Lets talk Vaginal exams
Ok so when did doing a vaginal examination become about normal birth? Why do we need to do them routinely on low risk normally progressing labours? If labour is tracking along and contractions are getting closer together and longer and stronger and she is moving into a more naturally ‘drugged’ out state suggesting high levels of endorphins and oxytocin why do we need to interrupt her inward focused coping space to put her on her back and put our fingers in her vagina to 'see' how she is progressing? We open at our own pace and our baby moves down in their own time.
Yes there are signs and times when an internal examination is appropriate but its when labour is digressing from normal and usually the woman feels it too. For a woman in spontaneous labour with her own watchful midwife I argue that an internal examination is not appropriate nor required....other than for the convenience of those caring for the woman. Internal examinations are not about undisturbed normal birth. They are about assessing for the abnormal...not the normal...the thought is 'gee something is not right here....lets check and get an idea of what is going on". Internal examinations can be very useful tools when they are needed...but it's about when they are needed.
Midwifery in its true essence is about quiet unobtrusive observation. It is about knowing the woman in front of you. It is about knowing women. It is about knowing normal physiological birth. If you know normal birth you know when it is no longer normal. Midwives have lost faith in birth. They have lost faith in their skills with normal birth physiological birth.
This is a political thing to say I know but most don't even know spontaneous physiological undisturbed birth because our system does not know spontaneous undisturbed birth . We spend 90% of our clinical training as midwifery students in obstetric units learning about abnormal birth with the secret hope of seeing a spontaneous birth where the woman isn't on her back, drugged up to the eyeballs and with a CTG in place and probably a catheter.
And when we are witness to a spontaneous undisturbed birth we jump for joy. Its like our heart bursts open with wonder at what a woman can do for herself and how enraptured and delighted she is that she did it and her husband cries tears of awe and love for the power of his woman and their baby.
I had a midwife say to me once "Its rare to see one of those births". This was after a woman who had gestational diabetes and had had a previous caesarean birthed her third baby on the floor on a mattress with her husband at her head and her mum catching her baby, dim lights and soft soothing music playing in a tertiary hospital. She had one VE on admission....and that was only to satisfy those on the outside of the room that she was in active labour enough to stay....not because she needed it...and she did not have another one. It was pure magic and it could be felt all through the room and almost thru the hospital ward. All staff who entered the room came in quietly and with such respect of the woman's space of surrender and peace.
Now as always I am not saying that a birth that requires intervention is wrong. I am the first to surrender to a good caesarean when its needed. I am merely saying that midwives are by definition experts in physiological pregnancy, labour and birth and detecting when other support is required and taking appropriate action as needed. I am also saying the reality is very different. The research has mounted and it states that most women want to birth in an undisturbed supported way and by the design of our anatomy and physiology. This has to be possible for most or the human race would die out. Simple things like internal examinations take away from the skills of a midwife and from the inward journey of a labouring woman. They take away from the power and serenity that birth can be for the woman. They turn it into an experience based on straight lines, numbers and having to 'achieve' or 'fail' when birth just like life is not about that.
