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Assessing Labour without VEs

Discussion in 'General Midwifery Discussions' started by iolaus, Oct 5, 2009.

  1. iolaus

    iolaus RM and Head of Clinical Practice
    Staff Member Plus! Member

    Jul 13, 2009
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    Thought this may be interesting, these are ways of assessing progress of labour without VEs, very handy if either the woman declines them or for deciding if a VE is necessary (for example if a woman is requesting an epidural but shows some of the later labour signs then you can back this up with a VE before it's due which may then mean she doesn't want an epidural)

    If anyone comes up with any more then please add them, or any experiences of using them. Will try to do a reference to show where to look for more info

    The purple line (Hobbs L (2007) Assessing Cervical Dilatation without VEs: watching the purple line revisited The Practising Midwife 10 (1) 26 : 27)
    A bluey/purpley line creeps up between the woman's buttocks as labour progresses from the anus upwards. When it reachs the top of the buttocks the woman is normally fully dilated. This happens in 89% of women and is best observed when a woman is on all fours or kneeling. Obviously does require a lack of clothing. Quite invasive if the woman has a high BMI as then you need to part the buttocks.

    The Rhombus of Michaelis (Sutton J (2003) Birth without active pushing and a physiological second stage of labour IN Wickham S ed Midwifery Best Practice Edinburgh: Books for Midwives)
    The lowest three lumbar vertebrae and the sacrum move backwards and the ilia fan outwards increasing the pelvic capacity. Only happens in second stage if the woman is upright or on all fours. If naked you can see it, if clothed then you can feel a 'lump' (diamond shaped) on her lower back - around the area a lot of women with OP babies want pressure adminstered.

    The Smell of Birth (Wickham S, Roberts K, Howard J & Waters S (2004) body wisdom ~ smelling birth The Practising Midwife 7 (1) 30 : 31)
    As the woman enters transition smell in the room changes however not many people can smell it. To me it smells of sex, normally tend to notice it outside of hospitals though, maybe there are too many other smells in hospitals.

    Angle of the body during a contraction (Lemay G (2005) To push or not? Midwifery Today 74 p 7)
    As a woman progresses in labour she'll align her upper body with her pelvis and as her labour progresses if she is standing then she'll lean further forward than before (so by tranisition she'll be nearly bent in two at the waist

    Space at top of fundus (Frye A (2004) Holistic Midwifery Volume 2,)
    the space between the xiphisternum and the fundus shortens (becomes narrower), dilation avances. This occurs, in part, because the uppersegment of the uterus thickens as labor advances. The uterus also rises more as contraction intensify.
    The number of fingerbreadths between the two show dilation as follows5 fb = not dilated
    4 fb = 2 cm
    3 fb = 4 cm
    2 fb = 6 cm
    1 fb = 8 cm
    0 fm = fully

    Book says to do it lying down, I tend to notice even with them standing and does seem quite accurate). Not good for a raised BMI

    Heavy Show
    As the woman goes over 8cm ish and the baby moves down you tend to get a heavy, bloody show - far heavier than the shows at the start of labour
  2. EvieMay

    EvieMay tea and chocoholic :)

    Aug 28, 2008
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    Thanks Iolaus, very interesting especially the change in smell. I'm a bit of a super-smeller so will be very interested to see whether I detect it x
    floss76 likes this.
  3. Butterfly

    Butterfly Guest

    Thanks Iolaus, really useful.

    I've noticed the smell (extremely distinct) but haven't noticed the change in smell as such. Like you say, perhaps its the general hospital atmosphere.

    I find the atmosphere in hospitals doesn't support labour assessment without the use of VE's. I'm hoping it will become a more realistic option when i'm making my own decisions xxxx
  4. peanut2

    peanut2 taking time out

    Dec 22, 2008
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    Thanks very much for this, I just wrote an essay on this and found the research very interesting. And I got an A!
  5. mamamoon

    mamamoon New Member

    Sep 25, 2009
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    oh yes when birth is near it has a very distinct smell. Also, I,ve notice quite a few women in labor tend to "kneed" their feet when they are close to transition, and woman's mood almost always matches her cervix ;-) also, I read in a midwifery book somewhere, a looooooong time ago, that if you ask a woman to close her eyes and show you with her fingers how far dilated is that she will "know" her dilation. I did this twice and both moms opened their fingers to how far open they thought their cervix was, and guess what both were right, one was 8 another was 7. crazy huh???!!!!! also, goose bumps on the bottom in transition
  6. spenders9

    spenders9 Member

    Feb 1, 2009
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    Thanks - very interesting - note the comment about parting the buttocks of a woman with a raised BMI being, 'invasive' - would prefer that to a VE though most probably. I actually dont have VE's at all, and the mw's dont like it! I was even refused pain relief during one delivery, because She said, she didn't know how dilated I was as I wouldn't let her perform the VE. Surely that isn't lawfull?
  7. Fairydust

    Fairydust Active Member

    Sep 8, 2009
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    iolous - thanks for this, very interesting - really cannot believe how much i am actually learning from this site!

    I was wondering if anyone could explain to me what you do when a woman refuses a VE... would you firstly try to persuade her, explaining why, saying you will be as quick and gentle as possible, or do you take a first no as a no?? and if talking to her still doesnt work and she still refuses, then what? I presume look at the above?

  8. serenity

    serenity Active Member

    Sep 28, 2009
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    It would depend on the situation and how adamant she was in the first instance that she didn't want a VE as to how much I would 'encourage her'. Bear in mind things like sexual abuse and be very careful not to make her feel that she has no choice.

    Women have the right to refuse VE's as they would any other treatment/ intervention/ assessment. Obviously there is a reason why a VE is being 'offered' and the woman needs to be fully aware of this and the possible implications of not doing it - which will be different depending on what's going on. If she has been fully informed and still refuses then you absolutely cannot do it. I'd then want to advise whoever is in charge (ward sister etc) so she is aware and document it in the notes.
  9. Mkunga

    Mkunga Guest

    I have also noticced the change in scent in the room, but never thought to put that and full dilatation together... It smells to me like a mixture of placenta and liquor... (which, IMO smells a bit like semen... Not that I'd know what that'd smell like! lol!)

    I've also seen the purple line, rhombus of michaelis and also anal dilatation, but the woman does need to be naked and on all fours to get the best view of that area.

    I've also known a woman to refuse VE's. She just said she didn't want one. The MW explained why she wanted to do one - assess dilatation and position, but the woman was happy to labour without and said she'd know when she was ready to push, and if labour was prolonged, then she'd ask for a VE. So it was documented in her notes and the woman progressed to a spontaneous vaginal delivery around 2 hours later.
  10. xnelliex

    xnelliex Well-Known Member

    Sep 23, 2008
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    Thanks for posting this iolaus, it's very interesting to read.
    I am learning so much from this site. I can't wait to be a student midwife! (If I get in that is;))
    dougalox likes this.

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