Is it time for a more holistic assessment of labour progress?
It's important that vaginal examinations are undertaken only when there is a clear clinical indication rather than applying a one-size-fits-all approach
This article considers the assessment of labour progress and questions the generalised acceptance of undertaking routine vaginal examinations during the care provision of women experiencing low-risk spontaneous labour. My personal experiences within practice and discussions with midwives and students has revealed that undertaking vaginal examinations to assess labour progress is commonly viewed as the gold standard on which all subsequent decisions and care choices are based.
I reflected that far less consideration is given to the holistic external signs of progress that many women exhibit during spontaneous labour and reviewed the evidence on which this standardised care practice is based. This article challenges the practice of routine vaginal examinations in labour and champions the need for a paradigm shift within practice where a more holistic assessment of labour progress is valued.
The onset and progress of labour is a complex biological process that is widely described as having three stages and several phases (National Institute for Health and Care Excellence [NICE], 2017; World Health Organization, 2018). An overview of the stages and phases of labour is shown in Figure 1. These stages and phases are used within contemporary clinical practice as a means of defining intrapartum care and measuring the parameters of normal progress within labour through the undertaking of routine vaginal examinations. The delineation of labour and birth as three stages developed during the 1800s as knowledge of anatomy increased with the inclusion of latent, passive and active phases from the 1960s (Dixon et al, 2013).
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