The frequency and reasons for vaginal examinations in labour

Abstract

Objective: Vaginal examinations (VEs) in labour are a routine part of intrapartum care. Current U.K. guidelines recommend that VEs are offered to women at regular intervals of not less than 4h and only performed when justifiably necessary. However, justification may be interpreted differently by different midwives. This study aimed to investigate (i) the number of VEs performed in relation to length of labour and (ii) the reasons given by midwives for performing the VE.

Methods: This study recruited a group of women (n=144) admitted in either spontaneous labour or for induction of labour from one NHS hospital in Scotland. The number of VEs performed, the reason provided by the midwife for its need and the length of labour were all recorded.

Findings: The number of VEs carried out (mean 2.9, SD 1.5, range 1-7) increased as length of time in labour in hospital increased. Approximately half the sample (52%) had 3 or more VEs during labour. Almost 70% of women had more VEs than expected when the criteria of 4 hourly VEs was applied. The most common reason given by midwives for performing a VE was to assess labour progress and to assess the commencement of labour.

Conclusions: Despite maternity care policy to limit interventions in normal labour, we found that a substantial number of women received more VEs than was consistent with adherence to guidelines. However, until further research is conducted to validate other measures of labour progress, the number of VEs undertaken during labour is unlikely to decrease.