Part of the reason it caught my attention was because my husband just recently pointed out to me that sometimes what I do is like an art. I had just told him about a mom I had taken care of that had come into the hospital with her bag of waters broken. At that point ,she was not contracting, but she was wanting to have a natural birth and did not want pitocin right away. After having experienced many women who are able to give birth in a timely manner after their water breaks and without pitocin ,I was willing to work with her ,but not sure if her physician would. So, I took my time with her iv and other initial assessments. She needed antibiotics, so I made sure I hung that first. All the time I was watching her and noticing that she was feeling more and more contractions and that they were getting stronger.
I did talk to her physician and told him she wanted to hold off on the pitocin. He agreed as long as her cervix was making adequate change. This usually means that it changes 1 cm in one hour. When I first checked her ,she was only 3 cm dilated. I knew she was just starting out in early labor ,but that once she got going, it could be fast. So.....I didn't check her the whole time I was getting her admitted, or her iv hung. I saw that her contractions were coming closer together and that she was having to work more through them. I knew something was happening by how she was behaving. Four hours later ,she was checked and then delivered within an hour after that...without pitocin.
The reason I mention this is because in most cases, this mom would have been checked every hour and may not have progressed adequatly to begin with ,then given pitocin. Or they may have looked at her labor pattern and deemed it inadquate to change the cervix because the contractions were not coming close enough together to begin with. I even had one nurse mention how stange it was that she delivered so fast with contractions so far apart.
The problem is, in the ob world,, the art of the physcial exam has been lost to us also. We go more by graphs and numbers than by what women are feeling or actually doing. I could tell the woman was progressing by how she was acting...I didn't need to check the cervix or see if her contraction pattern was "adequate" by the numbers. I also knew that early active labor takes longer than late active labor. Therefore, it may have taken her 2-4 hours to change 1 or 2 cm, and then go faster after that. I was content that her contractions were apparently getting closer together and changing in intensity.
There is an art to this...it is much easier to pull up a graph or do the numbers and determine that someone is not progressing adequately. It takes much more skill to assess and watch a woman in labor to determine this. And that art is definately something that is pretty much gone.