"How often do you do vaginal exams in labor?"
No woman wants more vaginal exams than necessary at any point in her life, this especially holds true in labor.
The most basic and classic reason why an excess of vaginal exams in labor should be avoided is because of infection.Once a woman's waters have released, she is more prone to infection because her sterile field has been compromised. Therefore every time someone does a vaginal exam they are introducing unnecessary bacteria into the vaginal canal and compromising the woman's ability to fight off infection. Once the woman develops an infection, she is more likely to go to C-Section, because the baby's health risks have increased. Better to keep hands off approach than to increase the likelihood of other interventions. Also, keep in mind that everytime a care provider does a vaginal exam, the aminotic sac is more likely to break even if it is still intact.
But of course there are other reasons to keep your hands to yourself as much as possible...
Ina May Gaskin in her Guide to Childbirth illustrates an extreme example of a vaginal exam retracting a woman's progress in labor. Gaskin decided that her client needed to be transported to the hospital due to fever, the woman was 7 cm dilated before they left the birthing center. Upon arrival at the hospital, and after a very rough vaginal exam, the attending physician stated that the woman was 4 cm. Upon another exam by Gaskin after the doctor’s exit, the woman was indeed 4cm. Gaskin states that "To the woman's neocortex, this man may have been an obstetrician. To her cervix, he was a predator" (Gaskin, 2003).
Ina May Gaskin's example of vaginal exams interrupting progress of labor is indeed extreme. Most of the time we aren't talking about transporting to a hospital in the middle of labor to be under the care of an unknown physician. Still, the concept of fight of flight holds true. We are biologically constructed to close up during labor (or have our babies immediately) if our primal brain (being different than our thinking brain) senses any sort of intrusion. If you think about an animal laboring in the woods, if they sense a possible threat, they need to be able to "close up" and run. If birth is imminent, they need to birth the baby as quickly as possible... and then run.
So do all women view vaginal exams as a threat? Of course not, but some absolutely do.
When care providers perform vaginal exams it needs to be with great care and caution, since you never know what you might be triggering for a woman. Most sexual abuse survivors repress the memory of their abuse, or they are simply unwilling to admit it ever happened to a care provider. In Penny Simkin's book "When Survivors Give Birth" Midwife Yeshi Neumann writes "Elements in the pelvic exam can bring up emotions, sensations, images or memories of prior sexual abuse" (Simkin, 2004). And with over 600 women being raped everyday in our country (http://www.now.org/) this is certainly an issue that should be on the forefront of every care providers mind.
Not to mention the woman’s state of mind. Every care provider should want to keep vaginal exams to a minimum to avoid discouraging the mother. If she is doing well but only progressing .3cm per hour, she needs to focus on her internal reserves and gather her strength. She does not need to hear how slowly she is dilating every couple of hours! According to A Guide to Effective Care in Pregnancy and Childbirth "A dilation rate of 1cm/hr in a woman who is having strong contractions and is in severe distress is far more worrying than a rate of .3cm/hr in a woman who is comfortable..." If a woman is progressing slowly in labor, a constant reminder like repeated vaginal exams can damage the morale of the entire birthing team.
No woman wants more vaginal exams than necessary at any point in her life, this especially holds true in labor.
The most basic and classic reason why an excess of vaginal exams in labor should be avoided is because of infection.Once a woman's waters have released, she is more prone to infection because her sterile field has been compromised. Therefore every time someone does a vaginal exam they are introducing unnecessary bacteria into the vaginal canal and compromising the woman's ability to fight off infection. Once the woman develops an infection, she is more likely to go to C-Section, because the baby's health risks have increased. Better to keep hands off approach than to increase the likelihood of other interventions. Also, keep in mind that everytime a care provider does a vaginal exam, the aminotic sac is more likely to break even if it is still intact.
But of course there are other reasons to keep your hands to yourself as much as possible...
Ina May Gaskin in her Guide to Childbirth illustrates an extreme example of a vaginal exam retracting a woman's progress in labor. Gaskin decided that her client needed to be transported to the hospital due to fever, the woman was 7 cm dilated before they left the birthing center. Upon arrival at the hospital, and after a very rough vaginal exam, the attending physician stated that the woman was 4 cm. Upon another exam by Gaskin after the doctor’s exit, the woman was indeed 4cm. Gaskin states that "To the woman's neocortex, this man may have been an obstetrician. To her cervix, he was a predator" (Gaskin, 2003).
Ina May Gaskin's example of vaginal exams interrupting progress of labor is indeed extreme. Most of the time we aren't talking about transporting to a hospital in the middle of labor to be under the care of an unknown physician. Still, the concept of fight of flight holds true. We are biologically constructed to close up during labor (or have our babies immediately) if our primal brain (being different than our thinking brain) senses any sort of intrusion. If you think about an animal laboring in the woods, if they sense a possible threat, they need to be able to "close up" and run. If birth is imminent, they need to birth the baby as quickly as possible... and then run.
So do all women view vaginal exams as a threat? Of course not, but some absolutely do.
When care providers perform vaginal exams it needs to be with great care and caution, since you never know what you might be triggering for a woman. Most sexual abuse survivors repress the memory of their abuse, or they are simply unwilling to admit it ever happened to a care provider. In Penny Simkin's book "When Survivors Give Birth" Midwife Yeshi Neumann writes "Elements in the pelvic exam can bring up emotions, sensations, images or memories of prior sexual abuse" (Simkin, 2004). And with over 600 women being raped everyday in our country (http://www.now.org/) this is certainly an issue that should be on the forefront of every care providers mind.
Not to mention the woman’s state of mind. Every care provider should want to keep vaginal exams to a minimum to avoid discouraging the mother. If she is doing well but only progressing .3cm per hour, she needs to focus on her internal reserves and gather her strength. She does not need to hear how slowly she is dilating every couple of hours! According to A Guide to Effective Care in Pregnancy and Childbirth "A dilation rate of 1cm/hr in a woman who is having strong contractions and is in severe distress is far more worrying than a rate of .3cm/hr in a woman who is comfortable..." If a woman is progressing slowly in labor, a constant reminder like repeated vaginal exams can damage the morale of the entire birthing team.
Gaskin, Ina May. "Chapter 4, P.174-5." Ina May's Guide to Childbirth. New York: Bantam, 2003. Print.
Simkin, Penny, and Phyllis H. Klaus. "Chapter 8, P.166." When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women. Seattle, WA: Classic Day, 2004. Print.
"Violence Against Women in the United States." National Organization for Women (NOW). Web. 24 Apr. 2011. <http://www.now.org/issues/violence/stats.html>.
Great post, dear!
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