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<div>Originally Posted by <strong>BugMacGee</strong> <a href="/community/forum/post/10137508"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Meh, I'd consider my mouth to be the more intimate of the two. Just me. In reality, you don't really need your teeth to be cleaned by anyone else either.</div>
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I actually agree with that as well.
 

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Ok, maxmama. I didn't realize some people don't associate sexuality with their vaginas. An interesting viewpoint. I can't relate. Anyway, I never said anything about how people should feel. I said it seemed strange to me that so many women are fine with strangers sticking hands in them. I do think it's strange. Don't tell me how <b>I</b> should feel about that. I'm allowed to think something is strange, just as you're allowed to view your vagina as just another body part like an ear.
 

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<div>Originally Posted by <strong>SublimeBirthGirl</strong> <a href="/community/forum/post/10140967"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Ok, maxmama. I didn't realize some people don't associate sexuality with their vaginas. An interesting viewpoint. I can't relate. Anyway, I never said anything about how people should feel. I said it seemed strange to me that so many women are fine with strangers sticking hands in them. I do think it's strange. Don't tell me how <b>I</b> should feel about that. I'm allowed to think something is strange, just as you're allowed to view your vagina as just another body part like an ear.</div>
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I just don't mythologize the vagina. It is a body part. I don't see how that's strange.
 

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Once again, as with the narcotics thread, those who actually attend laboring women on a regular basis think that exams are sometimes useful but not to be overused, and those with the strongly held opinions against exams don't see why exams are ever useful.<br><br>
Me, I've found that I've been attending most multip labors without ever doing an exam. Not by design or intention, it's just happened that way.<br><br>
Primips I like to check when I get to their house, mainly to know if I should be there yet or not. My volume is high enough that for me to be present during every primip prodromal labor is a foolish waste of my energy. FTR, I've never missed a birth because I left after doing an early labor check. Sometimes it's my inituition, sometimes it's the mom's, but when it appears to be early labor, but it's really 2 cms-about-to-deliver, I've know when to stay.<br><br>
I also like to do an exam on primips before actively pushing, because I've had a few too many of them pushing against a 4 cm cervix. I've also had the opposite-primips who are complete and +3 but somehow not pushing! In those situations, I don't "coach" them to push; I just encourage them to reconnect with their body.<br><br>
The single most valuable thing I can get from an exam in a protracted labor is the baby's position. Then I can figure out which positions will help facilitate the baby's way out.<br><br>
For those of you who are against any exams, ever-if/when you go to midwifery school, please come back and tell us how your perspective changes with your first genuinely protracted, pathologic labor-because they DO exist.<br><br>
Also-there is a subtle but at the same time large difference between "interfering" and "intervening".
 

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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">My volume is high enough that for me to be present during every primip prodromal labor is a foolish waste of my energy.</td>
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I'm definitely not arguing with the main message of your post, but just so you know, my labor would have gone WAY better if my midwife had stayed with me during my primip prodromal labor . . . As it was, I developed a serious fear/abandonment/unmet expectactions complex which held up my labor in a serious way. I felt like no one would help me and was very anxious to get my contractions close enough together to warrant my midwife being there . . . Now it was on me to communicate my expectations more clearly, but staying with a primip prodrome is not a complete "waste of time" IMO, and could very well provide the pyschological support that helps a scared first time mama progress faster. Just my .02<br><br><br><br>
ETA: People putting their fingers in your yoni is serious, IMO, even if some women have "no problem" with it . . . More likely they are just desenstizied to it . . . I definitely don't think it has no place, and I would even consent to it in certain situations, but it DEFINITELY is not regarded as seriously/reverently/modestly as it should be in our culture . . . . In history, it has been a very frequent introducer of infectious agents. And I don't entirely believe that gloves are 100% sterile. I think they could be more aptly described as 'relatively microbe free'.
 

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I think the key here is the laboring woman's choice, no? It always astounds me when practitioners have protocols about this and give women no choices. When I was interviewing midwives for my first birth, I was fortunately savvy enough to ask a lot about "required" VEs and drag out the answers (rarely was it information that was offered upfront). Amazingly, some midwives told me I wouldn't know when to push if they didn't check (??!!). I never got the answer that they would "require" a check to make sure they weren't wasting their time attending my birth "too early".<br><br>
I think the one size fits all approach is ridiculous...it smacks of hospital birthing rules and the "what ifs" but ignores a very real set of "what ifs"...such as what if the act of checking traumatizes the woman or impedes labor or introduces infection, etc. Clearly a VE can sometimes give good information, but egads, making it SOP? I think care providers need to think long and hard about this.<br><br>
FWIW, mostly aimed towards the posters who are dismissing birthing womens' concerns about routine VEs, a lot of what I've learned about non-interventive birthing has been on these boards from birthing professionals, in particular, pamamidwife and doctorjen.
 

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<div>Originally Posted by <strong>maxmama</strong> <a href="/community/forum/post/10141250"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I just don't mythologize the vagina. It is a body part. I don't see how that's strange.</div>
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I didn't say it was mythical. I said it was sexual.<br><br><div style="margin:20px;margin-top:5px;">
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<div>Originally Posted by <strong>jengacnm</strong></div>
<div style="font-style:italic;">Once again, as with the narcotics thread, those who actually attend laboring women on a regular basis think that exams are sometimes useful but not to be overused, and those with the strongly held opinions against exams don't see why exams are ever useful.</div>
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I can see how they might be useful, for example a mother getting to the hospital and not sure how active her labor is, trying to decide whether to stay or go home. I think exams are almost never <i>necessary</i>, though. They don't tell us when babies will come, and babies can be born without them.
 

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<div>Originally Posted by <strong>maxmama</strong> <a href="/community/forum/post/10141250"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I just don't mythologize the vagina. It is a body part. I don't see how that's strange.</div>
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<br><img alt="" class="inlineimg" src="/img/vbsmilies/smilies/yeahthat.gif" style="border:0px solid;" title="yeah that">:<br><br>
In the context of having sex, my vagina is a private and sexual thing. So are my breasts.<br>
In the context of having a pap smear or a VE, I don't feel like my vagina is at all sexual or in need of much privacy. In the context of nursing, or getting a mammogram, my breasts aren't private or sexual either. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/shrug.gif" style="border:0px solid;" title="shrug">: Just because a body part has one particular function doesn't mean it has to carry that function along with it to every other event it might participate in.<br><br>
Of <b>course</b> VE's are overused and of <b>course</b> a woman should always be able to refuse them if they make her at all uncomfortable. But for me, one of the main reasons I want a midwife to attend my births is so that she can see when a minor intervention can prevent the need for a major one later on. <b>Sometimes</b>, vaginal exams can help with that.<br><br><div style="margin:20px;margin-top:5px;">
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<div>Originally Posted by <strong>SublimeBirthGirl</strong> <a href="/community/forum/post/10148216"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I think exams are almost never <i>necessary</i>, though. They don't tell us when babies will come, and babies can be born without them.</div>
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I can agree with that whole-heartedly. My personal criteria, though, for whether or not to allow something is closer to "Is this helpful?" than "Is this absolutely necessary?"
 

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I get way overwhelmed and near panic attack when getting dental work and I have had alot of it-- I don't like vag exams either but in my face is a bit more invasive in that sense-- but even while doing a UC I did my own vaginal exams because I was having so much prodromal labor- I wanted to see if any thing was changing at all--I have done many many births infact the majority of births I have attended I /we haven't done vaginal exams... but I have found them useful on occasion--
 

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Once again, as with the narcotics thread, those who actually attend laboring women on a regular basis think that exams are sometimes useful but not to be overused, and those with the strongly held opinions against exams don't see why exams are ever useful.<br><br>
Me, I've found that I've been attending most multip labors without ever doing an exam. Not by design or intention, it's just happened that way.<br><br>
Primips I like to check when I get to their house, mainly to know if I should be there yet or not. My volume is high enough that for me to be present during every primip prodromal labor is a foolish waste of my energy. FTR, I've never missed a birth because I left after doing an early labor check. Sometimes it's my inituition, sometimes it's the mom's, but when it appears to be early labor, but it's really 2 cms-about-to-deliver, I've know when to stay.<br><br>
I also like to do an exam on primips before actively pushing, because I've had a few too many of them pushing against a 4 cm cervix. I've also had the opposite-primips who are complete and +3 but somehow not pushing! In those situations, I don't "coach" them to push; I just encourage them to reconnect with their body.<br><br>
The single most valuable thing I can get from an exam in a protracted labor is the baby's position. Then I can figure out which positions will help facilitate the baby's way out.<br><br><br><br><br>
jenacnm...<br><br>
Same as me - The initial exam on a primip gives me a lot of information that I can use to facilitate the birth and make good use of my time. I do think it's important that the women feels safe about doing their early labor with her partner or support person. Of course everyone is different - some want to be alone and get uncomfortable with everyone standing around twiddling their thumbs. Others need more support.<br>
Multips are an easier read.....I don't frequently do exams.<br>
On this same subject, and speaking of intuition - which is a favorite area of interest to me - have you ever kept track of how accurately you can determine dilation after the initial phone call or observation? I've gotten to be really good - and I'm almost always able to guess correctly. It is a skill - much like palpating the fetal position that I think has become a (one of many) lost art. I encourage my students to hone these skills and not to rely on sonograms for information that is usually right at their fingertips.<br>
Happy New Year.....<br><br>
Carla
 

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<i>I'm definitely not arguing with the main message of your post, but just so you know, my labor would have gone WAY better if my midwife had stayed with me during my primip prodromal labor . . . As it was, I developed a serious fear/abandonment/unmet expectactions complex which held up my labor in a serious way. I felt like no one would help me and was very anxious to get my contractions close enough together to warrant my midwife being there . . . Now it was on me to communicate my expectations more clearly, but staying with a primip prodrome is not a complete "waste of time" IMO, and could very well provide the pyschological support that helps a scared first time mama progress faster. Just my .02</i><br><br>
I'm clear with clients from relatively early that I want to be there during active labor-if they anticipate wanting or needing support during early labor, that they should hire a doula.<br><br>
I think the key here is the laboring woman's choice, no? It always astounds me when practitioners have <b>protocols</b> about this and give women <b>no choices</b>. When I was interviewing midwives for my first birth, I was fortunately savvy enough to ask a lot about <b>"required</b>" VEs and <b>drag out the answers</b> (rarely was it information that was offered upfront). Amazingly, some midwives told me I wouldn't know when to push if they didn't check (??!!). I never got the answer that they would <b>"require"</b> a check to make sure they weren't <b>wasting their time</b> attending my birth "too early".<br><br>
Whoa, back up the truck! My language in my original post is "I like". Nowhere do I say "I require". Don't look for demons when there isn't one. If a client flatly refuses an exam, I'll figure out how to work around it.<br><br>
For the most part, though, I like communication with my client to be open from the beginning. If a woman knows she doesn't want an exam for any reason ever, I would think she would screen herself out at the interview. I won't promise that I won't do an exam, but I CAN promise that if I think one needs to be done, that she'll understand why and we will achieve mutuality in the decision.
 

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<div>Originally Posted by <strong>doctorjen</strong> <a href="/community/forum/post/10138473"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">And those clients with premature pushing urges? Often it's because baby is mal-positioned, especially posterior and putting lots of pressure on the rectum causing a true pushing urge. Sometimes that's something that can be corrected by position changes, or maybe having mom get in the water which can relieve some of that pressure.</div>
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Whew.<br><br>
By the way, the rest of your description of when you do checks and how you do checks is exactly in line with what I know of you and exactly in line with my little happy bubble world of how all birth attendants could be.<br><br>
I'd thought the discussion was over routine VEs done "just because", since it's about VEs in general then there are definitely appropriate times for them. (And plenty of birth attendants who are capable of judging when those times are.)
 

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Great to see all these perspectives!<br><br>
My OP was definitely about exams done "just because." I was having severe contractions 2-3 minutes apart from Monday afternoon through Wednesday morning when I gave birth my first birth, so I definitely understand the prolonged labor concept! I gave birth with a midwife in a hospital, so the first exam I had was early Wednesday morning when I finally went in, and I did not then and do not now object to that exam. The next (and last) exam was when the midwife heard from my breathing that I was starting to push and wanted to be sure I was ready. Again, no complaints there.<br><br>
Now the midwives had tried to convince me to come in to their office during the day Tuesday to be checked, and I refused, for two reasons: 1) I was quite miserable already (hadn't slept since labor began Sunday evening), and their office was only two blocks from the hospital. I had the feeling that if I dragged myself down there I would not have the energy to go back home, and I wasn't ready to be in the hospital yet; and 2) some intuition told me I wasn't dilating very quickly and I knew that hearing a low number would depress me, maybe even lead me to get some intervention. There were over 12 hours between when they started pushing me to come in for an exam and when I was finally checked, so I'll never know how far dilated I was, but I'm glad I did what I did.<br><br>
What prompted my post was my talk with my current ob/gyn practice over VEs during labor. One doctor told me that I would have to have a VE every week from 36 weeks on, but the doctor I saw at 36 weeks admitted that there's basically no point and didn't do one. She argued, however, that at some point they become necessary for "deciding things like induction," to which I responded, "yes, well, we won't be inducing until 42 weeks barring fetal distress, so I'll consent to an exam at 41 weeks." In my birth plan, I acknowledged that they would want to do one VE when I went in to the hospital, but requested that there be no other VEs unless they were obviously indicated by some clear change in my laboring, sign of fetal distress, or a request for medications. The doctor insists that periodic exams during labor are necessary ("not every <i>hour</i>, but frequently enough that I know what's going on"). She said, "Well, if you were in the hospital for hours and didn't progress past 3-4 centimeters, we might want to send you home -- wouldn't you want to know about it?" I told her it was very unlikely I'd be in the hospital at that point, but that no, I wouldn't want to "know about it," at least not unless I asked. I have the feeling that she brought that example up, as opposed to "wouldn't you want to get pitocin?", because she knows I'm not interested in artificially enhancing labor, but I suspect the real reason they want the exams is so that they can interfere if progress isn't fast enough. I didn't really fight with her because I don't know that a VE is so terrible (personally, I'm okay with the invasion aspect, it's more the infection potential and the fact that I don't want to know if I'm not making progress because I don't want to start doubting myself), but I was just wondering if you all thought it was necessary.
 

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This is a bit off topic, sorry, but since we're talking about vaginas and how many women are very protective of them (myself included), I thought I'd mention a shocking little film that I saw the trailer for recently; Sublimebirthgirl, I know you've seen it. It's called "At your cervix" <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/orngbiggrin.gif" style="border:0px solid;" title="orange big grin">, and is about a group of women who are helping to train med students to do pelvic exams. Apparantly, it is routine in some (?) med schools to have students practice pelvic exams on unconscious women who are undergoing gynecological surgery. Yes, without their consent. Makes you realize how far women still have to go, doesn't it?<br>
Anyone else seen it?<br>
I'll go back and find the link to post it.
 

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<div>Originally Posted by <strong>gratefulmama2isaac</strong> <a href="/community/forum/post/10171324"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Apparantly, it is routine in some (?) med schools to have students practice pelvic exams on unconscious women who are undergoing gynecological surgery. Yes, without their consent. Makes you realize how far women still have to go, doesn't it?<br>
Anyone else seen it?<br>
I'll go back and find the link to post it.</div>
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<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/jaw.gif" style="border:0px solid;" title="dropjaw"> Seriously?! I have not seen it, and would be interested in it. Just wow. Unbelievable. Man, I really hope I never need gynecological surgery. And, if I do, I think I'll take my lawyer in with me to the surgery. Because that's just sick. Why would anyone think this was a good/moral idea?!
 

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<div>Originally Posted by <strong>Ecstatic</strong> <a href="/community/forum/post/10171604"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;"><img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/jaw.gif" style="border:0px solid;" title="dropjaw"> Seriously?! I have not seen it, and would be interested in it. Just wow. Unbelievable. Man, I really hope I never need gynecological surgery. And, if I do, I think I'll take my lawyer in with me to the surgery. Because that's just sick. <b>Why would anyone think this was a good/moral idea?!</b></div>
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Because anatomy is easier to identify under anesthesia (lax muscles). Not defending the practice, just pointing out why it's been done.
 

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thats interesting. i know its not that way everywhere though, or at least not here. myu husband and i had a roomate who was a med student and he said that models come in and they practice on them. I think that too is strange. He said he got to chatting with one and she said they post ads for models needed for med class and they have to go through several screenings and interviews and then they are told what they are wanted for at the time that they are offered the job. And then they can refuse or accept.<br>
i think that is just odd.<br>
but he thought the model i was telling of where everyone learns it together and learns on each other in a class was weird too.
 

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<div>Originally Posted by <strong>gratefulmama2isaac</strong> <a href="/community/forum/post/10171324"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">This is a bit off topic, sorry, but since we're talking about vaginas and how many women are very protective of them (myself included), I thought I'd mention a shocking little film that I saw the trailer for recently; Sublimebirthgirl, I know you've seen it. It's called "At your cervix" <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/orngbiggrin.gif" style="border:0px solid;" title="orange big grin">, and is about a group of women who are helping to train med students to do pelvic exams. Apparantly, it is routine in some (?) med schools to have students practice pelvic exams on unconscious women who are undergoing gynecological surgery. Yes, without their consent. Makes you realize how far women still have to go, doesn't it?<br>
Anyone else seen it?<br>
I'll go back and find the link to post it.</div>
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This is a good paper about the issue:<br><br><a href="http://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi?article=1009&context=fac_pubs" target="_blank">http://digitalcommons.law.umaryland....ntext=fac_pubs</a><br><br>
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.
 

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<div>Originally Posted by <strong>conniebonnie</strong> <a href="/community/forum/post/10174355"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">thats interesting. i know its not that way everywhere though, or at least not here. myu husband and i had a roomate who was a med student and he said that models come in and they practice on them. I think that too is strange. He said he got to chatting with one and she said they post ads for models needed for med class and they have to go through several screenings and interviews and then they are told what they are wanted for at the time that they are offered the job. And then they can refuse or accept.<br>
i think that is just odd.<br>
but he thought the model i was telling of where everyone learns it together and learns on each other in a class was weird too.</div>
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I read a novel about med school at one point where they gave prostitutes free STD screening & paps in exchange for exam practice. Don't know if that was/is really done but it seemed plausible and much more of a win-win kinda situation than victimizing unconscious women.
 

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I haven't seen the film but I have seen the trailer. If you ever go into the hospital for anything, it's a good idea to read every consent form carefully and write stuff in if you need to. Probably the general consent forms allow them to do this to women even without telling them. It's disgusting.
 
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