not getting in the way of birth

September 3, 2009 § Leave a comment

this is a comment from jan’s blog on dilation checks:

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.

i am all about getting rid of the blue bulbs, the dilation checks, the pelvic measurements, the station checks (how far into the birth canal is the baby’s head) etc. etc. etc.  we use technology and numbers and measurements to replace building relationships with folks and hearing their story and getting out of the way of their moments.

and i love the part about using pelvic measurements as a way to buy a bit of time…

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