Speculums (at last!)

Bet you never thought you’d hear the word “speculum” followed by ecstatic whoops of joy, but there you go. We’ve finally gotten to the GOOD stuff. After learning about corneas and retinas, absolutely disgusting skin lesions, breast exams, five point auscultation of the heart, percussion of the lung fields, superficial and deep abdominal palpation…yes, ladies and gentlemen, we have FINALLY gotten around to the one subject all of us are so keen to learn—the bread and butter of midwifery, if you will—the. . .*drumroll*. . . pelvis!

Yay!! (and there was much rejoicing)

Today’s lecture was f a b u l o u s. Picture after glorious picture of vaginas, vulvas, cervixes, anteverted uteruses, retroflexed uteruses, midline uteruses, adnexa, ovaries, squamo-columnar junctions etc. etc.. I found myself thinking, for the very first time this semester, that I am indeed, actually and truly and unmistakably, in midwifery school. Midwives study the pelvis. *squee* They bat words like labia minora and introitus around as if they’re saying “spoon” and “fork”. There is absolutely nothing ambiguous about a powerpoint slide entitled “Cervical Projection into Vaginal Vault”, which is then followed by four bulleted points.

Today we learned all about cervical cytology and how to do a pap smear (and a wet mount and a liquid prep and a SurePath and a gonorrhea and chlamydia culture and/or DNA test). We learned how to operate and insert a speculum. We learned about all of the tools and gear we’ll need to assemble before the exam can begin. We learned how to do a bimanual exam, and where to insert your fingers in order to check for cervical motion tenderness. I know all of this is old hat for all of you seasoned midwives out there, but daaaaamn, is it exciting to the newbie. Course, all of this was then practiced on mannequin models, where we quickly discovered that it’s very easy to insert a speculum into a model: they never scream if the speculum is not quite oblique and happens to take out their urethra in the process, and they could care less if the blades are accidentally closed on top of their cervix while we’re trying to remove it. I have a sinking suspicion it will be an entirely different ball of wax when we begin working on real life human beings during our peer pelvics next week.

Which, of course, brings me to the concept of peer pelvics, which is a subject so ripe for blogging, so full of such unchartered territory, unplumbed depths, and endless opportunities for mirth that it almost certainly needs a three part series. So, without further adieu:

Part One—whereby the author expounds upon the inevitability of spreading one’s legs for the purposes of education.

They warned us about this during our interviews, explaining that in general all of the students were expected to learn and perform their pelvic exams on each other, and if this was unacceptable to us, we would need to find and supply our own human model for the purpose of these exams. And to be honest, I don’t feel that squeamish about it. I mean, sure, I think it will be a little strange the first time I have to drop my pants in front of my partner, but I feel pretty comfortable with my body, and my vagina and vulva no less than my arms and legs. I’ve seen my own cervix with a mirror and have felt my own cervix numerous times, and yes, this involves putting my fingers up my own vagina from time to time, which, in my most humble opinion, is not really a bad thing at all. I know that there are a lot of women out there who have never seen their cervix…who probably couldn’t even tell you where there cervix is, if you asked them…but then, that’s kind of the point. If I don’t know my own body inside out and upside down, how am I going to be able to teach another woman about hers? And if I am not comfortable and accepting of my own body, how am I supposed to help another woman become comfortable and accepting of her own? Of course, this is not to say that midwives don’t have body issues (because of course we do!), but I do think that it’s vitally important to be incredibly familiar with what it feels like to be in “the stirrups”, so to speak—that sense of vulnerability, of helplessness, of exposure, of self-consciousness. Having a pelvic performed on us will teach us empathy, and learning by doing is always the best way to go, so honestly…I’m really looking forward to the pelvics next week. However, I’m not so sure I’m looking forward to having my nervous partner insert a shaking speculum into me for the very first time, possibly obliterating my urethra in the process, or accidentally clamping my cervix between the blades during the removal. Yikes. Practice makes perfect. Practice makes perfect. Practice makes perfect.

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