September 27, 2009

SVE

As a labor nurse, part of my job is to evaluate where a woman is at in labor, by determining if her contractions are the real deal, causing her cervix to dilate. In order to do this, I have to do a sterile vaginal exam, SVE, to see how far dilated she is, effacement, station and to make sure the presenting part is cephalic. I don't think any woman enjoys this part of the process. Sure, all that really matters is if the baby is crowning, but I do work in a hospital and when I call the doctor/midwife, they like to know where she is in the labor process. I do try to limit the number of SVE's that I do, especially if their water has broken, to minimize the risk of infection and the mother's discomfort. Most women tolerate this as part of the process. But, on occasion, I have run into some difficulty, like I did Friday night. I had a patient come in after her water broke. On her prenatal record, the doctor had noted that the patient was unable to tolerate any kind of SVE, and that she had recommended doing something to desensitize the area, since she would eventually go into labor and have to give birth. There was even discussion of delivery by c-section. So I knew what I was getting into. After going through the admission process, I get to where I need to check her cervix. She assumed the position but before I even touched her she moaned "oh, that hurts!" And no, she wasn't having a contraction. I tried a couple more times and if I even touched her, she grabbed my wrist and yelled that it hurt. She told me to go ahead, even if she yelled, but I just couldn't do it. I felt like I was molesting her. Not only that, she was tensing her muscles so tight, and would grab my wrist, so I couldn't physically perform the exam anyway. She is part of a large group of people in my community that belong to a culture that women must keep covered, marriages are arranged, the husband speaks for his wife and that the father's mother comes to live with them for several months after they have a baby. The wife's duty is to care for her husband and if you were to ask her, she would probably say that in her spare time, she likes to care for her husband. The only time the woman is in control and is catered to is when she is in labor. And they accept this as a way of life. Anyway, so I called the doctor and gave her report, and she said to get her an epidural (patient wanted one) and after she was comfortable, to check her cervix. She knew this was the only way she would tolerate the exam and labor. So that's what we did. She got an epidural, was comfortable, and I tried again. She was very kind and apologetic, but even after the epidural, I was unable to check her. I don't think she realized that she wouldn't be completely numb. I was able to feel that the baby's head was low, and I guessed she was probably somewhere between 7-10 cm, but that was just a guess. I'm fairly certain she was delivered by c-section. I have had two other patients that needed an epidural to have a SVE, and they were fine afterwards, and even delivered vaginally (they were also part of the same culture). I'm not quite sure how this mama got pregnant. This culture is known for the "scoop method". Where they don't actually do the deed, but that the mom scoops the "stuff" up there to get pregnant. I'm not sure she could even tolerate this. I'll have to find out tonight how she did and when she finally (and how) delivered.

13 comments:

AtYourCervix said...

All I can say is...oh wow. Either major cultural issues, or abuse.

SMT said...

Wow that is wild. I've never heard of that before.

BirthdayNurse said...

That's the worst part of SVE's for me..the feeling that I'm hurting/molesting a patient...and it's all "part of my job!" I often find myself wondering how some of my patients get pregnant...without an epidural!!

Nurse Lochia said...

We often wonder about these women and how they are treated at home. Of course, none of them admit to any abuse. But you have to wonder.

Anonymous said...

What is generally reasonable for a woman who actually feels she was violated at the last birth? I had so many invasive cerical exams (at least every 20 mintues) last time I had a baby. I am not nervous in the doctor's office for normal pap etc. I am nervous about the hospital exams because last time I was having decels when placed on my back for the exams, and the nurse was stretching my cervix (grand multipara...so why?) and also stretching my perineum to my rectum which hurt. I felt very violated and didn't realize how until after the birth. I just don't want to be checked at all by the nurse, and prefer maybe one check or two by the doctor. Is that crazy or over the top? It's not that it hurts, it's that I fear feeling oppressed and being layed open as much as I was last birth. I have never had issues before...and most of the time feel my dignity has been spared in checks...but that last time it was just too much. To top it off, I also had two OB's check me twice beyone the nurse's check...and this was all in a 5 hour time period...three checks an hour by the nurse plus two checks per OB. 19 checks in 5 hours...just too much!

Blessings!
Dawn

Nurse Lochia said...

Dawn- that seems like an excessive amount of exams, I can imagine that you would feel violated! I just can't imagine any reason for that many exams. It *could* be difficult to get through labor at a hospital without a nurse checking you, unless there is always a doctor in the hospital (there's not at mine) but you can absolutely refuse to be examined that often. If labor is progressing, especially with a multip, you could get away with an exam in admission and an exam when mom starts to feel pressure or "pushy", so they can get the doc there.

Anonymous said...

One thing with me, if I feel "pushy" then I'm having the baby within 2 minutes...it's how it's happened the last 4 times. So I understand the nurse's worry. I didn't feel pushy with this last one until the last two pushes, but she even had me pushing at 9cm because she said I'd push the lip out of the way. It didn't happen because baby was OP. By the way, the only one who figured that out with all those exams was the OB 10 minutes before the baby was born. Ugh!

My doctor did say she would come to the hospital if I am at 4cm. Funny, I get dilated to 4 before ever being in labor and have walked around like that for weeks in the past.

Blessings!
Dawn

Alethea said...

I have only see this once in my nursing career. The mom ended up with a C/S because she was a primip in very early labor with PPROM. The doc know if she should start pitocin or cytotec. And since she had no idea what her cervix was doing, they opted for cesarean birth. Before being involved in this, I was very critical of primary cesarean on maternal request. I figured if there isn't a good reason for major abdominal surgery, why would anyone in thier right mind want one. But after caring for this woman, I do believe it was the most compassionate thing we could do for her at that time. Whatever the cause (abuse, who knows), we couldn't get to the bottom of it in labor. I do hope that she got some follow up counseling.

Joy said...

Oh my goodness!

SVEs don't bother me in the least unless it becomes excessive. But I don't plan on letting them check me often. Just when I get there and maybe a few hours later depending on how I feel.

Jamie said...

Scoop method? You would think with as much as these woman cater to their husbands, the men wouldn't allow them to, well, NOT have sex. Wow. You learn something new everyday.
Jamie

LadyMiko said...

Wow, how did she ever get pupped in the first place?

I know it wasn't the ideal situation but I delivered my stillborn son without any VE's, I had a Dr that thought they useful but not something that needed to be routine for sake of charting.

JMHO, but unless the babe is crowning or labor is stalling, are they really "that" important?

Knitted in the Womb said...

I have to wonder if the "scoop method" is an urban legend applied to this group of people because "they ar 'different' from us, so they can't possibly know how to enjoy sex?" Kind of like the idea that orthodox Jews have sex through a hole in a sheet? The hole in the sheet method is not true.

Nurse Lochia said...

One of the OB's in town actually confirmed that some people really do use teh "scoop method". She had a couple who had been having difficulty getting pregnant. She asked them what they were doing, etc., and after awhile, she asked them if they were actually having sex. They were not, no penetration, just ejaculating on the perineum and then the husband was scooping his seed into the vaginal opening.