September 27, 2009
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.