vaginal exams during labor - Page 4

[BeckiCNM]

Originally Posted by Romana9+2

This is a good paper about the issue:

http://digitalcommons.law.umaryland....ntext=fac_pubs

I have a friend in med school and she was horrified at the prospect of something like that. She didn't have the opportunity to do a single vaginal exam on a live person during her entire OB rotation. Obviously, different medical schools handle this differently.

Wow, that's pretty impressive. Most med students are doing births during their rotations.

Absolutely the idea of doing exams on unconsenting, unconscious patients is awful - I have heard of it, but have not seen it at any teaching hospital I have been at. When I was teaching nursing students in their OB rotations, I would allow them to do exams on a laboring woman if the woman agreed under two conditions - they had to have an epidural and they had to be intact (no ROM). But only if the woman agreed. Most women were OK with it.

[Robinna]

Originally Posted by trimestersdoula

I also have that very hang up. That area is mine and my husbands.....no one elses.

me too. I did hypnosis for phobia so that the concept no longer causes panic attacks, but still no motivation whatsoever to permit it unless there seems a very good reason.

And no, I was never abused by anybody - experiencing the procedure itself was enough to create the phobia.

[Ecstatic]

Originally Posted by maxmama

Because anatomy is easier to identify under anesthesia (lax muscles). Not defending the practice, just pointing out why it's been done.

I figured that part. My question was more directed to why any medical professional would think it's a moral idea to have this done without specifically asking the woman for consent. Really just makes me sick to even think about it.

[maxmama]

Originally Posted by Ecstatic

I figured that part. My question was more directed to why any medical professional would think it's a moral idea to have this done without specifically asking the woman for consent. Really just makes me sick to even think about it.

Because technically they have consented as part of their general consent, and because it was not even a norm to require any consent until the 1960s, and then only sporadically. It's not currently done in any med schools that I know of, but it's important to remember that the concept of patient's rights is very new.

[mwherbs]

there are several articles in the bigger journals and it continutes to what degree I am not sure but in 2003 it was done in about 90% of the schools-- and it appears that OB clerkship has a negative impact as far as regarding patient's rights ---




Am J Obstet Gynecol. 2003 Feb;188(2):575-9.

Comment in:
Am J Obstet Gynecol. 2003 Dec;189(6):1808; author reply 1808-9.

Don't ask, don't tell: a change in medical student attitudes after
obstetrics/gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient.

Ubel PA, Jepson C, Silver-Isenstadt A.

Veterans Affairs Health Services Research and Development Center of Excellence, Veterans Affairs Ann Arbor Healthcare System, USA. [e-mail]

OBJECTIVE: We explore whether the completion of an obstetrics/gynecology
clerkship is associated with a decline in the importance that students place on
seeking permission from the patient before conducting a pelvic examination while she is anesthetized. STUDY DESIGN: Students at five Philadelphia area medical schools (n = 401 students) were asked how important it would be for a patient to be told that a medical student will perform a pelvic examination while she is anesthetized. We examined associations between the completion of an obstetrics/gynecology clerkship and attitudes toward consent with the use of linear regression to adjust for gender and the total amount of clerkship
experience. RESULTS: After the data were controlled for gender and the total
number of clerkships that had been completed, we found that students who had completed an obstetrics/gynecology clerkship thought that consent was
significantly less important than did those students who had not completed a
clerkship (P =.01). CONCLUSION: To avoid this decline in attitudes toward seeking consent, clerkship directors should ensure that students perform examinations only after patients have given consent explicitly.

PMID: 12592274 [PubMed - indexed for MEDLINE]


===============================
J Okla State Med Assoc. 2005 Aug;98(8):386-8.

Ethics versus education: pelvic exams on anesthetized women.

Schniederjan S, Donovan GK.

University of Oklahoma College of Medicine, USA.

In a survey of junior and senior medical students at the University of Oklahoma, a large majority of respondents reported having performed pelvic exams on anesthetized gynecologic surgery patients. Nearly three-quarters also reported believing that these patients had not specifically consented to undergo exams by students during their surgical procedures. While some students and medical educators maintain that pelvic exams under anesthesia are necessary for the development of students' examination skills, this assertion has not gone unquestioned. Serious ethical concerns have been raised by members of the medical community and women's advocacy groups, and the practice was recently outlawed in one state. Despite this widespread opposition, non-consented pelvic examinations evidently remain a common practice in US teaching hospitals. Our consideration of this controversial issue leads us to conclude that explicit, informed consent must be obtained in order for pelvic examinations to be performed on surgical patients, or risk compromising the doctor-patient relationship.

PMID: 16206868 [PubMed - indexed for MEDLINE]

[dinahx]

Because technically they have consented as part of their general consent, and because it was not even a norm to require any consent until the 1960s, and then only sporadically. It's not currently done in any med schools that I know of, but it's important to remember that the concept of patient's rights is very new.

The concept is certainly not new. Medical awknowledgement of that concept may be new . . . .

[3xx1xyFamily]

I've been declining vaginal exams to this point in my pregnancy. My midwife suggested I let her do one previous to onset of labor to have a 'baseline' of where I started labor at and how long it's taking to progress (not setting a timeline, just tracking).

I'm still not really wanting one... we'll see. I have an appt tomorrow and am 3 days to EDD... I am kinda curious if I've had any progress thus far so I may give in.

During labor I only plan to let her check me once I feel the urge to push, just to make sure my cervix really is ready.

[Robinna]

what is "clerkship"?

[Romana]

Originally Posted by Robinna

what is "clerkship"?

I'm guessing an OB rotation? i.e. the weeks you spend doing OB stuff while a 2nd, 3rd, or 4th year med student.

[doctorjen]

Usually med students do some required rotations through the major medical fields during their third year and those are called clerkships. These hospital rotations are where the student learns the specific history and exam skills for that specialty.

In my med school, we learned to do pelvic exams on trained, paid models. I'm not sure who that sort of job appeals to, exactly, but I'm grateful that the first person I ever did a pelvic exam on knew it was the first time I'd ever performed one, knew how to guide me, and wasn't in need of any medical care and trading her body for the care she needed.

The only time I ever did a pelvic exam under anesthesia was when a patient was having pelvic surgery. For example, if I was on the gynecology rotation and working with a surgeon who was doing a vaginal hysterectomy that day, when s/he did his initial exam prior to starting the surgery, s/he might have the student also feel the position of the uterus, or the nature of the muscles, or whatever, along with explaining how s/he used the exam to determine what type of incision and how to proceed during surgery. It would have been part of the whole process of doing the surgery - not like "heh, heh, she's asleep let's feel her vagina" kind of thing.

I know in the past students sometimes were allowed to do pelvic exams even on women who were under for non-gyne surgery, or when the surgery itself wouldn't normally involve an exam.

For labor, I don't like to do routine exams anyway, but when we are training a new labor and delivery nurse, I will let them do an exam if we are doing one anyway, membranes are intact, and the client consents.

[maxmama]

Originally Posted by doctorjen

Usually med students do some required rotations through the major medical fields during their third year and those are called clerkships. These hospital rotations are where the student learns the specific history and exam skills for that specialty.

In my med school, we learned to do pelvic exams on trained, paid models. I'm not sure who that sort of job appeals to, exactly, but I'm grateful that the first person I ever did a pelvic exam on knew it was the first time I'd ever performed one, knew how to guide me, and wasn't in need of any medical care and trading her body for the care she needed.

The only time I ever did a pelvic exam under anesthesia was when a patient was having pelvic surgery. For example, if I was on the gynecology rotation and working with a surgeon who was doing a vaginal hysterectomy that day, when s/he did his initial exam prior to starting the surgery, s/he might have the student also feel the position of the uterus, or the nature of the muscles, or whatever, along with explaining how s/he used the exam to determine what type of incision and how to proceed during surgery. It would have been part of the whole process of doing the surgery - not like "heh, heh, she's asleep let's feel her vagina" kind of thing.

I know in the past students sometimes were allowed to do pelvic exams even on women who were under for non-gyne surgery, or when the surgery itself wouldn't normally involve an exam.

For labor, I don't like to do routine exams anyway, but when we are training a new labor and delivery nurse, I will let them do an exam if we are doing one anyway, membranes are intact, and the client consents.

Um, I was a pelvic and breast exam model while in school. The kind of person it appeals to ? The broke kind. We were paid $25/hr, which was a lot of money when I was living on $700/month.

[mwherbs]

one of the midwives I use to work with was a paid exam model for the local medical school-- she wanted to teach folks and give feedback about doing a good exam- as well as getting paid to do it--
when learning as a midwife we practice/learned on each other

[doctorjen]

The model I learned with was a nurse practioner! I didn't mean any disrespect with the comment about who the job appeals to - just sort of commenting that I wasn't sure what field most of the folks were in, or what their motivation was in response to some one above mentioning the idea of using prostitutes. I was just meaning I didn't know who/what occupation/why most of our models were. The one I worked with said that she did it because she felt it was important for people to learn on volunteers, and to have someone able to teach them what to do. It was great to have her guiding me "you need to push down a little more with the speculum" kind of stuff. Also, I think having trained, paid models emphasizes to students more that the learning we do comes at a price - in this case the price is actual money for the paid volunteers, in other cases it is the comfort of the clients who suffer through learners. In many settings poor clients especially must let the trainees do their exams in order to get what they need (birth control, STD testing, whatever.) I don't think that's fair.

Originally Posted by mwherbs

one of the midwives I use to work with was a paid exam model for the local medical school-- she wanted to teach folks and give feedback about doing a good exam- as well as getting paid to do it--
when learning as a midwife we practice/learned on each other

[nashvillemidwife]

I was never able to participate in a class that employed practicing on each other. I have a pelvic pain disorder so that scenario just wasn't appropriate. The only option I had was to find a friend willing to stand in for me, and I couldn't find one (can't blame them). Though needless to say, I've always been very gentle with pelvic exams because of my own experiences.

Luckily when I went to nursing school we used paid models.