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
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Van: A forum for
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Namens Jennifer
Cameron
Verzonden: zondag 30
mei 2004 10:06
Aan:
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Onderwerp: rectal examination
intrapartum
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.
