Gynecological exams: Are they necessary in a healthy birth?

Upon reading the book titled “Lying-In A history of Childbirth in America” by Richard W. Wertz and Dorothy C. Wertz, and also from my own research into this subject, there is a question that has been nagging at me lately. If vaginal exams are something that is relatively a new practice in human birth, more importantly vaginal exams done by male midwives and gynecologist, where did this practice stem from?? If we think about it, routine vaginal exams are not something have been around since humans have been having babies. Studies indicate that they are sometimes even counterproductive, increasing the risks of infection, and they are just also not a very good indication of if labor will start seeing as our cervices are not crystal balls, among other reasons… so why do we even do them?!?! When and why did this start becoming a routine thing? Among traditional peoples the cervical check or vaginal exam was practically unheard of. It was considered unwise to preform one, unless there was a hard birth or something very abnormal, and for good reason. And there is also a difference between a compassionate female midwife or trusted mother or mother-in-law preforming a gentle exam to see how things are progressing when needed during a labor, and a clinical exam for routine purposes “just to see how things are doing” every week beginning at 38-39 weeks until labor begins. And then of course there are the hourly checks that are preformed by the nurses during a hospital birth to diagnose “failure to progress” or if things are moving along as fast as the “Friedman Curve” states that they should be. In the texts that I have been studying it seems as if they really become popular in the 1800’s when male midwives and gynecologist really being to take over. In my personal opinion I feel as if they really took off during that time period because frankly, men do not have vaginas, they do not deliver babies, and they needed something concrete to measure labor and birth by. They also came about as a need for the good doctor to “do something” to cure this pregnant woman and ease her labor. As indicated from this excerpt from “Lying-in” clearly states.

” A patient, after the waters are discharged, requires a little management. It is not just to stay with her at the time; and yet it is necessary, if we leave her, to leave her in confidence. Therefore we may give her the idea of making provision for whatever may happen in our absence: we may pass our finger up the vagina or opening of the womb, and make a moderate degree of pressure, for a few seconds, or any part of it so that she may just feel it: after which we say to her, “there ma’am, I have done something that will be of great use to your labor.” This she trusts to: and if, when she sends for us, we get there in time, it is well: if later then we should be, we easily satisfy her. “Yes! You know I told you I did something which would be of great use to your labor!” If the placenta is not yet come away-“Oh, I am quite in time for the after-birth, and that, you know, is of the greatest consequence in labor!” And if the whole has come away-“We are glad that the after-birth is all come away in consequence of what we did before we last left, and the labor terminated just as we intended it should.”       Wooster Beach, An improved System in Midwifery (New York, 1851), p. 19. 

I believe that this can only be the evidence of the disconnect that occurred in America between women and their bodies when men took over the task of childbirth. Would a female midwife feel the need to resort to such a thing just to feel as if they “did something”? Or would they be better able to explain the feelings a woman may have as they go through labor (vomiting, shaking, increased pressure) as a good indication her patient is progressing and then give the credit where it is due, to THE MOTHER who is doing all of this hard work? Because of the delicate matter of modesty when men entered the obstetrical field, examinations where done while the woman was covered. In almost every case the baby would also be born in the dark, under the cover of the bedclothes. The male midwife or gynecologist was considered to be unfit to practice if he could not preform such tasks (delivery, use of forceps, exams, ect.) by touch alone. Consequently women were not visually SEEING how babies were born. It was some big mystery that only a male doctor can cure. It then was immodest to witness such an act. This made the disconnect even more severe. One has to question then: if we had left birth and midwifery in the hands of women where it traditionally has always been, would we have had this dangerous disconnect that we have seen between women, birth, and their bodies?? Would these routine exams that most American women now undergo be happening as they are today? When a woman is not progressing during a hospital birth and is diagnosed with “failure to progress” or is 40 weeks pregnant and is “high and tight” meaning not dilated or effaced at all, this then leads to a cascade of interventions that are almost always unnecessary. Women are now re-learning our bodies. As female midwives make a comeback we are learning all over again that not all cervices dilate at the same rate, a woman with a tightly closed cervix can give birth successfully hours later without the need for intervention and induction. As we women begin to learn and reclaim knowledge about our bodies and our births, we can collectively avoid unnecessary Cesareans and inductions. We can work together to make birth safer in America, as it should be.



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