Hi everyone/Soo,
This is a fascinating thread thank you.
I recently noticed (when searching google images for representations of a partograms) that some partograms/partographs measure 'active labour' from 8cm onwards - that is, the progress line and action line only start at this point in the labour. I have never come across this, what I as a English midwife would classify as an extended 'latent labour', in the UK but suspect that such a classification of the stages of labour would have a powerful impact, not only on how VEs can and are recorded but also on when and how frequently they would be legitimately carried out.
I don't know where the 8cm latent phase comes from or where it is practiced unfortunately but I would be interested to find out!
As far as observations from clinical practice goes, my research data suggests that a VE operates as a precursor for the partogram as well as, as you suggest, the other way round. The process of recording the findings of a VE functioned as a kind of boundary symbol used by practitioners to justify the commencement of 'labour care' practices, which included the use of the partogram. In many circumstances this examination procedure, this symbolic boundary, appeared to be used to usurp the embodied experiences of the mother, particularly with primips, and therefore was applied for two quite distinct purposes - the first, mentioned above, was the intensification of care but equally it was also used as a mechanism for the withdrawal of midwifery care and support e.g. sending a mother home because 'she was not in labour' or refusing her access to hydro therapy or other pharmaceutical forms of pain relief (interestingly with the exception of opiates in some cases)
I did also observe midwives avoid performing the labour diagnosis VE with the principle objective of postponing the commencement of the partogram. The justification for such a 'delay' was to provide individualised care where the mother could labour spontaneously at her own personal pace.
Warm wishes
Mandie Scamell
________________________________________
From: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] On Behalf Of Jans, S.M.P.J. [[log in to unmask]]
Sent: 02 August 2011 13:49
To: [log in to unmask]
Subject: Re: query about the use of vaginal examination in labour and/or the use of the partogramme
Dear Soo,
Very interesting discussion! (as is evident from the reactions that your
query generated).
In addition to the comments of my colleagues Trudy and Ank, I would like
to add the following:
In 2006 the Dutch midwives organisation published the guideline "Failure
to progress in second stage of labour". The introduction of the
partogram was part of this guideline and as Ank said the VE is part of
this. The Dutch partogram contains an action line.
Before publication of the guideline very few Dutch midwives used or were
familiar with the partogram.
Officially midwives can only deviate from national guidance with good
(supported) arguments which means that the use of the patrogram is
currently official midwifery policy in the Netherlands.
Unfortunately all the material is in Dutch but it is freely available
through the website of the Dutch midwives organisation, KNOV.
The extended version of the guideline contains all the literature used
(see page 273.
I am giving you the links below:
The partogram:
http://www.knov.nl/docs/uploads/KNOV_standaard_NVO_praktijkaart_partogra
m_2008.pdf
and the extended version of the guideline with refs on page 273:
http://www.knov.nl/docs/uploads/standaard_NVO_wetenschappelijke_versie.p
df
The authors are contactable through the KNOV. I am sure they are happy
to talk to you should you wish to do so.
Best wishes
Suze Jans
Suze Jans RM, MSc.
Researcher,
Community Genetics
EMGO Instituut voor onderzoek naar gezondheid en zorg
VU medisch centrum | BS7, D428
Postbus 7057 | 1007 MB Amsterdam
T 020-4446446
E [log in to unmask]
-----Oorspronkelijk bericht-----
Van: A forum for discussion on midwifery and reproductive health
research. [mailto:[log in to unmask]] Namens Klomp, Trudy
Verzonden: dinsdag 2 augustus 2011 11:27
Aan: [log in to unmask]
Onderwerp: Re: query about the use of vaginal examination in labour
and/or the use of the partogramme
Dear sue,
In the Netherlands an VE is often used without a Partogramme, to measure
progress in labour. Most of the primary care midwives use a partogramm
only with nulliparous and only when they are in active labour. In the
learning environmont of students however, we advice to use a partogramm
in every labour.
When a partogram is used, all the elements included are usually used on
whether to intervene including the capacity/ability of the women
herself.
With best wishes,
Trudy Klomp
Verloskunde Academie Amsterdam
Louwesweg 6, 1066EC Amsterdam
T0031-20-5124231
[log in to unmask]
________________________________________
Van: A forum for discussion on midwifery and reproductive health
research. [[log in to unmask]] namens Soo Downe
[[log in to unmask]]
Verzonden: dinsdag 2 augustus 2011 9:34
Aan: [log in to unmask]
Onderwerp: query about the use of vaginal examination in labour and/or
the use of the partogramme
Dear all
We are completing a protocol for a review on the value of the vaginal
examination as a measure of progress in labour. We have been advised
that the VE is never used without the partogramme (and without attention
to all the elements on the partogramme). From our clinical experience,
we are not sure that this is the case - we have practical experience of
the VE being used as a measure of progress in labour without reference
to the partogramme (even where it is part of the routine recording
process) but our experience may well be very limited. We would be very
interested in your experience in the following areas:
1. In your experience, is vaginal examination ever used on its own,
without using a partogramme?
2. Where the partogramme is used as a record, are all the elements of it
usually used in a decision on whether to intervene?
Many thanks for your advice
All the best
Soo
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