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Visit Susan Burvill's paper on her qualitative study: British Journal of Midwifery, Vol 10, No 10, 600-605 Rosie Jackson Project Midwife, Norwich, UK -----Original Message----- From: Amelink-Verburg M.P. [mailto:[log in to unmask]] Sent: 30 May 2004 23:30 To: [log in to unmask] Subject: Re: RE intrapartum + behaviour of women in labour Dear Marianne and other listmembers, I trained as a midwife in 1973 - 1976 ( Amsterdam) and we were taught the technique of RE as well. In contrast with Jenny's description, we just had to perform this examination when the mebranes were ruptured (with the same rationale: to prevent infection). Recalling the past, I wonder whether the costs/efficiency may have been an argument as well: a RE could be performed using an unsterile glove - which is a major advantage compared to the time-consuming process of cleaning and sterilisation of the non-disposable gloves which were used those days, or compared to the scrubbing procedures we had to perform before examination with bare hands ( ! ! ). (To put your mind at rest: both are considered obsolete since long time). Emanuel Friedman, the godfather of the curves of labour, used RE for determination of cervical dilatation because "with minimal training considerable accuracy may be obtained". Examinations should be made at the peak of the contraction, preferably half-hourly, in order to collect enough measurements for constructing the curves. Poor women! However, his studies resulted in usefull information. (e.g. EA Friedman. The graphic analysis of labor. Am J Obstet Gynecol, December 1954, pag. 1568 - 1575) In the framework of developing a guideline on 'diagnosing progress of labour' we also searched literature also on RE. We have only found the article by Murphy which Ann Thomson already mentioned. It will be usefull to you, because it descibes some historical background information as well. In Murphy's RCT (involving 307 women) 28 % of the women in the RE group compared with 11 % in the VE-group described their examinations as 'very uncomfortable'. When asked to identify a particular aspect of their labour, 9 % versus 2 % mentioned the pelvic assessments. No differences in morbidity was found between both groups. In this study Murphy got guidance from Kieran O'Driscoll - it may be assumed that the clear results convinced O'Driscoll to change his policy of RE within his Active Labour Management. (K. Murphy et al. Maternal considerations in the use of pelvic examniations in labour. Midwifery 1986, 2:93-97) By the way, it is interesting how many comments Marianne's question has generated! **** Another question on my part: Does anyone of you know Margaret Duff? I happened to read a very interesting paper of hers, concerning a method of assessing labour progress by observing the behaviour of labouring women (title: Labour behaviours: a method of assessing labour progress). As far as I know, this paper has not been published until now. I really like to get in touch with her. I'm very interested in this particular aspect of the 'art of midwifery'. I'm sure that midwives, by experience, have a large sensitivity about the meaning of the behaviour of a labouring woman in relation to the labour's progress. But this experience remains rather hidden, because as far as I know there are no explicit publications on it. I interviewed a number of Dutch midwives on this issue and found quite a number of similar observations. Does anyone of you have suggestions for literature? Best wishes, Marianne Amelink -----Oorspronkelijk bericht----- Van: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] Namens Jennifer Cameron Verzonden: zondag 30 mei 2004 10:06 Aan: [log in to unmask] Onderwerp: rectal examination intrapartum Greetings all I trained as a midwife in 1974 and we were taught to perform rectal examination, particularly early in labour & while the membranes were intact. The rationale was that it avoided introducing infection into the upper genital tract. Rectal examination was useful if the cervix was posterior. It was easier to find the os. I can remember being able to assess station, dilatation and the state of the membranes which is all we needed to know. Assessing position is only necessary if labour has slowed. Jenny