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Speculum Happy???

693 Views 1 Reply 2 Participants Last post by  doctorjen
Ok, some of you know that last week, I made a trip into the dreaded L&D ward. I was having very bad pain, and I ended up having cxs every 2-4 min while there, and THEN my blood pressure dropped WAY low (which is surprising, because normally that building sends my bp HIGH!!!).

While I was there, I was asked four different times if I would consent to a speculum exam! I am (according to their records) 35 wks. I was in an obvious labor pattern. When I asked why a SE was needed, I was first told "To check to make sure your water hasn't broken." Now, I have had 3 other children, all in a hospital, one with a CNM and two with an OB, and I have NEVER had a SE to check my membranes!!! Is this some new thing? And when I said "If you have to check, I'd prefer nitrazine paper.", the nurse looked at me like I'd grown horns and asked what that was! It seems to be "hospital policy" that they do fern tests on everyone.

THEN, after I got that all cleared up, I was told that I HAD to have a SE "It could save your lives..." to make sure that infection wasn't causing my cxs. Um, hello! Did you actually look at my history??? It's not an infection causing my cxs, it's my uterus! I've never gotten through a pregnancy (and I already have 3 kids at home) without having to go in for PTL nine thousand times. It's amazing to me that this time, I've only been in two or three times! AND, if you want my labor to STOP, the last thing you need to do is put a speculum in there!!!! The last thing on earth a contracting uterus needs is a speculum up close and personal!!!

Is this some new doctor dementia that is spreading across the nation? Or do I only need to slap the doctors at the hospital here?

(and thanks for letting me vent....)
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I am answering this speaking completely from an allopathic medical perspective, so keep that in mind. I don't necessarily agree with the whole thinking, but it is the way I was trained, so I do understand what they were thinking.
In general, for preterm labor or preterm contractions, the standard of care is not to do a digital cervical exam at all, or if one is deemed necessary (to determine degree of dilation, especially if you are not sure if this is labor or not) to only do one if you have definitively concluded that the membranes are intact. To definitively conclude this, a sterile speculum exam is performed, and any fluid seen tested usually with nitrazine and by ferning. Ferning is more specific than nitrazine paper, since nitrazine can also turn blue due to blood, or cervical mucus. Especially in a case where the docs in question don't know the patient, I expect they would proceed with this standard of care. A gentle speculum exam should not theoretically stimulate contractions since the speculum theoretically only touches the outside of the cervix.
Preterm contractions can be caused by vaginal infections or by urinary tract infections so that is why they like to rule those things out.
Anyway, I'm guessing that's why they were bugging you to have an exam. When you don't want something the docs are recommending, they generally come up with more and more forceful and sometimes outlandish reasons why you should have it done, so you tend to go from "well, since you are having regular contractions and you're not due for over a month, we really should do a speculum exam to make sure there isn't a reason for these contractions, like a vaginal infection, or a slow amniotic fluid leak" to "If you don't have this test you and your baby could die." (Like, um, hello isn't the worst we're talking here is a slightly preterm baby born to a healthy mom since there aren't any other signs of generalized infection?)
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