Friday, June 7, 2013

Vaginal Exam Fetish

As you can imagine, I am a magnet for birth stories.  I hear them all the time.  Just this week, I have heard the birth stories of 4 women.  At a local pool, over the phone, at my children's school, and in a meeting.  I have been confronted recently, several times with birth stories that share a common theme, they have reflected a firm belief of mine that there is a concrete link between constant vaginal exams and slowed or stalled, cervical change.  I'm just going to name it a Vaginal Exam Fetish here because there isn't another term that captures the irrational CONSTANT (commonly every 1-2 hours, sometimes less) interest in checking the cervix.

This is generally (in my experience) a hospital specific issue and my belief is that it is directly tied to the overuse of pain medication in labor.  When medicated, women aren't demonstrating the normal progression of outward signs and symptoms of labor progress.   I can imagine that when a woman can't feel the exam anyway, that an exam wouldn't seem like quite the invasion it would otherwise be.  Add the use of epidural anesthesia being upwards of 90% (just a guess), and you have an ingrained standard of care that SEEMS necessary all the time, even if a woman is not being medicated for pain.  Doctors and nurses can become downright agitated if we don't want them checking us because it is how they are accustomed to judging the progress of labor and with out it they feel out of control.

I have had women use words like "dehumanizing" and "traumatizing" to describe (among other oblivious practices) this hyper focus on her cervix.  "They didn't even ask" one woman told me recently, instead the OB announced "I'm going to check you now".  I've seen this myself, too many times to recount.  I'm sorry, but that is just plain rude.  When did that become OK? We should always be given the opportunity to give permission, even when medicated.  It may seem like plumbing to the doctor, nurse,  or midwife, and they may do this all the time every day, but having virtual strangers shove their hand up my vagina is a rare occurrence, you?  I would even argue that if the roles were reversed in that moment, that the provider would prefer to be given the opportunity to give permission, because while he or she may PERFORM these exams every day, he or she doesn't likely have a vaginal exam (perhaps rectal exam in the case of a male doctor or nurse) performed on them any more regularly than we do.

I don't really like to assign the use of the word trauma or traumatic to a birth, even when it is a less than desirable experience. To me, words that are used too broadly, lose their power.  Like calling an OB a hero for performing a cesarean, even if he or she caused it in the first place.  I know there is some trauma in birth, I have read the reports about women suffering from PTSD after their birth experience, I do want to reserve the use of the word "trauma" for those specific experiences and for those women so when they file a lawsuit using the term "Trauma" it still has the power they need it to have.  There are other words we can use though for being invaded without permission.  Disrespected.  Unacknowledged.  Mistreated.  Even Assaulted (any touch without permission) would be better terminology.

I'm ready for the laboring woman to be regarded, treated with kindness and compassion, respected, in the hospital in the same ways that I see it in the midwifery community.  There is really no excuse for the  disconnect.  IF there is a medical complication that requires more intervention...she is still a human being and deserves to have her course of treatment explained thoroughly, be treated with dignity (which is an art form, finding a way to empower a woman with her feet in stirrups with 8 people all up in her business) , create a trust, so that a even a vaginal exam (when actually necessary) doesn't feel dehumanizing.  If she can look in your eyes and know that you are in HER corner, working for her and her alone, then we will rarely hear the words listed above.  We should all want that.  What are the words you want to use to describe the care you receive, or on the off chance a provider is reading this...the care you give?
We'll meet at Safe and Healthy, you can take it from there.  Please comment below!

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