belly flower    

Pregnancy Yoga - Belly Flex...Childbirth Education....Labor/Birth Support...Mother Baby Yoga...Infant Massage...Breastfeeding Support

New!  Belly Flex - yoga based childbirth preparation...more than just pregnancy yoga!

Margaret River...Busselton...South Western Australia

                                  info@bellyflower.com.au    0417186673                                   

Natural birth: No need for vaginal examinations

By Natalie Burgess

In today’s routine obstetric care a woman in labor is often subjected to at least one vaginal examination, and often this is applied every four hours on obstetric orders or practice requirements of the birth unit.  The use of vaginal examinations as a method of assessing progress of labor is a routine practice, yet there is very little research based evidence that suggests any benefit to woman or baby in natural labor and birth (Enkin, 1992).

It was noted in 1914 by Dr Austin Miller that the use of “internal examinations” in labor and birth was an unnecessary and dangerous practice.  Dr Miller noted that the ‘internal examination’ exposed the woman and her baby to potential pathogens that could cause puerperal infection and the death of both mother and baby.

“…the internal examination adds but little to the very complete diagnostic information obtained by the external examination of the abdomen.”

Many women find vaginal examinations a painful and invasive procedure (Menage, 1996), and a pilot study conducted by Mary Stewart (2007) also identified that many midwives express emotional discomfort related to performing vaginal examinations.

So why are vaginal examinations a routine obstetric practice to which many women are subjected to?  It has been suggested that the use of vaginal examinations in labor is a means of demonstrating (a health professionals) control over the laboring woman and birthing process (Stewart, 2005).  Advocates of the use of this invasive practice in natural labor and birth indicate that the vaginal examination can provide essential information necessary for the care of the laboring woman.  However, abdominal palpation can provide a skilled practitioner with a great deal of information; the presenting part (head or bottom), the depth of engagement of the head (or bottom), the position of the baby (posterior, lateral, anterior) and the strength and duration of uterine surges.  It can easily be ascertained if the membranes are intact simply by asking the woman if her waters are still intact, or even perhaps observing that her waters have broken by the little puddles of amniotic fluid on the floor following in her footsteps.

Vaginal examinations can provide an estimation of cervical dilation, however this measure varies when performed by different examiners (Clement, 1994), and every woman dilates in response to her natural birthing rhythm.  The sounds and behaviours of the (undisturbed and uninhibited) laboring woman can also provide estimation to the opening of her cervix.  A woman in early labor will perhaps still be a little excited and somewhat talkative.  A woman in active labor will be focused, breathing, vocalizing, chanting, moving, swaying or yelling.  A woman in transition will perhaps have a change in mood, from quiet and focused to alert and confident, or from calm and confident  to emotional and overwhelmed.  A woman in second stage of labor will often indicate when the baby is about to birth, and even if she does not make an announcement she may well be making the characteristic sounds of a birthing woman; moaning and gently guiding her baby into the world.

Vaginal examinations place a laboring woman on a time schedule for cervical opening and birthing.   Labor and birth is a natural process, and the birthing body does not follow the guidelines of obstetric progress of labor, nor should women have these limitations of birth imposed upon them and their babies.

Clement, S. (1994). `Unwanted vaginal examinations'. British Journal of Midwifery 2, 8, 368-370.

Enkin, M. (1992). Commentary: `Do I do that? Do I really do that? Like that?' Birth 19, 19-20.

Menage J (1996). `Post-traumatic stress disorder following obstetric/gynaecological procedures'. British Joumal of Midwifery 4, 10, 532-533.

Miller, A.  (1914)  The dangers of vaginal examinations during labor.  California State Journal of Medicine Vol Xll No 8.

Stewart, M.  (2005)  “I’m just going to wash you down”: Sanitizing the vaginal examination.  Journal of Advanced Nursing 51 (6) 587-594.

Stewart, M.  (2007).  Pilot Study, University of West England.

Warren, C.  (1999).  Invaders of privacy.  Midwifery Matters.  Issue No 81.

Page updated: 23/07/2010   Copyright ©belly flower 2005/2010   

ABN 96 282 733 677

info@bellyflower.com.au

web page design Natalie Burgess

belly flower

Registered Trade Mark

Belly Flex TM pending

All rights reserved.  No part of this website may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher.