Why cervical exams are unnecessary during labor

February 8, 2011

First, there are many reasons why it would be beneficial or helpful or preferable to be able to check your progress without having a vaginal exam. The most obvious is the discomfort of having someone (as I read on another blog) “search for my tonsils via my lady parts.” Also, vaginal exams increase the risk of infection if the water has broken — even when sterile gloves are used, there are bacteria on your body that get on the sterile gloves and then are given a free ride up to your cervix. Before sanitation (even simple hand-washing) was practiced by birth attendants, it was common for women to die of “childbed fever” due to germs being introduced directly into the uterus this way.

As an aside, when you hear people decry modern homebirth because “women used to die all the time before they started having their babies in the hospital,” you now know that the high maternal death rate was at least partially attributable to doctors’ dirty hands infecting scores of women. It was common practice to teach medical students how to do vaginal exams by using cadavers — dead women (who frequently were victims of childbed fever) — and then to go down the hall to where women were laboring and without washing their hands, perform vaginal exams on them, directly introducing the germs from a dead person into the body of a living person.

But another reason would be to assess where you are in your dilation so that you know when to go to the hospital (if you’re planning a hospital birth). A frequent concern of women is that they’ll go to the hospital (or call the midwife) too soon…. or else too late. In the first case, they may be turned away until they are dilated more; and in the second case, they may have a harrowing ride to the hospital with a white-knuckled husband fighting his way through traffic while she tries not to push.
On this thread at Midwifery and More, there are a few different ways mentioned, but the one I want to talk about most is one that Anne Frye wrote about in Holistic Midwifery, Vol. II, p. 376. Sarah Wallbaum mentioned it on our childbirth educators email list, and it intrigued me. Here’s how it works:

During a contraction and with mom on her back, determine how many fingerbreadths of space are between the fundus (top of the uterus) and xiphoid process (the triangular tip of the breastbone) at the height of a contraction.

  • 5 fingerbreadths = no dilation
  • 4 fb = 2 cm
  • 3 fb = 4 cm
  • 2 fb = 6 cm
  • 1 fb = 8 cm
  • 0 fb = complete

She said that she has practiced this for accuracy with a midwife, and has both found it to be fairly accurate, but that if a mom is very obese, it would be difficult to use. Even if it just gives a “ballpark figure” it just feels empowering to me to be able to know this information without having somebody else’s hand stuck up inside me. Remember also, that the World Health Organization’s guidelines for Safe Motherhood says that vaginal exams should be kept to a strict minimum, and in the first stage of labor once every four hours should be enough (3.3).

read the full article here: womantowomancbe.wordpress.com

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Marissa Robert February 8, 2011 at 11:05 am

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