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Premature Rupture of Membranes & Repeated Pelvic Examines

Jacqueline Levine, a sister doula and occasional writer for  Lamaze research blog Science and Sensibility, gracefully gave me permission to post her comments about premature rupture of membranes… or PROM.

Very eye opening!!!

Hello all…There are some studies that point to the fact that repeated pelvic exams in the last month can irritate the membranes and lead to PROM at term (premature rupture of membranes), meaning labor is immanent, and mothers are close to their “due date”, but pelvic exams insert an artificial factor into the circumstances that lead to the healthy beginning of effective labor. Onset of labor may be just a few weeks or days away, but if waters break and labor doesn’t ensue, although mom is almost-but-not-quite ready, they must induce. Pelvic exams are not predictive or probative and unless there is compelling medical reason, should not be done week after week at the end of the last month. Being able to say to a mom that her cervix is softening but still not opening is nice, or to tell her that she is 50% and 1 cm is interesting indeed, but what really does it do for the process? Does it tell her when she’ll go into labor? Not bloody likely! If enough acid in the vagina is pushed to migrate upwards, or mother’s flora (or yikes! foreign germs from the glove covering the inserted hand) are forced up towards, and finally permeate the mucous plug to irritate and eventually disturb the integrity of membranes, they will respond by breaking. Now we have put another whole category of mothers onto the c-section express.

Here are some studies:
* Obstet Gynecol. 1984 Jan;63(1):33-7. Relationship of antepartum pelvic examinations to premature rupture of the membranes.

Lenihan JP Jr*
* Obstet Gynecol. 1987 Dec;70(6):856-60. Histologic chorioamnionitis in pregnancies of various gestational ages: implications in rupture of membranes.Perkins RP, Zhou SM, Butler C, Skipper BJ. SourceDepartment of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque.

* vaginosis and its implication in preterm labor and premature rupture of membranes. A review of the literature. Reynolds HD. Source Yale University School of Nursing, New Haven, CT

There are more studies. This knowledge has been around for a while. When, d’ya suppose, will caregivers heed some evidence-based stuff? Here’s the answer, I guess:

* Do the Medical Policymakers of Maternity Care Resist Changing Their Protocols to Reflect Best-Evidence Scientific Practices for Childbearing Women?

Olatunbosun OA, Eduoard L, Pierson RA. Physicians’ attitudes toward evidence based obstetric practice: a questionnaire survey. Br. Med. J. 316, 365–366 (1998).*
Abstract: In 1998, a questionnaire mailed to family physicians and obstetricians found that only 40% felt that evidence-based medicine was “very applicable to obstetric practice”. Concerning comments from this survey included “obstetrics requires manual dexterity more than science”, “evidence-based medicine ignores clinical experience”, and that following guidelines could result in “erosion of physician autonomy”. These views were described as obstacles to the adoption of evidence-based practices, and the authors recommended emphasis of critical analysis of the literature as part of medical education.”

Let’s let our mothers know about this and Bishop scores and give them the facts so that they can refuse pelvic exams and other procedures except for compelling medical necessity, and wait to get exams until they are well into labor and need to know whether they should be admitted!! There…I’ve said it!!!

Thank you, Jacqueline!!!

If you wish to weigh in….send your comments to

KennyShulman@aol.com

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