Vaginal Examination Case Study

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Throughout clinical placements on the labour ward as a student midwife, I have been introduced to the concept of vaginal examinations (VEs) as a method of assessing the progress of labour. These consented vaginal examinations are generally routinely performed on women every four hours unless otherwise clinically indicated. From my experiences of performing and observing routine vaginal examinations, I have chosen to review the literature and guidelines surrounding these examinations and to see if the evidence is evolving and developing in favour or against four hourly VEs. Monitoring progress of labour is intrinsic in providing care to a woman in labour. It is the midwife’s role to clinically assess the woman and monitor progress so to recognise…show more content…
Performing VEs can provide the clinician with a variety of information such cervical dilatation and effacement along with position and decent of the presenting part (Thorpe & Anderson, 2006). However, there are many negative aspects to take into consideration when assessing the impact of vaginal examinations. Vaginal examinations are an invasive procedure and can have a negative impact on women emotionally. NICE (2007) has said that vaginal examinations “can be distasteful for women due to the intimate nature of the examination and can be very distressing for others”. Due to the level of intimacy involved in VEs, special consideration should be made for women, particularly those with a history of sexual abuse. A study done by Robohm & Buttenheim in 1996 found that survivors of sexual abuse had significantly “more intense negative feelings” during a VE than non-abused women. Ying Lai and Levy’s study (2002) found that women felt “powerless to control when and how the vaginal examination was conducted” which ultimately comes down to whether or not clinicians take the woman’s opinion and preferences into consideration when caring for her in labour and if informed consent was obtained correctly. Also, despite vaginal examinations being performed under aseptic technique, they pose a threat of possible infection. Lewis & Dunnihoo (1995) found that the rate of infection was increased in women with premature rupture of membranes who received vaginal examinations. Imseis et al., (1999) states that this is because “vaginal organisms can be introduced into the cervical canal even during sterile conditions” and that there is a reported direct link between VEs and puerperal sepsis, particularly in underdeveloped countries. However, a study conducted by Lewin et al., (2005) found that not all experiences of vaginal examinations were negative. The study
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