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Cervical exams

490 Views 3 Replies 3 Participants Last post by  Carolinamidwife
Do you do them? How frequently? Do you feel they are necessary?

In the area where I live most midwives are, IMO, cervical exam happy. They don't want women pushing until they have confirmed completion. As I have only been a student here I'm worried my perception is skewed and I want other opinions, philosophies etc.

Am I being naive to think that when a woman's body tells her to push she should push? I'm being serious here, not flip. If it hurts that would be her sign to stop... or at least that makes sense to me.

I would love a practice where I didn't do routine cervical checks. Possible? Not possible?
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Definatly possible.

I've done several births with no VE at all, including my first birth as primary. During my apprenticeship, I've worked with 12 (!) midwives in our area, and some like to check, some don't unless there's a problem, or the mom really wants a VE.

My primary preceptor is very minimalistic with VE. So much so that I felt like I couldn't get ANY experience checking dilation! I was thrilled that moms weren't being subjected to "routine" VE, but I was also (I admit, very selfishly
getting frustrated that I didn't have but a few chances a year to find a cervix and assess dilation. And I'm sorry, but those "flesh-like" teaching models don't feel a thing like the real thing.

Then I went and worked at one of the birth centers and was suprised at how much more checking they did there.

Made me very happy that my first year of apprenticeship was spent learning with one of the most hands-off midwives in the area, IME.
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Checking to see if a woman is complete is basically telling the woman that it's the midwife, not her body, that will be dictating the labor. I also feel that when a woman is checked to see if she is complete, second stage is sooo much longer and there is more directed pushing.

Here is something I wrote once about this issue:

When a woman is at 8 or 9 cm, I have observed small grunts at the peak of contractions. These small pushes appear to be totally involuntary-in fact, women do not realize they are doing it at all. This actually seems to help with the last couple of centimeters of dilation.
One of the most disruptive things a provider can do at this point is to ask, "Were you pushing? Did you feel pushy? Wait-don't push. Let me check you first to see if you're ready." Of course she's not ready-she's not doing that full-baby-on-the-pelvic-floor type of pushing. She's got a couple of centimeters to go, but she's close. So the provider will tell her that NO, she's NOT ready, and DON'T push, not yet.
The effect of this is that she's now in her head about her labor, no longer trusting her body. Body = wrong. Midwife's fingers = right. She continues to look to the provider for direction now. Nothing she feels or knows is true. The birth no longer belongs to the mother and the wisdom of her body.
Then again, if she is 10 cm, there's movement and sometimes cheerleading to get her pushing: having her hold her breath, then, "Quick! Another breath quickly. Now push, push, push push PUSH PUSH PUSH!!!" to counts of ten, whether or not the mother actually feels the urge to push. The clock of progress for second stage has started.
It's okay for mothers to wait-to sleep, to rest, to take a shower, to eat-while waiting for a true urge to push. She can let her uterus do the hard work of bringing the baby down until the overwhelming, spontaneous urges begin.
By forcing a woman to push just because she's 10 cm-or even take her out of her labor space by doing dilation checks to see if she's "complete," we create a situation in which the woman needs input and direction from others in order to birth her baby. Forced pushing leads to maternal exhaustion and more direction, typically, by the provider. In addition to not being in tune with her body's messages, there are often more vaginal exams during this time, which interferes with the natural response to second stage.
The theory about the cervix swelling if a woman pushes too soon is mostly bul*sh&t. Seriously. In many cultures, women start bearing down quite a bit even in the earlier parts of labor. It takes a malpositioned baby or some very serious pushing to swell a cervix!

The idea that there are so many anterior lips is also a pure product created by midwives who are checking to see if women are complete. It is my belief that anterior lips naturally happen as the final portion of dilation occurs - it's not something that necessarily needs to be pushed out of the way or fiddled with. If a woman is listening to her body, she more than likely adopts a different position that naturally puts pressure of the presenting part on the cervix that helps it melt away.

It's hard when you learn with more aggressive midwives - in some ways you have to "unlearn" so many things. I'm still doing that and I have to admit that I'm not even close to being the mw I want to be.

I do vaginal exams when I'm concerned about position, and only after asking. I've had many clients turn me down and I, in turn, have turned many clients down when they requested one (for fear of them being disappointed, etc.).
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Thank you, both. It's very affirming when you learn that your instinct is correct, KWIM?

And also interesting about the anterior lip because I attended many births with one midwife whose clients always seemed to have the lip... I have worked with 9 or 10 midwives and they do run the gamut intervention wise but only one that comes to mind did I never see do more than one check.
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