my journey through the first semester of midwifery school has been a lot like birth—it’s been a trial-by-fire adventure that’s pushed me to the edge of my ability; or rather, it has allowed me to see that the edge is just an illusion and that if i try hard enough, my ability is boundless. oh, so you have twenty pages of worksheets to do fill out, you have two exams, there’s that power-point you’ve been putting off, you’ve got no groceries, your checking account is empty, your food stamps are late, AND the lady at dhs (aka lifeline to groceries) hasn’t returned your phone messages for two weeks? no worries!!! just another week in abbyland! truth: surviving this semester of school has proven to me that i can survive anything. you hear me, universe? a–n–y–t–h–i–n–g.
which is fantastic, since on top of everything else, i’ve recently had my last little shred of modesty ripped from my cold, naked hands. yes folks—i’ve learned to do pelvic exams.
so, an important part of learning to care for someone in any medical capacity is the ability of the practitioner to imagine him/herself in the patient/client’s place. in so many ways, the modern medical practitioner seems to resemble the watchmaker at his table—meticulously picking, putting, placing, assembling parts into their correct order, never really stopping to wonder what the experience is like from the perspective of the watch. luckily, watches don’t have feelings (i hope). women, however, do.
i remember my first time on the ol’ chopping block. i was 20, and i couldn’t find a gynecologist who would take a new patient (since i wasn’t pregnant) so i wound up going to the new women’s health clinic (now reduced to rubble by the april tornado). the nurse practitioner who saw me was kind enough i suppose, but the experience was so cold, impersonal, and mysterious. i wore a paper gown and had to lie flat on a bed, feet in stirrups, and stare at some shitty inspirational poster tacked to the wall while a complete stranger did god-knows-what to my ladybits. i had no clue what she did, why she was doing it, or what it all meant—i just knew that, as a woman, i needed to have pap smears every year. after a vigorous and totally unexpected breast exam (warning, please!), i was sent home with a bill for $450—dad hadn’t told me i was no longer on his insurance. (let’s wonder together, shall we, whether that got paid or just rolled off my credit report 3 years ago. hmmmm.)
the second time i had a pap smear, i went to a doc in my old home town and did so because i needed birth control pills. he was nice (and looked like fred flintstone), but again, there was so much mystery and discomfort as he hurriedly ran through the motions and then went on to his next zillion appointments. he didn’t have to open the speculum quite so wide—and if he was interested in actually finding breast lumps, he didn’t have to buzz through the breast exam quite so fast. rather than talking incessantly the whole time (to lighten the mood?) he could have asked me meaningful questions about my health.
despite waiting for 2 hours in the waiting room, i spent all of about four minutes with my doctor—during which time no information or warnings were given on the birth control pills that i was about to start taking. none. just another day in gynoland. thank-you-come-again!
check out http://www.stirrupsandstories.com for some pretty moving photos
i’ve backed up a bit to share all of this with you for a very important reason. when practitioners approach their craft without care and gentleness, real damage can be done. young women are going to the gynecologist without knowing why, without knowing what’s happening, and without any sense of empowerment in their own health. so much of this came flooding home for me when our physical assessment teacher modeled a pelvic exam for us. i was dumbfounded by how utterly, insanely different everything was.
the table was leaned up into a sitting/reclining position (you mean, i actually get to SEE what’s going on here? i don’t have to stare, terrified, at the ceiling?)
“the most important thing to remember is that this is YOUR exam—you are in charge, and we can stop or i can change anything that i’m doing if you need me to.” (what the fuck? i never heard that!!)
“you’ll feel my touch” (oh, so you aren’t just going to surprise me with your hurried and overly-confident hands all over my vulva? fantastic!)
“now i’m checking the outside of your vulva—everything looks pink and healthy. now i’m checking your glands—looks and feels totally normal” (ok, so not only are you TELLING me what you’re actually doing, but you’re also reassuring me that everything is in good shape? what a nice change of pace.)
“next i’m going to check your cervix. would you like a mirror?” (holy mother of god, you mean that i can actually LOOK?? i’ve never seen a cervix before, much less my own! lemme see, lemme see!)
being taught procedure for pelvic exams in the midwifery model of care absolutely blew me away. it radiated good communication, client empowerment, education, reassurance, and compassion. it wasn’t hurried. it was respectful. it was gentle. hopefully plenty of my readers will have had such good care, but for me, i found this to be wholly unlike the care that i received in a health clinic, a busy obgyn practice, and the student health center.
pretty soon after the demo, my euphoric medical-empowerment-high was punctured by one gut-wrenching realization. we were about to begin the hard work of leaning how to give this kind of woman-centered care, but we were going to learn it on each other.
in medical schools, there are paid pelvic models (sheesh, what a job) who come in for students to use as practice. this, i believe, is where the medical community goes wrong, although with the percentage of gyns who are male, it’s hard to have it any other way. when you practice on a model, you aren’t forced to approach the situation with great care and humility. models are there to be learning tools. it isn’t until you the practitioner are ass-up in front of your classmates that you learn the respect, the humbly appreciative attitude, and the great care that’s required to do what we do. nothing teaches a caregiver so much as having to become the patient.
i remember getting limitless “what the hell?”s when i told people that we were going to be learning pelvic exams on our classmates, but how can you as the practitioner know what feels ok unless you offer yourself up to others as a learning tool? i think it takes having a speculum yanked out while still open to know that, yes indeed, you should try your best never to do that to a woman!
practice was definitely slow and clunky in the beginning. there’s a learning curve to figuring out how to set up your tray, how NOT to touch anything (wipe your brow, adjust the lamp) when you have your gloves on, and how to move fluidly through external check, bartholins check, vaginal tone check, speculum insertion, paps, cultures, and bimanual exams without taking 45 minutes or repeatedly having to insert fingers or tools.
then there’s the script. there’s what you have to say while you’re doing everything. the second year students joked that, despite all of your trying, when you’re nervous, you unintentionally say the most god-awful and/or sexually suggestive things. a lot of thought has to go into what you say when and how you say it. and once you get the motions down, you have to superimpose that script over-top. the end result hopefully matches up 🙂
in addition to the newness of it all, the space at birthwise really posed a challenge when it came to practice. there are three exam beds at the back of the classroom, and they can be partitioned off with curtains. only one of these beds actually has stirrups that fit it. the other exam spaces were on couches, chairs, and beds throughout the school. since i’m quite sizeable and can’t hold my legs crazy ways for an indefinite amount of time, my group needed the stirrups, so we were always in one of the curtained partitions. when you add in the beds, the exam stool, the tables and the lamps, it’s possible that we were actually working in negative square footage. there was always something to run into or knock over—not exactly a calming environment.
once we got used to doing the exams and got much better at them, the whole process was not without humor. i quickly lost any sense of modesty that i still had, otherwise i’m sure humor would have evaporated. i remember being on the exam bed that faced the classroom door and out into the hall. people were coming and going willy-nilly, and the curtain had gotten pulled back. my partner was finding supplies, so i was left spread-eagle facing the door and yelling for someone, anyone, to shut the fucking curtain—or at least the classroom door. a week before that, i’m sure i would have been mortified at the thought—but at this point, all we could do was laugh. in a similar vein, we once got through an entire night practice without realizing that the window right by the exam bed was open and the neighbors were home. oops! on second thought, they have to be used to it, living next door to a midwifery school and all.
so we practiced and practiced and practiced, and for the first time in my life, i can say with utter confidence that my vagina was TIRED. i’d been poked and palpated and papped something like ten times. i’m positive i have no epithelial cells left on my cervix. BUT! the practice was all worth it because last wednesday i aced my physical assessment exam. i had to perform a full physical with pelvic exam and charting in front of my teacher. the flow had to be right, the assessments had to be accurate, and the script had to be spot on. many props to my partner who practiced with me over and over so that we could get everything just right!
it feels odd now that physical assessment class is over. learning pelvic exams seemed to be such a huge part of what we were doing this semester, but until i start seeing clients, i won’t use the skills again.
at any rate, the experience had made me look forward to being able to give stellar care to pregnant mommas and well-women alike. it has shown me that pelvic exams can be client-involved teaching experiences, and that rather than mechanically going through the motions assembly-line style, practitioners should, MUST, take the time to be gentle and respectful.
remember that this is your exam. YOU are in charge. we can stop any time you need to, even if you don’t feel like you have a good reason. what a concept!
to be continued…..
p.s. if you have anything that you’d like to share about what you think makes for a good trip to the gyno, please share in the comments section.
idylls of acadia 