#WeMidwives - Tuesday 21st November 2017 8pm (GMT Standard Time) Vaginal examination to measure labour progression

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Hello, I am a 3rd year student midwife at Bangor University. I am currently planning my research proposal which involves assessing current literature and research about a topic in which I am interested in. I have chosen to further look into the routine use of Vaginal Examinations (VE) as a measure for assessing progress in labour and the evidence which supports this practice. Vaginal examinations have become a routine intervention in labour as a means of assessing labour progress (Dahlen et al. 2014). Midwives and obstetricians conduct VE’s at regular intervals during a woman’s labour. They are either conducted alone or as a component of the partogram with the aim is to assess if labour is progressing physiologically, and to provide an early warning of slow progress.Abnormally slow progress can be a sign of labour dystocia or prolonged labour, which is associated with maternal and fetal morbidity and mortality due to infection, increased risk of fetal distress and increased risk of postpartum haemorrhage. However, over-diagnosis of a prolonged labour can lead to complications due to unnecessary intervention (Downe, et al. 2013).NICE (2014) currently recommend that vaginal examinations should be offered to women at regular intervals of not less than 4 hourly intervals and only performed when justifiably necessary, although it is this justification that varies among midwives.According to Dixon et al. (2010), a vaginal examination is an important skill that can support midwives to interpret labour rhythms and deviations from the normal physiological process. However, they also argue that a vaginal examination is an invasive procedure which can be very distressing and painful for some women as well as feelings of losing control, vulnerability and previous experiences of sexual abuse arising. There are several other measures for assessing progress that can be observed, confirming normality and indicating progress in labour. These include:Assessing maternal behavior through 1:1 care, listening for changes in her breathing, noises and posture.Assessing the Thomboid of Michalis which is where a bulge appears between the sacrum and the ilea becoming increasing visible when the fetus head descends.Observing for any further “shows” which is often noted towards the end of the first stage of labour (Jackson et al. 2014).Observing for a purple line which appears from the woman’s anal margin and extends to the top of her bottom which indicates progressAnd finally, an abdominal palpation could be performed to assess position and fetal descent as well as to assess any increased strength or frequency of contractions (Walsh, 2012). Therefore, in my opinion it can be argued that vaginal examinations are a core skill of the midwife but must only be performed when absolutely necessary, clinically indicated and justification of the intervention documented as well as gaining the woman’s informed consent. Questions to consider:- What are your thoughts about the use of VE in labour?- How reliable do you think VE are in assessing progress?- Do you have any experiences with other means of assessing labour?- What are women’s experiences of having a VE in labour?- Are midwives informing women of the alternatives to VE?- How would you feel if a woman declines a VE?- Do you think more research needs to be carried out on the routine use of VE in labour? References:- Dahlen,H., Downe, S., Duff, M. and G. Gyte. (2014). Vaginal examination during labour: Routine examination or routine intervention? Midirs Midwifery Digest, 24 (1) pp.67-76.- Dixon, L., & Foureur, M. (2010). The vaginal examination during labour: Is it of benefit or harm? New Zealand College of Midwives Journal 42, 21-26.- Downe,S., Gyte, G.M.L., Dahlen, H.G. & Singata, M. (2013). Routine vaginal examinations for assessing progress of labour to improve outcomes for women and babies at term (Review). The Cochrane Library, (7) pp. 1-42.- Jackson, K., Marshall, J. E., & Brydon, S. (2014). Physiology and care during the first stage of labour. IN J. Marshall & M. Raynor (Eds). Myles Textbook for Midwives (pp. 327 – 366).- National Institute for Health and Care Excellence. [NICE]. (2014). Intrapartum care for healthy women and babies NICE guidelines [CG190]. Retrieved from: https://www.nice.org.uk/guidance/cg190- Walsh, D. (2012). Evidence and Skills for Normal Labour and Birth: A Guide for Midwives. (2nd edition). Oxon: Routledge.





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 #WeMidwives transcript

 
@WeMidwives
21 November 2017 20:00
Welcome to tonight’s #WeMidwives chat on vaginal examination with @AmyReidSTMW
@AmyReidSTMW
21 November 2017 20:01
@WeMidwives Thank you for hosting! #WeMidwives
@WeMidwives
21 November 2017 20:01
RT @AmyReidSTMW: @WeMidwives Thank you for hosting! #WeMidwives
@WeMidwives
21 November 2017 20:01
@AmyReidSTMW Pleasure very excited about this chat #wemidwives
@susieep21
21 November 2017 20:02
RT @WeMidwives: Welcome to tonight’s #WeMidwives chat on vaginal examination with @AmyReidSTMW
@CharleneSTMW
21 November 2017 20:02
RT @WeMidwives: @AmyReidSTMW Pleasure very excited about this chat #wemidwives
@CharleneSTMW
21 November 2017 20:02
RT @AmyReidSTMW: @WeMidwives Thank you for hosting! #WeMidwives
@CharleneSTMW
21 November 2017 20:03
@WeMidwives @AmyReidSTMW Hello! #wemidwives
@melinebt
21 November 2017 20:03
RT @WeMidwives: Welcome to tonight’s #WeMidwives chat on vaginal examination with @AmyReidSTMW
@ElaineMoore15
21 November 2017 20:03
@WeMidwives @AmyReidSTMW Hello this is my first chat. Hope I get the hang of things #WeMidwives
@AmyReidSTMW
21 November 2017 20:03
@WeMidwives Who do we have joining us for our discussion tonight, please feel free to join in and retweet #Wemidwives
@CharleneSTMW
21 November 2017 20:03
RT @ElaineMoore15: @WeMidwives @AmyReidSTMW Hello this is my first chat. Hope I get the hang of things #WeMidwives
@midwife_cw
21 November 2017 20:03
@WeMidwives @AmyReidSTMW Sorry forgot #wemidwives
@WeMidwives
21 November 2017 20:04
RT @ElaineMoore15: @WeMidwives @AmyReidSTMW Hello this is my first chat. Hope I get the hang of things #WeMidwives
@AmyReidSTMW
21 November 2017 20:04
@ElaineMoore15 @WeMidwives Hello! Follow the hashtag and you can't go wrong #Wemidwives
@susieep21
21 November 2017 20:04
@AmyReidSTMW @WeMidwives Will be dipping in and out I think! Hoping to discuss some good points #Wemidwives
@WeMidwives
21 November 2017 20:04
@ElaineMoore15 @AmyReidSTMW Perfect start! And welcome - the main thing to remember is the #wemidwives which you’ve done ????
@WeMidwives
21 November 2017 20:05
RT @susieep21: @AmyReidSTMW @WeMidwives Will be dipping in and out I think! Hoping to discuss some good points #Wemidwives
@WeMidwives
21 November 2017 20:05
RT @AmyReidSTMW: @ElaineMoore15 @WeMidwives Hello! Follow the hashtag and you can't go wrong #Wemidwives
@WeMidwives
21 November 2017 20:05
RT @midwife_cw: @WeMidwives @AmyReidSTMW Sorry forgot #wemidwives
@WeMidwives
21 November 2017 20:05
RT @AmyReidSTMW: @WeMidwives Who do we have joining us for our discussion tonight, please feel free to join in and retweet #Wemidwives
@AmyReidSTMW
21 November 2017 20:05
@WeMidwives So i would like to start off by asking what are your thoughts and feelings about the use of vaginal examinations during Labour? #Wemidwives
@ElaineMoore15
21 November 2017 20:05
@AmyReidSTMW @WeMidwives Thank you. I’ll try #WeMidwives
@Shaherezad
21 November 2017 20:05
RT @AmyReidSTMW: @ElaineMoore15 @WeMidwives Hello! Follow the hashtag and you can't go wrong #Wemidwives
@WeMidwives
21 November 2017 20:05
@AmyReidSTMW @ElaineMoore15 Do you have a First question @AmyReidSTMW ? #wemidwives
@WeMidwives
21 November 2017 20:05
RT @ElaineMoore15: @AmyReidSTMW @WeMidwives Thank you. I’ll try #WeMidwives
@Shaherezad
21 November 2017 20:06
RT @DeeDavies12: @AlisonBrindle @WeMidwives @Twidmife @CharleneSTMW #WeMidwives Always encourage Mum/Partner to accompany baby #zeroseparat…
@Shaherezad
21 November 2017 20:06
RT @susieep21: @AmyReidSTMW @WeMidwives Will be dipping in and out I think! Hoping to discuss some good points #Wemidwives
@CharleneSTMW
21 November 2017 20:07
@AmyReidSTMW @WeMidwives I would like to see less, i have loved labours where women labour uninterrupted with no ve #don’tstarttheclock #wemidwives
@midwife_cw
21 November 2017 20:08
@AmyReidSTMW @WeMidwives #wemidwives it is not always necessary. Unmediated labours so much easier to assess what is happening with out
@AlisonBrindle
21 November 2017 20:08
@AmyReidSTMW @WeMidwives Personally I don't like them for assessing progress of labour. I will never understand why clinical decisions are made based on something which is so subjective and inaccurate #WeMidwives
@midwife_cw
21 November 2017 20:08
@AmyReidSTMW @WeMidwives Should have said unmedicated #wemidwives
@AmyReidSTMW
21 November 2017 20:08
@WeMidwives Yes which would give women more time to naturally progress without invasive procedures #Wemidwives
@melinebt
21 November 2017 20:09
@AmyReidSTMW @WeMidwives can often feel over reliant on them to assess progress, instead of observing the purple line for example #WeMidwives
@ElaineMoore15
21 November 2017 20:09
@CharleneSTMW @AmyReidSTMW @WeMidwives Yes I would agree. More ways of evaluating labour progress than VE. Can disrupt the flow of labour and woman’s concentration on her experience #WeMidwives
@AmyReidSTMW
21 November 2017 20:10
@midwife_cw @WeMidwives Agree, in practice i have heard senior midwives and doctors say just do a examination which much thought to why we are actuallt doing them, alwayhs question what findings we will et from one! #Wemidwives
@CharleneSTMW
21 November 2017 20:10
RT @AmyReidSTMW: @WeMidwives Yes which would give women more time to naturally progress without invasive procedures #Wemidwives
@CharleneSTMW
21 November 2017 20:10
RT @midwife_cw: @AmyReidSTMW @WeMidwives #wemidwives it is not always necessary. Unmediated labours so much easier to assess what is happen…
@ElaineMoore15
21 November 2017 20:11
@AmyReidSTMW @WeMidwives Focus on the clock and subjective assessments can develop into cascade of interventions. #WeMidwives
@AmyReidSTMW
21 November 2017 20:11
@AlisonBrindle @WeMidwives They are very subjective! Discrepencies between midwives and doctors makes me wonder how reliabe actually are they if the findings can vary so much #WeMidwives
@BUMidwiferySoc
21 November 2017 20:11
Follow #WeMidwives for @AmyReidSTMW discussion on the use of VEs during labour
@AmyReidSTMW
21 November 2017 20:12
@melinebt @WeMidwives have you had much experience with other means of assessing labour such as the purple line? #Wemidwives
@AmyReidSTMW
21 November 2017 20:12
@ElaineMoore15 @WeMidwives Interventions that could be avoided if we were to watch and wait and attend to the womans needs not the insitutions #WeMidwives
@ElaineMoore15
21 November 2017 20:12
@AmyReidSTMW @WeMidwives Also how many times have we heard women in labour being told they are only so many cmon dilated. The of negative language disempowered women #WeMidwives
@CharleneSTMW
21 November 2017 20:13
@AlisonBrindle @AmyReidSTMW @WeMidwives Especially considering the evidence it is based on, Zhang et al 2010 suggest active lab doesn’t start until 5cm in multip, even later in primip, is ve background outdated? #wemidwives
@luybenans
21 November 2017 20:13
RT @WeMidwives: Welcome to tonight’s #WeMidwives chat on vaginal examination with @AmyReidSTMW
@CharleneSTMW
21 November 2017 20:14
RT @BUMidwiferySoc: Follow #WeMidwives for @AmyReidSTMW discussion on the use of VEs during labour
@AmyReidSTMW
21 November 2017 20:14
#WeMidwives questions 2: so how reliable do you think vaginal examinations actually are? #Wemidwives
@CharleneSTMW
21 November 2017 20:14
RT @midwife_cw: @AmyReidSTMW @WeMidwives Should have said unmedicated #wemidwives
@EdmondsonMary
21 November 2017 20:14
RT @AmyReidSTMW: #WeMidwives questions 2: so how reliable do you think vaginal examinations actually are? #Wemidwives
@CharleneSTMW
21 November 2017 20:14
RT @AmyReidSTMW: #WeMidwives questions 2: so how reliable do you think vaginal examinations actually are? #Wemidwives
@Midwife_VC
21 November 2017 20:14
@AmyReidSTMW @AlisonBrindle @WeMidwives #WeMidwives If are going to use to assess progress / make clinical decisions then need clear rationale for doing and consider whole holistic picture
@ruth_stmw
21 November 2017 20:15
@AmyReidSTMW Subjective due to multiple midwives and doctors performing. Have had instances of doctors trying to manually dilate a cervix, unnatural stretching!! #wemidwives
@AmyReidSTMW
21 November 2017 20:15
@ElaineMoore15 @WeMidwives And could this negative language have a detrimental effect on a womans oxytocin levels hence her not progressing further inbetween invasive VE's? #WeMidwives
@CharleneSTMW
21 November 2017 20:15
@AmyReidSTMW They are subjective. Different people will judge different dilatation, this may or may not lead to intervention #wemidwives
@AmyReidSTMW
21 November 2017 20:15
@CharleneSTMW @AlisonBrindle @WeMidwives More up to date research is needed, have you seen the recent cochrane review on cervical dilation patterns? #WeMidwives
@ruth_stmw
21 November 2017 20:16
@ElaineMoore15 @CharleneSTMW @AmyReidSTMW @WeMidwives This negative language and clock watching really impacts on sense of control and reduces oxytocin in room. No positive energy to use! #wemidwives
@susieep21
21 November 2017 20:16
@AmyReidSTMW @melinebt @WeMidwives I've not really seen a purple line often, but always have been able to get a good indication from rhombus of michaelis and second show. There are so many signs we can look for! #WeMidwives
@AmyReidSTMW
21 November 2017 20:16
@ruth_stmw @WeMidwives Do women no that there are other ways to assess progress? if not then informed cosnent is not being achieved #WeMidwives
@Midwife_VC
21 November 2017 20:16
@AmyReidSTMW @AlisonBrindle @WeMidwives #WeMidwives - also need to acknowledge not only subjective but relies on honestly reporting findings
@ElaineMoore15
21 November 2017 20:17
@AmyReidSTMW @WeMidwives As a community midwife a rarely undertook VE’s. I used my experience/observation and communication skills to ascertain progress. Women can normally tell you verabally or nonverbally how they are #WeMidwives
@ruth_stmw
21 November 2017 20:17
@AmyReidSTMW @WeMidwives Exactly. They are not educated to trust their bodies and believe in natural labour. Medicalisation has made it about numbers. #wemidwives
@CharleneSTMW
21 November 2017 20:17
@AmyReidSTMW @AlisonBrindle @WeMidwives Have you got a link for that @AmyReidSTMW #wemidwives
@AmyReidSTMW
21 November 2017 20:17
@melinebt @WeMidwives Thats great to hear! yes if a woman is supine then this method cant be used, a change in a woamans behaviour and breathing may be more effective than a VE #encouragemobilisation #wemidwives
@CharleneSTMW
21 November 2017 20:19
@AmyReidSTMW @melinebt @WeMidwives I have also seen it used for labour progression assessment on MLU, I only saw it at the point of the 2nd stage, but still fascinating to see #wemidwives
@AmyReidSTMW
21 November 2017 20:19
@susieep21 @AlisonBrindle @WeMidwives women do not follow the same labour patterns so may be 2cm to 10cm in a hour.. cervical dilation is a poor predictor of when a woman will give birth and we must therefore question their usefullness #WeMidwives
@AlisonBrindle
21 November 2017 20:19
RT @Midwife_VC: @AmyReidSTMW @AlisonBrindle @WeMidwives #WeMidwives - also need to acknowledge not only subjective but relies on honestly r…
@Midwife_VC
21 November 2017 20:19
@AmyReidSTMW @WeMidwives #WeMidwives Often professionals focus purely on dilation & "forget" other signs of progress.
@AmyReidSTMW
21 November 2017 20:19
RT @Midwife_VC: @AmyReidSTMW @AlisonBrindle @WeMidwives #WeMidwives If are going to use to assess progress / make clinical decisions then n…
@ruth_stmw
21 November 2017 20:19
@AmyReidSTMW @WeMidwives But are we as #futuremidwives challenging practice or being taught to assess via VE? #Wemidwives
@nursemaiden
21 November 2017 20:19
RT @WeNurses: TONIGHT 8pm Vaginal examination to measure labour progression with @AmyReidSTMW via #WeMidwives > http://www.wecommunities.org/tweet-chats/chat-details/4079
@AmyReidSTMW
21 November 2017 20:20
@ruth_stmw Which is so uncomfortble for the woman! #WeMidwives
@CharleneSTMW
21 November 2017 20:20
@susieep21 @AmyReidSTMW @melinebt @WeMidwives Interpretation/recognition of other signs not as black and white as ve I wonder if this is why not used as much? Not so quantifiable- more education in this area needed?! #wemidwives
@AmyReidSTMW
21 November 2017 20:20
@louise_ann_StMw @WeMidwives @BeckWilde Have you had any experience of other methods? #Wemidwives
@AmyReidSTMW
21 November 2017 20:21
@ruth_stmw @ElaineMoore15 @CharleneSTMW @WeMidwives Women also loose faith in their own bodies to birth their babies! #WeMidwives
@susieep21
21 November 2017 20:21
@CharleneSTMW @AmyReidSTMW @melinebt @WeMidwives Like with most things in midwifery, you have to look at the bigger picture and assess everything in order to provide holistic care I feel, progress of labour no different #WeMidwives
@CharleneSTMW
21 November 2017 20:22
@AlisonBrindle @AmyReidSTMW @WeMidwives We need more research into this area. The data for VEs is based on studies going back as far as the 50s. Do you think they labour differently because of routine care they receive? I imagine all women labour differently/the same whichever country they are in #wemidwives
@AmyReidSTMW
21 November 2017 20:22
@Midwife_VC @AlisonBrindle @WeMidwives Yes, some healthcare professionals may try to make their findings 'fit' #WeMidwives
@AmyReidSTMW
21 November 2017 20:23
@CharleneSTMW @AlisonBrindle @WeMidwives http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14930/epdf?platform=hootsuite #WeMidwives its great to see evidence around this subject area
@Midwife_VC
21 November 2017 20:23
@AmyReidSTMW @melinebt @WeMidwives #WeMidwives This is yet another demonstration of importance of true 1:1 care. Midwife and woman in tune & observant of changes in behaviour. V.fulfilling for both.
@CharleneSTMW
21 November 2017 20:24
RT @AmyReidSTMW: @CharleneSTMW @AlisonBrindle @WeMidwives http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14930/epdf?platform=hootsuite #WeMidwives its great to see evidence around this subject…
@AmyReidSTMW
21 November 2017 20:24
@CharleneSTMW @susieep21 @melinebt @WeMidwives I think the Midwive/ student needs to have confidence in using other methods which comes from good education and a supportive mentor #WeMidwives
@ElaineMoore15
21 November 2017 20:25
@AmyReidSTMW @WeMidwives Yes I would agree that this is a real possibility #WeMidwives
@CharleneSTMW
21 November 2017 20:26
@AmyReidSTMW @AlisonBrindle @WeMidwives Thank you! “1cm p/h unrealistic for women regardless of parity” #wemidwives
@AmyReidSTMW
21 November 2017 20:26
@louise_ann_StMw @WeMidwives @BeckWilde Women no their bodies best! i also have found observing a womans behaviour tells the biggest story about how her labour is progressing! 1:1 care is needed for this, are staff shortages impacting on midwifes time? #WeMidwives
@CharleneSTMW
21 November 2017 20:27
@AlisonBrindle @AmyReidSTMW @WeMidwives Yes you’re right - a shame #wemidwives
@WeMidwives
21 November 2017 20:27
RT @CharleneSTMW: @AlisonBrindle @AmyReidSTMW @WeMidwives Yes you’re right - a shame #wemidwives
@AlisonBrindle
21 November 2017 20:28
@CharleneSTMW @AmyReidSTMW @WeMidwives sorry...keep forgetting to put #Wemidwives...I have no excuse now with extra character space do I? ??
@ElaineMoore15
21 November 2017 20:28
Haaaaa just found an easier way to do this. It’s interesting that a lot of the chat is about physiological birthing in midwifery settings. How do we support women by reducing VE’s in obstetric suits #WeMidwives
@WeMidwives
21 November 2017 20:28
@AmyReidSTMW @louise_ann_StMw @BeckWilde Some women want to be assessed vaginally #wemidwives
@Midwife_VC
21 November 2017 20:28
@AmyReidSTMW @CharleneSTMW @susieep21 @melinebt @WeMidwives Not to mention experience, observation and their own confidence in the bodies ability to birth #WeMidwives
@AmyReidSTMW
21 November 2017 20:28
@susieep21 @CharleneSTMW @melinebt @WeMidwives It calls to question the partagrams that we use, are these really individualised and centred around a womans needs and care - not all women labour the same so why are we comparing to one chart, progress isnt linear #WeMidwives
@CharleneSTMW
21 November 2017 20:29
RT @AlisonBrindle: @CharleneSTMW @AmyReidSTMW @WeMidwives sorry...keep forgetting to put #Wemidwives...I have no excuse now with extra char…
@AmyReidSTMW
21 November 2017 20:29
@ruth_stmw @melinebt @WeMidwives Completley!!! it is a intervention although sometimes it seems to be viewed as routine labour care #WeMidwives
@SusanCrowtherMW
21 November 2017 20:29
@AmyReidSTMW @CharleneSTMW @AlisonBrindle @WeMidwives I did research on midwifery diagnosis of labour onset published in BJM in 2002. VE was found to be the least helpful. #wemidwives
@louise_ann_StMw
21 November 2017 20:29
@AmyReidSTMW @WeMidwives @BeckWilde I think CTGs have a lot to answer for! We need to still be spending time in the birthing room with women. Build that trusting relationship so women are empowered to let go and believe in their own bodies and ability #wemidwives
@AmyReidSTMW
21 November 2017 20:30
@ElaineMoore15 @melinebt @WeMidwives Are staff shortages hindering care that women need, time and patience often take a back seat in a busy unit #WeMidwives
@AmyReidSTMW
21 November 2017 20:30
#WeMidwives question 3: how would you feel if a woman declined a vaginal examination?
@CharleneSTMW
21 November 2017 20:30
@SusanCrowtherMW @AmyReidSTMW @AlisonBrindle @WeMidwives Why does it persist so much? #wemidwives
@louise_ann_StMw
21 November 2017 20:31
@WeMidwives @AmyReidSTMW @BeckWilde And thats where the individual, personalised care comes into play #betterbirths #wemidwives
@AlisonBrindle
21 November 2017 20:31
@WeMidwives @AmyReidSTMW @louise_ann_StMw @BeckWilde So we should question why that is? Did they before Midwives started doing VEs? Is it because for years midwives have done them so routine that we have changed womens attitudes towards them, and if so. If we stopped would we change attitudes back? #WeMidwives
@AmyReidSTMW
21 November 2017 20:31
@ruth_stmw @WeMidwives It was only in my second year that i realised the true impact of VE, i never knew about other methods and that VE are not actually truley necessary in normal labour care #WeMidwives
@ElaineMoore15
21 November 2017 20:31
In obstetrics suites across the country we use the partogram formulated years ago with no scientific evidence of its efficacy or robustness in assessing progress in labour. A lot of the assessments we use are subjective. Strength of contractions/VE’s #WeMidwives
@CharleneSTMW
21 November 2017 20:32
RT @WeMidwives: @AmyReidSTMW @louise_ann_StMw @BeckWilde Some women want to be assessed vaginally #wemidwives
@AmyReidSTMW
21 November 2017 20:32
@louise_ann_StMw @WeMidwives @BeckWilde Midwife means with woman, not sitting outside the room looking at a CTG computer screen, research shows that women want midwives in the room with them #WeMidwives
@SusanCrowtherMW
21 November 2017 20:32
Link https://www.researchgate.net/publication/260598056_Midwifery_diagnosis_of_labour-onset VEs found to be least helpful #wemidwives @WeMidwives in my maiden name Burvill! Feeling old https://twitter.com/amyreidstmw/status/933068339533971456
@AmyReidSTMW
21 November 2017 20:33
@WeMidwives @louise_ann_StMw @BeckWilde Yes, it is a womans choice that should be offered not enforced, some women feel reassured after a VE #WeMidwives
@CharleneSTMW
21 November 2017 20:33
@AlisonBrindle @WeMidwives @AmyReidSTMW @louise_ann_StMw @BeckWilde Think it’s a bit of both, would be great to have other ways of assessing labour progression taught formally on degree, bit just discussed but shown vids etc #wemidwives
@louise_ann_StMw
21 November 2017 20:33
@WeMidwives @AmyReidSTMW @BeckWilde But does the 'assessment' really show a true reflection of progress? And do women know that it is subjective and can change in a second?!?! #wemidwives
@CharleneSTMW
21 November 2017 20:33
RT @AmyReidSTMW: @louise_ann_StMw @WeMidwives @BeckWilde Have you had any experience of other methods? #Wemidwives
@AmyReidSTMW
21 November 2017 20:34
@CharleneSTMW @AlisonBrindle @WeMidwives I agree! women need more time, espcially low risk women #WeMidwives
@AmyReidSTMW
21 November 2017 20:34
RT @CharleneSTMW: @AmyReidSTMW @AlisonBrindle @WeMidwives Thank you! “1cm p/h unrealistic for women regardless of parity” #wemidwives
@louise_ann_StMw
21 November 2017 20:34
@AmyReidSTMW @WeMidwives @BeckWilde But do all midwives practice that way? And is it fair on the women who don't have that 1:1 support #wemidwives
@AmyReidSTMW
21 November 2017 20:34
@ElaineMoore15 @WeMidwives I have seen women feel deflated after being told they havent progressed or not progressed 'enough' #WeMidwives
@CharleneSTMW
21 November 2017 20:35
@louise_ann_StMw @AmyReidSTMW @WeMidwives @BeckWilde Rocking onto toes and back, “going into the zone”, and transition phase are ways I’ve observed women coming to 2nd stage #wemidwives
@ElaineMoore15
21 November 2017 20:35
@AmyReidSTMW @melinebt @WeMidwives I think at times they may be. Pressure on midwives and fear of litigation could@also be an effect #WeMidwives
@CharleneSTMW
21 November 2017 20:35
RT @AmyReidSTMW: @CharleneSTMW @AlisonBrindle @WeMidwives I agree! women need more time, espcially low risk women #WeMidwives
@AmyReidSTMW
21 November 2017 20:35
@AlisonBrindle @CharleneSTMW @WeMidwives It is a complete different setting to that in the UK, more evidence is needed in our birth settings, high risk consultant led units, MLU, freestanding MLU and homebirth settings #WeMidwives
@SusanCrowtherMW
21 November 2017 20:36
@CharleneSTMW @AmyReidSTMW @AlisonBrindle @WeMidwives Because mws follow institutions & not women. Relational care 1:1 enables care without VEs as 1st diagnostic tool. #wemidwives @WeMidwives
@AmyReidSTMW
21 November 2017 20:37
@AlisonBrindle @WeMidwives @louise_ann_StMw @BeckWilde If women had VEs in their previous labour, they may question the midwifes ability if she does not routinely perfom one? - this is where more education is needed #WeMidwives
@CharleneSTMW
21 November 2017 20:37
@AmyReidSTMW @louise_ann_StMw @WeMidwives @BeckWilde Even with ctg I’ve always been in the room with the woman #wemidwives
@ElaineMoore15
21 November 2017 20:37
Need to support physiological birthing and midwifery philosophy of childbirth no matter what women’s risk factors are #WeMidwives
@AmyReidSTMW
21 November 2017 20:37
@SusanCrowtherMW @WeMidwives Thank you for that! I will have a read later #WeMidwives
@Midwife_VC
21 November 2017 20:38
@WeMidwives I worked with a MW who commented on progress due to temp changes in the woman's legs. Also diagnosed SRoM by smell #WeMidwives
@CharleneSTMW
21 November 2017 20:38
@louise_ann_StMw @AmyReidSTMW @WeMidwives @BeckWilde That’s the beauty of having students working with you - generally they stay in the room if mw has to pop out #wemidwives
@AmyReidSTMW
21 November 2017 20:39
@ElaineMoore15 @ruth_stmw @WeMidwives Hopefully students are being educated earlier on in their training about the ? benefits of VE or that there are actually other reliable methods to measure progress #WeMidwives
@AmyReidSTMW
21 November 2017 20:39
@susieep21 Yes sometimes it can provide reassurance to the midwife that is looking after her #WeMidwives
@ElaineMoore15
21 November 2017 20:39
Women will compare experiences yes but when we explain why they are not being performed they understand #WeMidwives
@AmyReidSTMW
21 November 2017 20:40
@louise_ann_StMw @WeMidwives @BeckWilde Unfortunately not, yes as a student i feel privaliged to have the time to spend in the room with the room and really get to no her and her needs #WeMidwives
@CharleneSTMW
21 November 2017 20:40
@AmyReidSTMW @ElaineMoore15 @ruth_stmw @WeMidwives I would say ve is formal way of assessing labour progress which is taught, discussion of other techniques but they are learned on the job if you’re lucky enough to work with someone with those skills/ confidence #wemidwives
@CharleneSTMW
21 November 2017 20:41
RT @ruth_stmw: @AmyReidSTMW @WeMidwives But are we as #futuremidwives challenging practice or being taught to assess via VE? #Wemidwives
@AmyReidSTMW
21 November 2017 20:41
@CharleneSTMW @louise_ann_StMw @WeMidwives @BeckWilde I have only seen the Rhombus of Michaelis once, have seen the purple line a few times but it is usually the womans behaviour that i notice most coming up to 2nd stage of labour, 'wanting to go home' 'asking for a epidural' #WeMidwives
@ruth_stmw
21 November 2017 20:41
@AmyReidSTMW @ElaineMoore15 @WeMidwives Educated yes but is this reiterated in clinical practice? Evidence based practice or routine? #Wemidwives
@CharleneSTMW
21 November 2017 20:42
RT @ElaineMoore15: Women will compare experiences yes but when we explain why they are not being performed they understand #WeMidwives
@CharleneSTMW
21 November 2017 20:42
RT @AmyReidSTMW: @susieep21 Yes sometimes it can provide reassurance to the midwife that is looking after her #WeMidwives
@CharleneSTMW
21 November 2017 20:42
@Midwife_VC @WeMidwives I’ve heard of the leg temp thing, is there any evidence for it? #wemidwives
@ruth_stmw
21 November 2017 20:42
@CharleneSTMW @AmyReidSTMW @ElaineMoore15 @WeMidwives Yes depends on midwife mentor but also exposure to Midwifery led care vs consultant led care. #wemidwives
@SusanCrowtherMW
21 November 2017 20:43
So is intervening with a VE for the mw or for the woman? I suspect it is not always for the woman's benefit. #wemidwives @wemidwives https://twitter.com/amyreidstmw/status/933072433904578561
@ElaineMoore15
21 November 2017 20:43
@Kookie31 @CharleneSTMW @AmyReidSTMW @WeMidwives How I hate the ‘magic 4’ and the 3 in 10 strong. Total nonsense #WeMidwives
@AmyReidSTMW
21 November 2017 20:43
@SusanCrowtherMW @ruth_stmw @WeMidwives And therefore they do not no to question the use of VE if they do not no about alternatives #WeMidwives
@AmyReidSTMW
21 November 2017 20:44
@Kookie31 @ElaineMoore15 @CharleneSTMW @WeMidwives when women are sent home, do they feel able to call up half an hour later knowing things have changed but worried/anxious about being sent home again? #WeMidwives
@SusanCrowtherMW
21 November 2017 20:45
@ruth_stmw @CharleneSTMW @AmyReidSTMW @ElaineMoore15 @WeMidwives If a VE is unlikely to change care being provided then why do it? Surely not to comply with a protocol or partogram? #wemidwives @wemidwives
@CharleneSTMW
21 November 2017 20:45
@ruth_stmw @AmyReidSTMW @ElaineMoore15 @WeMidwives I’m so lucky home trust getting MLU next summer and other trust already has fab Lucina MLU, working in MLU was a great insight into other methods #wemidwives
@AmyReidSTMW
21 November 2017 20:46
@ruth_stmw @ElaineMoore15 @WeMidwives Very true! i find on the MLU midwives tend to use other means of assessing more often but sometimes still in addition to VE's in line with 'routine' care and guielines. #WeMidwives
@ElaineMoore15
21 November 2017 20:46
I do think we have much more understanding and will listen to women if the refuse VE’s but how many midwives actually take truly informed consent and how many women feel able to refuse #WeMidwives
@Kookie31
21 November 2017 20:46
RT @AmyReidSTMW: #WeMidwives questions 2: so how reliable do you think vaginal examinations actually are? #Wemidwives
@louise_ann_StMw
21 November 2017 20:46
@AmyReidSTMW @WeMidwives @BeckWilde Definitely ?????? #wemidwives
@CharleneSTMW
21 November 2017 20:46
@Midwife_VC @louise_ann_StMw @AmyReidSTMW @WeMidwives @BeckWilde That’s a shame! Culture changing? #wemidwives
@CharleneSTMW
21 November 2017 20:47
@AmyReidSTMW @Kookie31 @ElaineMoore15 @WeMidwives That’s the problem if sent home, knocks woman’s confidence in her own intuition #wemidwives
@AmyReidSTMW
21 November 2017 20:47
@SusanCrowtherMW @WeMidwives No, some women do feel reassured and will ask for a VE 'just to check' but many women also may want to delcline but maybe not realise they are able to? clear informaiton giving is needed to ensure informed consent #WeMidwives
@CharleneSTMW
21 November 2017 20:48
@louise_ann_StMw @AmyReidSTMW @WeMidwives @BeckWilde And build that rapport and trust #wemidwives
@ElaineMoore15
21 November 2017 20:48
Culture shift is happening more and more women and midwives becoming truly involved in holistic care #WeMidwives
@Kookie31
21 November 2017 20:48
Ahhh back to the football... #wemidwives loving tonight’s discussion #VEs
@WeMidwives
21 November 2017 20:48
RT @CharleneSTMW: @AmyReidSTMW @AlisonBrindle @WeMidwives Thank you! “1cm p/h unrealistic for women regardless of parity” #wemidwives
@WeMidwives
21 November 2017 20:48
RT @ElaineMoore15: @AmyReidSTMW @WeMidwives Yes I would agree that this is a real possibility #WeMidwives
@SusanCrowtherMW
21 November 2017 20:48
@CharleneSTMW @AmyReidSTMW @Kookie31 @ElaineMoore15 @WeMidwives Good to read @Helen_shallow s work about how women are not listened to when in early labour #wemidwives
@AmyReidSTMW
21 November 2017 20:48
@ElaineMoore15 @Kookie31 @CharleneSTMW @WeMidwives I observed a lady decline VE on admission, and was having 2 moderate contractions in 10, told she probably wasnt in labour and then went on to deliver her baby (still 2:10) shortly after. She knew her body - not all women fit the box #WeMidwives
@AlisonBrindle
21 November 2017 20:48
@AmyReidSTMW @susieep21 But why do women get reassurance from a VE? Is it because they have never been reassured by anything else? If so that is quite sad really. We can reassure women lots of ways #WeMidwives
@WeMidwives
21 November 2017 20:49
RT @ruth_stmw: @AmyReidSTMW @WeMidwives But are we as #futuremidwives challenging practice or being taught to assess via VE? #Wemidwives
@CharleneSTMW
21 November 2017 20:49
RT @SusanCrowtherMW: Link https://www.researchgate.net/publication/260598056_Midwifery_diagnosis_of_labour-onset VEs found to be least helpful #wemidwives @WeMidwives in my maiden name Burvill! Feeling…
@CharleneSTMW
21 November 2017 20:50
@SusanCrowtherMW @WeMidwives Thank you! Very interesting #wemidwives
@AlisonBrindle
21 November 2017 20:50
@AmyReidSTMW @SusanCrowtherMW @WeMidwives I always say that the VE is like the Sat Nav of labour assessment....use it too much and you lose your ability to find your way without it #WeMidwives
@ElaineMoore15
21 November 2017 20:50
@helen_shallow work on women’s experiences of interactions with maternity services is a must read #WeMidwives
@SusanCrowtherMW
21 November 2017 20:50
RT @CharleneSTMW: @SusanCrowtherMW @WeMidwives Thank you! Very interesting #wemidwives
@CharleneSTMW
21 November 2017 20:51
@SusanCrowtherMW @WeMidwives Would be good to embed more rounded education of labour progression into Midwifery degree curriculums #wemidwives
@Midwife_VC
21 November 2017 20:51
RT @SusanCrowtherMW: Link https://www.researchgate.net/publication/260598056_Midwifery_diagnosis_of_labour-onset VEs found to be least helpful #wemidwives @WeMidwives in my maiden name Burvill! Feeling…
@AmyReidSTMW
21 November 2017 20:51
@SusanCrowtherMW @ruth_stmw @CharleneSTMW @ElaineMoore15 @WeMidwives Walsh (2012) argues this is in much of his work that i have read, a VE must only be performed if absolutley clinically necessary, justified and no other way to gather the findings #WeMidwives
@CharleneSTMW
21 November 2017 20:51
RT @ElaineMoore15: @helen_shallow work on women’s experiences of interactions with maternity services is a must read #WeMidwives
@AmyReidSTMW
21 November 2017 20:51
@Kookie31 exactly!! #WeMidwives
@CharleneSTMW
21 November 2017 20:52
@AlisonBrindle @AmyReidSTMW @SusanCrowtherMW @WeMidwives That’s hilarious analogy Ali! And very true #wemidwives
@ElaineMoore15
21 November 2017 20:52
This is why in Scotland we are introducing continuity of care with decreased caseloads for midwives to build trust through relational continuity. Evidence is there #WeMidwives
@AlisonBrindle
21 November 2017 20:52
RT @CharleneSTMW: @AlisonBrindle @AmyReidSTMW @SusanCrowtherMW @WeMidwives That’s hilarious analogy Ali! And very true #wemidwives
@CharleneSTMW
21 November 2017 20:52
RT @Kookie31: Ahhh back to the football... #wemidwives loving tonight’s discussion #VEs
@CharleneSTMW
21 November 2017 20:52
RT @ElaineMoore15: Culture shift is happening more and more women and midwives becoming truly involved in holistic care #WeMidwives
@AlisonBrindle
21 November 2017 20:53
@CharleneSTMW @AmyReidSTMW @SusanCrowtherMW @WeMidwives ha ha just the best way I can describe it ?? #WeMidwives
@CharleneSTMW
21 November 2017 20:53
RT @louise_ann_StMw: @AmyReidSTMW @WeMidwives @BeckWilde Definitely ?????? #wemidwives
@SusanCrowtherMW
21 November 2017 20:53
@AmyReidSTMW @WeMidwives Agree. But it is a paradox that an intervention (VE) that has little clinical evidence can reassure women. Informed coercion? #wemidwives
@AmyReidSTMW
21 November 2017 20:53
Final question: what have you observed in practice about women's experiences of VE? Are they able to decline? Are they truly informed? #wemidwives
@CharleneSTMW
21 November 2017 20:54
RT @AlisonBrindle: @CharleneSTMW @AmyReidSTMW @SusanCrowtherMW @WeMidwives ha ha just the best way I can describe it ?? #WeMidwives
@midwife_cw
21 November 2017 20:54
@AlisonBrindle @AmyReidSTMW @SusanCrowtherMW @WeMidwives #wemidwives that is too funny. VE is fundamental to modern practices. Used as a way to manage busy wards etc.
@AlisonBrindle
21 November 2017 20:54
@ElaineMoore15 @AmyReidSTMW @SusanCrowtherMW @WeMidwives Absolutely you can! ha ha ?? #WeMidwives
@CharleneSTMW
21 November 2017 20:54
@AmyReidSTMW @SusanCrowtherMW @ruth_stmw @ElaineMoore15 @WeMidwives I’ve read Walsh’s book form cover to cover and love it. Not so easy to put into practice #wemidwives
@AmyReidSTMW
21 November 2017 20:54
@hannahdahlen @WeMidwives @midwife_jane @JennytheM @AnnaMarshMW @samcase77 @CovUniMidSoc @BUMidwiferySoc @BUmidsoc @radical_midwife @midwife_cw @MancMidwife @OBUMidSoc @SagefemmeSB @AlisonBrindle @DeirdreMunro @Humanisingbirth @SallyPezaro @TinaSouth3 @KathEvans2 @godfrey_isaacs @hallmum5 Thank you for that! I would have to say routine intervention! Which is very sad #WeMidwives
@AlisonBrindle
21 November 2017 20:54
RT @midwife_cw: @AlisonBrindle @AmyReidSTMW @SusanCrowtherMW @WeMidwives #wemidwives that is too funny. VE is fundamental to modern practic…
@Saudimidwifery
21 November 2017 20:55
RT @WeMidwives: 30 mins until our #WeMidwives tweet chat on vaginal examination! Who’s joining us? https://twitter.com/wemidwives/status/932705622805671936
@ElaineMoore15
21 November 2017 20:55
I would say in most cases the way it is discussed is that it has to happen and compliance is expected unless birthing at home or MLU. Culture is changing but much work still to be done #WeMidwives
@Saudimidwifery
21 November 2017 20:55
RT @WeNurses: TONIGHT 8pm Vaginal examination to measure labour progression with @AmyReidSTMW via #WeMidwives > http://www.wecommunities.org/tweet-chats/chat-details/4079
@ElaineMoore15
21 November 2017 20:55
RT @AlisonBrindle: @ElaineMoore15 @AmyReidSTMW @SusanCrowtherMW @WeMidwives Absolutely you can! ha ha ?? #WeMidwives
@CharleneSTMW
21 November 2017 20:56
RT @AlisonBrindle: @ElaineMoore15 @AmyReidSTMW @SusanCrowtherMW @WeMidwives Absolutely you can! ha ha ?? #WeMidwives
@Midwife_VC
21 November 2017 20:56
@CharleneSTMW @WeMidwives I'd be interested to find out. It was fascinating to observe. #WeMidwives
@Saudimidwifery
21 November 2017 20:56
RT @WeMidwives: Tonight! #WeMidwives chat on #vaginalExamination with @AmyReidSTMW and @CharleneSTMW come and join in the debate @AlisonBri…
@Saudimidwifery
21 November 2017 20:56
RT @WeMidwives: Welcome to tonight’s #WeMidwives chat on vaginal examination with @AmyReidSTMW
@AmyReidSTMW
21 November 2017 20:56
@CharleneSTMW @SusanCrowtherMW @ruth_stmw @ElaineMoore15 @WeMidwives No but has some great food for thought! How do we enable students and midwives to put this into practice? Education #Wemidwives
@Saudimidwifery
21 November 2017 20:56
RT @WeMidwives: #WeMidwives Tweet chat tomorrow night! 8-9pm. Is vaginal examination necessary? With @AmyReidSTMW come and join us @midwife…
@CharleneSTMW
21 November 2017 20:57
RT @Midwife_VC: @CharleneSTMW @WeMidwives I'd be interested to find out. It was fascinating to observe. #WeMidwives
@CharleneSTMW
21 November 2017 20:58
@Midwife_VC @WeMidwives Apparently it’s also know as Mexican Hot Legs! #intrigued #wemidwives
@SarahBeer1
21 November 2017 20:58
@AmyReidSTMW @WeMidwives I knew - but as a woman in labour with 1st baby didn’t feel empowered to say no to MW who ordered me out of pool 4 examination. (A nurse who has found this #WeMidwives chat!)
@ElaineMoore15
21 November 2017 20:58
I think through example and challenging practice daily as it happens. Our midwifery students are great at asking the great question WHY. Why do we do what we do what we do and what are the benefits #WeMidwives
@SusanCrowtherMW
21 November 2017 20:59
Doing the same thing in a bad system over and over again changes nothing #enough #wemidwives follow women not institutional dictates https://twitter.com/charlenestmw/status/933076253791354880
@CharleneSTMW
21 November 2017 20:59
@AmyReidSTMW @SusanCrowtherMW @ruth_stmw @ElaineMoore15 @WeMidwives More education and confidence to speak up. Give women the information so they can speak up for themselves #wemidwives
@AmyReidSTMW
21 November 2017 20:59
@SarahBeer1 @WeMidwives This is so sad to hear! Antenatal education should empower women to understand their choices in labour and recognise that it is a intervention that can be declined! #WeMidwives
@CharleneSTMW
21 November 2017 20:59
RT @SusanCrowtherMW: Doing the same thing in a bad system over and over again changes nothing #enough #wemidwives follow women not institut…
@AmyReidSTMW
21 November 2017 20:59
RT @SusanCrowtherMW: Doing the same thing in a bad system over and over again changes nothing #enough #wemidwives follow women not institut…




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