonable to me. After all, how many of us actually reguarly do breast self-exams etc? (And seriously, for those of us who are nursing, would we be able to tell anything anyway?)

[valeria_vi]

Originally Posted by sevenkids

Oh, and I was gonna ask, does anybody even do pelvimetry outside of the classroom anymore?

i interviewed a dem 3 years ago who wouldn't take me as a client if i didn't let her do it. i didn't want it done and explained my reasons to her, but she didn't think they were more important them her reasons to get it done. in the end i didn't choose this mw, partially because of how pushy she was about this issue. besides, it made me wonder how pushy she might get the next time we disagree or in general.

[Reha]

Originally Posted by valeria_vi

i interviewed a dem 3 years ago who wouldn't take me as a client if i didn't let her do it. i didn't want it done and explained my reasons to her, but she didn't think they were more important them her reasons to get it done. in the end i didn't choose this mw, partially because of how pushy she was about this issue. besides, it made me wonder how pushy she might get the next time we disagree or in general.

Wow. :

[MidwifeErika]

[veganf]

My midwife never did. I wouldn't have hired her if she required one.

[Mamabeakley]

My homebirth CNMs did, including breast exam and pelvic, and I'm pretty sure at least one of them actually did pelvimetry and wrote something down about it. It didn't bother me. But I certainly hope it wouldn't bother them if someone declined.

I do breast self exams. It's easier now that my cycle has resumed. I find that things are pretty smooth in there right after my period.