28 April 2009

Dilation Checks: When Are They Necessary?

Why are we going in and up to check dilation when the baby is coming down and out? I wonder when we first started to invade the woman’s body in this way? Was it after World War II or the turn of the century? What about women who have suffered sexual abuse? What damage are we doing? What information do we really need? Many midwives in the UK and even in the US have stopped doing such checks unless they really need a certain piece of information. What are your thoughts about this?

My midwife partner and I turned away a woman because her bones were so small that we could not even get in to measure her pelvis. She said her mother and sister had both had cesareans for small pelvises. We thought she might do better with our backup doctor because she would probably need a cesarean. I ran into her several years later in the grocery store. She had had her baby vaginally after a short labor and a short second stage.

So, what information are we looking for and how do we know what the outcome will be? We can’t know what the outcome will be. Isn’t midwifery a beautiful art?

Jan Tritten
Midwifery Today

The “Rule of 10” Versus Women’s Primal Wisdom by Lydi Owen

Midwifery Today, Issue 86, Summer 2008

Comments

# Joy Johnston said:

Jan I am one of those midwives who for the past 15 or so years have avoided doing vaginal examinations without what I consider to be a valid reason.  I have recorded these in my birth register.  Until the mid 1990s midwives in Victoria, Australia, practised under Midwives Regulations which included supervision by a doctor, and having the doctor's permission to perform vaginal examinations.  I had learned midwifery without great reliance on knowing the number of centimeters dilated, or the station of the presenting part.  When those regulations sunsetted (1996) it seemed to me that midwives had no reason to adopt the medical ritual of routine VEs.

Also I don't ask women to let me check their pelvic diameters prenatally, and I don't try to predict whether she will be able to give birth vaginally or not.  

Some women have read about 'self checking', but I discourage this too.  I think if they are using their thinking brains enough to want to know dilation, they probably are not in established labour.

One of the reasons I would offer to assess dilation is when a labouring woman (usually primip) is saying she can't continue at home, and needs to go to hospital.  It can buy a bit of time, and allow me a careful assessment of progress to that point.

Thursday, April 30, 2009 9:31 PM
# not getting in the way of birth « guerrilla mama medicine said:

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Wednesday, September 02, 2009 7:54 PM