I started working as an L&D nurse in the early 70's. I worked in a hospital where it was standard for nurses to be trained to do VEs but at that time, some hospitals still restricted nurses to rectal exams. The nurses with whom I worked who had to do rectals in previous jobs had lots to say about it. Mostly they hated doing them - they felt that they were more uncomfortable for the women, that they were far more often inaccurate and that the "double standard" held lots of messages about the hierarchy between physicians and nurses and what is considered to be appropriate work (and "places" of work) for each - in other words, the "dirtier" work was given to the nurse. In many jurisdictions, examination with an instrument or digit beyond the introitus is a restricted act and therefore only part of the scope of practice of professionals who have this act defined in their scope or can be delegated the act by another profession. 

In Ontario, the Midwifery Act does include vaginal examination. But, the Nurses Act does not - nurses have to be "delegated" this act by another professional such as a physician or at least theoretically a midwife. The nurse who is delegated the act will have to be approprately trained and monitored - which is why this becomes part of the ongoing credentialling of a nurse who works in L&D. Because this restriction did not apply to rectal exams, nurses could do rectal exams without medical delegation. These days, the use of vaginal exams in L&D is so common, many nurses don't even know that it is not actually part of their regulated scope of practice. I guess we have active management of labour to thank for that. 

Just a little other anecdote from my first job - we had a "head nurse" who had trained and worked as a midwife in the UK in the 50's and she believed that most women did not need to have any vaginal exams at all (nor rectals) and she would not allow a new nurse to even start taking the vaginal exam "training" until that nurse was fairly consistent in approximating a woman's progress through other observations. Once "trained" she required that any time a woman had more than 2 vaginal exams by a nurse in labour, the nurse had to write up an incident report explaining why those other exams were required. This sure cut down on the number of exams, but also made the nurse think hard about rationale. We were never asked to explain to her any exams where we had a strong rationale, but if we didn't we had to sit and hear her lecture about labour is more than the dilating cervix ...

Susan

***************************************************
Susan James
Directrice
Programme de formation des sages-femmes
Université Laurentienne
Sudbury, ON 

>>> [log in to unmask] 5/28/2004 2:47:52 PM >>>
I used to house-share with an American nurse-midwife overseas.  I remember
that rectal examination was part of her booking examination for pregnant
women, and she seemed to think nothing of it.  We British midwives on the
team were horrified!  It seems that it was at that time (1995) standard
practice in the USA.

Joy Kemp



  _____

From: A forum for discussion on midwifery and reproductive health research.
[mailto:[log in to unmask]] On Behalf Of Marianne Mead
Sent: 28 May 2004 10:52
To: [log in to unmask] 
Subject: Rectal examination



I have had a request from a French colleague who is looking at the history
of midwifery in Europe and is particularly interested in the practice of
midwives in the UK.  In particular, he is interested in finding out if the
old, now abandoned, practice of rectal examination for the assessment of the
progress of labour might have originated in the fact that midwives and
obstetricians might have been more aware of the risk of transmission of
infection through vaginal examination.

I qualified as a midwife in 1975 and remember then some "older" midwives
talking about rectal examinations to assess the progress of labour, though I
never saw the practice and was never taught it.

I wonder if the practice stemmed from the fact that midwives might not have
been allowed to undertake vaginal examination in the earlier version of
midwifery legislation or if indeed the practice stemmed from an awareness of
reduced risks of the transmission of infection.

I have done a rapid exploration of Medline, without success.  Same with the
Internet.

I have found two references, one from China and one from Australia, but
nothing from the UK.

McCalman, J (2002). "Labour Ward 30, Royal Women's Hospital, Melbourne
1947-72." Nursing Inquiry 9(1): 31-36.

Qian, X, Smith, H, Zhou, L, Liang, J and Garner, P (2001). "Evidence-Based
Obstetrics in Four Hospitals in China: An Observational Study to Explore
Clinical Practice, Women's Preferences and Provider's Views." BMC Pregnancy
Childbirth 1(1).
http://www.blackwell-synergy.com/links/doi/10.1046/j.1440-1800.2002.00128.x/ 
abs

I wonder if anyone has more information.

Many thanks

Marianne





Dr Marianne Mead
Principal Lecturer (Midwifery) and Associate Research Leader
Department of Nursing and Midwifery
University of Hertfordshire
Hatfield
Herts.  AL10 9AB
Tel. 01707 285286
Fax. 01707 285995