'I'm just going to wash you down': sanitizing the vaginal examination

Abstract

Aim: This paper reports findings from an ongoing study exploring the qualitative experiences of midwives and women in relation to vaginal examination in labour, focusing on how vaginal examination is discussed and on the wash-down procedure used by some midwives.

Background: The body is a source of considerable ambivalence in sociological terms. Women's bodies, in particular, have been viewed as problematic and as a potential source of dirt and pollution. It has been suggested that vaginal examinations during labour are used, at least in part, as a ritual procedure by which healthcare professionals demonstrate that they are in control of both the labouring woman and the process of labour itself. Methods. In-depth interviews were undertaken during 2003 with six childbearing women and 10 midwives who had been involved in these women's care. Non-participant observation was also carried out of each woman's labour and birth.

Findings: During interviews, when discussing vaginal examination, midwives persistently used abbreviations or euphemisms as a means of distancing themselves from the realities of the procedure. Some midwives were observed washing women's genitals in a highly ritualized manner prior to vaginal examination, apparently as a strategy for establishing power differentials.

Conclusion: Midwives commonly state that they are advocates for woman-centred care but their behaviour in relation to vaginal examination belies this and suggests that they regard women's bodies as contaminated and polluting. Healthcare students need to be taught specific communication skills to enable them to discuss vaginal examination more fully with women so that they feel less need to resort to euphemisms and abbreviations when discussing the procedure. It is also important to carry out vaginal examination in a way that is not demeaning and does not reinforce notions that women's bodies are dirty.