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Vaginal Examination In Labour

Clinical Skills Group: Molly, Jenna, Bounmy, Karlee, Rebecca
by

Rebecca T

on 17 October 2012

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Transcript of Vaginal Examination In Labour

Vaginal Examination Bounmy
Jenna
Karlee
Molly
Rebecca Indications for Vaginal
Examination Assessment Alternatives to the
Vaginal Examination References Perspective of the
Woman Effacement
Dilation
Position
Station "Vaginal examination, the gold standard for assessment of labour progress." Power
Pain
Disconnect Cunningham, Gary; Leveno, Kenneth J.; Gilstrap, Larry C.. Williams Obstetrics (22nd Edition). Blacklick, OH, USA: McGraw-Hill Professional Publishing, 2005. P 441-442. http://site.ebrary.com/lib/oculmcmaster/Doc?id=10176686&ppg=442
Fraser, Diane., Margaret A Cooper, and Margaret F Myles. Myles Textbook for Midwives. 15th ed. Edinburgh ; New York: Churchill Livingstone, 2009.
National Collaborating Centre for Women’s and Children’s Health. NICE clinical guideline 55: Intrapartum care – Care of healthy women and their babies during childbirth. Sept 2007: 24-27
Stuart, CC. Invasive actions in labour: where have the ‘old tricks’ gone? Pract Midwife 2000 Sep;3(8):30-33.
Shepherd A, Cheyne H, Kennedy S, McIntosh C, Styles M, Niven C. The purple line as a measure of labour progress: a longitudinal study. BMC Pregnancy Childbirth 2010;10:54.
Vicki Van Wagner, RM, PhD and Hedrey Chu, RM. Using Simple Simulation to Teach Midwifery Skills. Canadian Journal of Midwifery Research and Practice Volume 11, Issue 1, Winter - Spring 2012.
Walsh D. Rhythms in the first stage of labour. In: Evidence-based care for normal labour and birth – a guide for midwives. 2nd ed. New York: Routledge; 2007. Ch. 3 p. 29-43. Guidelines Language Touch you, check you,
up there, an internal, a VE,
wash you down.... What is or is not being conveyed by these phrases? Vaginal Examinations as a
Ritual There is power to incite a disembodiment or disassociation in the administration by the caregiver Caregivers must touch sexual parts while avoiding inappropriate intimacy
and they often inflict pain or discomfort in the process Rituals allow intimacy and suffering to be ignored by participants ...it develops a barrier to interaction Participants become actors unscripted responses such as those of pain are not assimilated
there is an absence of eye contact from the care provider
and a depersonalization of the mother Make a positive identification of presentation
Determine whether the head is engaged in case of doubt
Ascertain whether the forewaters have ruptured, or to rupture them artificially
Exclude cord prolapse after rupture of the forewaters, especially if there is an ill-fitting presenting part or the fetal heart rate changes
Assess progress or delay in labour
Confirm full dilation of the cervix
Confirm the axis of the fetus and presentation of the second twin in multiple pregnancy, and if necessary in order to rupture the second amniotic sac. Perception of Power Outcomes not being shared
Depersonalization by caregiver disassociation during exam
Requirement for progress to be assessed regularly
Faith in assessment more than woman's intuition
thorough sterilization of her genitals prior to each examination Encourage the maintenance of Power Use straightforward communication
Administer vaginal examinations more judiciously during labour
Acknowledge associated pain and discomfort
caregiver re-embodyment Cervical Effacement Cervical Dilation Station of the Presenting Part Described by length of cervical canal compared with the uneffaced cervix The cervix is 50% effaced when the length had decreased by one half.
The cervix is 100% effaced when it is as thin as the adjacent uterine segment. Uneffaced Cervix? Generally thought to be 2.5 cm
A cervix will feel solid, muscular and rubbery Measured from 0-10cm
Determines the ability of the presenting part to pass through the cervical os
Primiparous usually efface than dilate
Multiparous can achieve both simultaneously Physiology 1. Inner fibers are drawn up first (thinning), then external fibers (dilation)
2. Outer fibers are drawn up into lower pole of uterus, moving inward. How to Assess Dilation Examining finger is swept across the margin
Examine for even dilation
Estimated in cm Tips for Practice Jar lids
play dough Position The position of the cervical os in relationship to the presenting part is categorized as posterior, midposition or anterior. Level of presenting part in relation to maternal ischial spines
+4 (5) to -4 (5) cm
Station 0 is when presenting part is level with ischial spines Alternatives Abdominal palpation
'Purple line'
The smell of birth
Rhombus of Michaelis
Vocalization
Space at top of fundus
Temperature change in lower leg
Markers on forehead
Intuition
Tidal flow The amount of cervical dilation can be determined given the descent of the fetal head, the rotation of the presenting part in degrees and the frequency of uterine contractions 5/5 4/5 3/5 2/5 1/5 0/5 Ischial spine None of head palpable Sinciput +
Occiput not felt Sinciput +
Occiput just felt Sinciput ++
Occiput + Sinciput +++
Occiput ++ Completely
above Pelvic brim Engaged head
Vaginal examination: Station 0 Figure adapted from Stuart, 2000 Attitude: Figure adapted from Stuart, 2000 O O S S S O Deflexed Flexion Extended As Midwives we Need to Ask Ourselves why do I need to know this information?
is there any other way I can obtain it?
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