In respect of vaginal examinations

By Kathryn Gutteridge, President on 17 December 2020 Maternity Safety

This last year has brought with it many challenges and surprises for maternity care, all of which midwives have risen to. Women and their families have had to face birthing in a different way than they planned and for some this has caused them disappointment and, for some, distress. I know that midwives have tried very hard to be that comforting presence when women have been frightened and perhaps alone.

For some women, part of the excitement of labour is finding out that 'yes you are progressing in active labour; well done, you are on your way'. A midwife will give the woman validation of this. However, it has saddened me to read over the past few weeks of stories from women who have felt that they had to consent to having an internal examination in order to 'prove' that they were indeed in labour and could therefore have their birth partner with them.

Even though, as midwives, performing an internal examination is an everyday routine practice, let us not forget how stressful an event this is for many women. Who enjoys going along for our dreaded cervical smear test? Having worked for many years as a midwife and knowing so many fantastic midwives, I know that we take this part of our work seriously and aim only to do this examination for the right reasons.

I also know that midwives are increasingly aware that women bring with them stories and experiences that we may not know about – a history of assault and abuse is so common. We do not want any of the care we provide to do harm.

In my work with traumatised women who think they may be in labour I apply some general rules that you might find helpful;

• What is this woman telling me?
• What has happened in previous labours?
• How does she look now or at this moment?
• Does this woman show active signs of labour?
• Does this woman understand what a vaginal examination is?
• Does this woman consent to this examination?
• How many previous vaginal examinations has this woman had?

And then and only then I will talk to the woman about what she wants at this time. I try to remember that a vaginal examination is a clinical intervention that has consequences and use all the other ways of identifying active labour. You might find this article that I wrote helpful. 

Informed consent for all interventions is a key aspect of safe, high quality maternity care and continues to be even in these difficult current times.

When making a decision about whether a woman is now at a stage in labour where she needs continuous one to one midwifery support and the presence of her birth partner, I would suggest that all of these different observations – the woman’s level of discomfort and distress, her verbal and nonverbal behaviours, the regularity, length and strength of her contractions, are all as important, if not more important to my assessment of the number of centimetres found on a vaginal examination.

Finally, perhaps the most important factor of all is the question 'why am I doing this examination?' When writing up the notes let us all be clear that we are doing things for the right reasons.