Let’s talk about childbirth

Vaginal examination

We are conditioned as women, to downplay the trauma of childbirth. How often have we heard it said that all women forget the pain of childbirth and that is why we are able to keep going back to the labour wards again and again?

The actual birth pangs – the contractions and the pushing – can be ‘forgotten’ – though not by all. But there are other aspects of childbirth that women never forget.

One of them is the shock of vaginal examinations.

When you are lying on a hospital bed with your legs wide open and some stranger is pushing fingers into your vagina…..it feels like an assault. If they have Donald Trump like fingers …….ole wako!

It is at the point of vaginal examinations that midwives will remind you that you enjoyed having sex – so don’t complain. And with a ‘firm’ voice tell you….

‘Relax!’

I have heard people (men mainly) say …….

‘Well, it’s just hands, you are about to push a head of a child anyways – and that is way larger….’

The reality is, when you start labour, the vagina does not just suddenly expand – vaginal examination are often painful and only lessen hours into the labour when the passage is ready to let the baby out.

Men – let me give you a visual………

It’s like having a knife stabbing repeatedly into your belly and then being asked to lie down with your legs apart, naked bottom exposed and have a stranger stuff several fingers into your rectum.

I believe you have the picture now …. there is nothing remotely ‘natural’ about that or sexual in any way.

So why are these examinations done?

Those fingers examine how wide the cervix – which is the door to the womb- has opened. For a baby to be born, the cervix goes from fully shut to about 10cm dilated. The fingers also investigate what part of the baby is presenting for delivery. The head needs to be presenting in the right position for birth.

These examinations assure staff that the birth is progressing normally and if things are moving too slowly, then it gives staff a chance to transfer mother to hospital care for a C-section.

But how effective are vaginal examinations at reducing problems for mother and babies in labour?

Cochrane reviews which are highly respected reviews that consolidate data on various health issues have written one on vaginal examinations for assessing the progress of labour and there are very few studies ever done in this area….

Review of vaginal examinations in labour

This paper is available free online.

There is very little research on how frequently during the labour that vaginal examinations should be done. One of the studies showed that there was no difference in health outcomes in mothers examined every 2-hours compared to every 4-hours.

The authors conclusions are telling ……..

It is surprising that there is such a widespread use of this intervention without good evidence of effectiveness, particularly considering the sensitivity of the procedure for the women receiving it, and the potential for adverse consequences in some settings. The effectiveness of the use and timing of routine vaginal examinations in labour, and other ways of assessing progress in labour, including maternal behavioural cues, should be the focus of new research as a matter of urgency. Women’s views of ways of assessing labour progress should be given high priority in any future research in this area.

Another Cochrane review looks at the use of a partogram which is a graph in which midwifes record cervical dilatation and other measurements taken during labour to determine when intervention is required. This paper is available free online….

Review on partogram use in labour

The data appears to show that in developing countries some form of a partogram, which is a graphical representation of data collected from vaginal examinations, among other observations, is helpful in determining which women need to be moved to a hospital with extra facilities to avoid serious birth complications.

It appears that the main tool to examine progress of labour remains vaginal examination – there is no running away from this. The procedure, however, needs to be studied and streamlined. After all, vaginal examinations are not without their risks. Infections can be introduced into the mother during these examinations, especially if they are done frequently.

It is very clear that more research is needed in Africa to determine when and how often vaginal examinations to access the progress of labour should be conducted. There is a dire shortage of midwifery research in Africa – this is something that seriously needs to be addressed to reduce the number of women dying at childbirth and the even higher number of babies that die as a result of the birth process.

But while more midwifery research is required, there are small things can be done to make childbirth easier for women.

In public hospitals, women are treated callously during vaginal examinations and for that reason, it feels to them like these proddings are done gratuitously.

There is little privacy when the process is undertaken. In public hospitals, thin curtains, when present, separate the mother from the outside world. Lying there with legs apart, being harangued by an overworked midwife, then being aware that the curtain has been blown in the wind and anyone who wants to, can see them in that position – is just humiliating.

More research is required in African settings on the way in which vaginal examinations can be done to enable maximum value with minimal distress. A vaginal examination should also be done in a sensitive manner and maintain the dignity of the mother.

A woman bringing a baby into the world is performing a function higher than any other – yet she is treated like it is punishment. Childbirth need not be undignified.

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