References
Women's experiences of vaginal examinations in labour: a literature review
Abstract
Background/Aims
Evidence for vaginal examinations to assess labour progress is inconclusive and indicates some negative psychological impacts for women. Understanding women's perceptions of vaginal examinations is essential to guide future clinical practice. This literature review aimed to explore women's experiences of vaginal examinations in labour.
Methods
A comprehensive review of four databases was carried out, searching for publications made between 2012 and 2023. Findings were synthesised using thematic analysis.
Results
Eight relevant papers were included. Four themes emerged: frequency of vaginal examinations, true, informed consent, emotional reactions and rapport building and humanisation.
Conclusions
Negative experiences were associated with overuse and lack of properly informed consent. Positive experiences linked to continuity in carer. Further research into alternative ways of assessing labour progression to minimise non-clinically indicated vaginal examinations may improve women's labour experience.
Implications for practice
There is a need for further education for healthcare professionals on ongoing informed consent, appropriate communication, the necessary frequency of vaginal examinations and avoiding desensitisation. Additional training should be well-established in hospitals to minimise exams when not clinically indicated.
Vaginal examinations are the most common intervention in labour (Pickles and Herring, 2020), and are historically embedded in maternity care (Downe et al, 2013; Shepherd and Cheyne, 2013; Shabot, 2021). Developed as a quantifiable measure for use in the 1950s alongside a partogram (Friedman, 1956), vaginal examinations are now used routinely by midwives and obstetricians to assess labour progression. They can also be used to confirm commencement of active labour, providing information on cervical dilation, effacement and position and descent of the presenting part of the fetus in the maternal pelvis (Downe et al, 2013; Moncrieff et al, 2022).
Global and national guidance currently recommends offering vaginal examinations at 4-hourly intervals in the active first stage of labour (National Institute of Health and Care Excellence (NICE), 2017; World Health Organization, 2021). However, this is based on limited and dated evidence (Moncrieff et al, 2022). Additionally, overuse of vaginal examinations has been consistently reported (Naughton, 2019; Shabot, 2021; Miller et al, 2022). This may have both a psychological impact on maternal mental health, inhibiting hormones involved in physiological labour progression, and can lead to overdiagnosis of labour dystocia, a delay in the progress of labour (Çalik et al, 2018). This can contribute to a cascade of unnecessary interventions (Downe et al, 2013; Hazen, 2017), potentially resulting in adverse maternal and fetal outcomes (Çalik et al, 2018). Research does not highlight any conclusive improved birth outcomes as a result of vaginal examinations (Downe et al, 2013; Naughton, 2019; Moncrieff et al, 2022). However, as studies have yet to produce high-quality evidence to support another method of assessment of labour progression, there has been minimal change in recent years (Moncrieff et al, 2022).
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