From MIDWIFERY MATTERS, Issue No.
Anonymous
Well, shock horror! You might be thinking how under-qualified I must be, or you might think, "Good for her - and the women!"
My lack of practice at ARM has been due to circumstances: most women I attended didn't actually need an ARM (I was lucky enough to be allocated nearly all 'normal' labours) but I also confess to a 'fear' of doing it (knowing all the possible consequences) albeit on someone else's registration) and declined various offers from my mentors. That said, I didn't actually challenge the 'need' to do it. I kept my head down and played the game and nervously said, "No, I'd rather watch you first." I had been offered the chance several times but, having felt a footling breech once and thought it was a hand, (at least I knew it wasn't a head!) VE scared the life out of me, so if I was uncertain, my mentor happily did it. As most students and midwives know, mentors can make assumptions and some would have been unaware that until the last week of my training I had never done a single ARM and, of course, I didn't advertise the fact.
My one and only 'half' an ARM was in my last week in clinical practice. I had been working with an excellent holistic midwife. Labour had been totally physiological, the fetal heart heard and regular all the way through; now the woman was fully dilated and getting tired, station - low cavity, she almost there, the membranes were bulging and I felt no abnormalities. My mentor passed me the amnihook, suggesting I break the waters. Well, I didn't really want to do it, not because I felt incompetent but because I felt it was unnecessary. My mentor was unaware that I had never performed one but as she was so lovely and we had facilitated some lovely births together, totally natural - I did not want to undermine her in front of the woman so I took the amnihook and made a 'scratch' rather than a big hole in the membranes and said that the membranes were as tough as old boots! The 'scratch' I made was followed by a small trickle of clear liquor, 15 minutes later the rest of the waters 'popped' and the baby was born without any problem.
So does this make me incompetent? I think not, as I have passed my assessment in theory and simulation and feel I know what to do should the need arise. What worries me is that the 'need' arises far too often. I realise that as part of the induction process it may be warranted (but then I question the majority of inductions anyway!).
Do I have any regrets? Well, part of me wishes I hadn't done even that one, so I could secretly have a 'clean sheet'. However, it isn't about me. I maintain that I feel competent to perform ARM when needed and, like many other clinical procedures, I feel I am well versed in the knowledge, skills and drills (even if in simulation) for when it is absolutely necessary. I think ARM should be up there with emergency procedures or where there is concern for fetal or maternal wellbeing.
This article was originally published in Midwifery Matters ISSUE 115 Winter 2007, p16
AH updated 30 January 2009