Tuesday, March 22, 2011

Interesting New Comment

I wanted to quickly call attention to an interesting new comment on an old post "The Art and Joy of Pelvic Exams". The comment describes a developing technology that seems to assist with pelvic exams. I'm really interested to hear what people have to say about the possibility of using some sort of video probe to visualize the cervix rather than performing a vaginal exam. Would something be lost if we stopped doing pelvic exams or if we changed them in such a significant way? What do we have to gain and would


  1. I definitely see the benefits of a less invasive way of assessing the cervix. The only real drawback I see is that we may not always have technology available (missionaries, power outage, hippie home with no electricity, etc). If we don't have the skills needed to check the cervix without monitors and gadgets, we could be in real trouble. Otherwise, go for it!

  2. Perhaps rather than looking at new ways of assessing the cervix, we should be considering whether assessing the cervix is relevant at all?

    Checking for dilation doesn't tell us what has been happening, or what is going to happen - only what we think (because it is so subjective!) is happening right now. And the cervix is a marvellous thing that can go from 4cm to fully in 15 minutes, or 12 hours. Both normal, too.

    Cervical lips are usually a non-event, if hands are kept out of vaginas and mums are supported to birth their babes when they are ready (without coaching etc), there are other physioligical signs of full dilation (red line up the bum crack, a baby emerging...), and helping mum be mobile enough to move AND giving her time will in most cases allow an oddly positioned babe to re-adjust.

    I personally don't think we would lose anything by not doing routine internal examinations - not with hands, not with probes :) We might even GAIN something - a fuller understanding of how a woman's body can function just fine when it is supported but unhindered, and a reduction in the need to "manage" birth.

    disclosure - I'm a homebirthing mum (and newbie lay midwife student) who has had only one internal exam in three pregnancies. I'm currently trying to find any evidence-based reasons for internals, and so far haven't found many reasons at all :)

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  4. yeah i dont do internal exams unless absolutely necessary. i just dont get relevant information that way. and i think the exams can be really disrespectful to the mama. it doesnt really matter how far dilated someone is...the babe will come when the babe comes usually. dilation doesnt happen at an even rate.
    i definitely wouldnt want to stick a probe up there. i mean from watching the mama's face, listening to her sound, palpating outside the belly to check the baby's descent and position, having a history of previous births, gives me more than enough information.
    and ive seen mamas go from 4 cm to 8 cm to 5 cm to 9 cm in under two hours. the cervix doesnt always open consistently. and telling a mama oh you are only 4 cm, just drops the oxytocin levels in her, as her sense of confidence drops as well.
    thats just my two cents.
    plus when i was preggers i hated hated internal exams. no matter how gentle my hb mw was. it was more about what she needed to know to feel comfortable, rather than what i needed to know.