Re: UK Pap rules was Sexual abuse was Spanking babies
From: fran wilson (530rose@msn.com)
Mon Feb 27 11:47:33 2006
I have many women who are "frequent flyers," ie a baby every one to two years. They are typically in specific religious groups in this area. They have extremely low rates of STD's and, after a couple normal exams, I don't redo a pelvic exam with each pregnancy without a specific concern or indication. I usually wait for about 2-3 years between pelvic exams in these ladies.
Like others have said, the guidelines are guildelines, and do not preclude you from specific action or inaction based on knowledge of your individual patients.
Fran Wilson, CNM
Kennewick, WA
From: Cheri Van Hoover <cherivh@xdcr.com>
Reply-To: ob-gyn-l@obgyn.net
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
Subject: Re: UK Pap rules was Sexual abuse was Spanking babies
Date: Mon, 27 Feb 2006 12:23:46 -0600
GA12L@aol.com wrote:
> I am a MIDWIFE not an obstetrician. As a MIDWIFE I am expert in
>normal, low risk pregnancy and childbirth.
Please keep in mind that your definition of midwife is not the only one accepted internationally. In the United States, midwives also provide well-woman GYN care and some primary care. Our scope of practice includes the entire reproductive and post-reproductive life span of women.
At the first prenatal visit a pelvic examination is standard in the United States. In addition to appropriate cultures and Pap testing, a general
inspection by speculum and bimanual examination is performed. I have discovered many abnormal findings by doing this examination, despite my midwifery persepective of presumed normalcy. A few of the things uncovered by this exam have been cervical polyps, large fibroids, infibulation (the woman was unaware that this had been done), size-dates inconsistency, etc., etc., etc.
I looked in the British standard text, Mayes' Midwifery, which I consider a first rate text on midwifery care (you can read my review of it for the Journal of Midwifery and Women's Health, May 2005, Vol. 50, Issue 3, Page 253). Mayes' Midwifery recommends that the first prenatal visit be a thorough history and the ordering of appropriate laboratory tests, but does not mention a physical exam of any kind. The editors then go on to state that the "woman usually has a medical examination generally carried out by
the obstetrician once her pregnancy is confirmed, and this is focussed in content." This exam includes a "cervical smear if necessary," but it appears that this is not routinely done. The text says, "A vaginal examination is only made in pergnancy if there is a specific indication. If a routine cervical smear is due to be taken, it may be deferred until the postnatal examination."
Fascinating difference. I, of course, prefer what I'm used to, and believe that it has proven valuable over the years. But apparently this is not considered to be necessary or valuable by midwives and/or obstetricians in other parts of the world.
Cheri
Cheri Van Hoover, CNM, MS
Faculty, Midwifery Institute at Philadelphia University
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