Improving Vaginal Examinations Performed by Midwives = تحسين مهارة الفحص المهبلي للقابلات

Rhoda S Muliira,Vidya Seshan,Shanthi Ramasubramaniam

doi:10.12816/0003268

Abstract

A vaginal examination (VE) is an essential part of midwifery care, and is routinely performed when assessing the progress of labour. As evidence shows that during labour women may find VEs unpleasant, embarrassing and sometimes painful, the aim of this article is to review literature on the use of VEs during labour and to synthesise information from the available literature on how to provide an effective VE. The studies considered were retrieved from three databases (the Cumulative Index to Nursing and Allied Health Literature [CINAHL], SCOPUS and MEDLINE) using the following search terms: "VEs in labour", "midwives and use of VEs" and "women experiences of VEs in labour". The literature reviewed suggests that midwives are not careful about VEs. Therefore, a concerted effort is needed to pay attention to the frequency of VEs, the management of pain and distress, information-giving and the preferences of the patient, so that the patient can feel in control during a VE.

Highlights

Avaginal examination (VE) is an extremely intimate examination which is performed regularly and accepted as a routine procedure by midwives during labour.[1,2] A VE can be performed digitally, or by using instruments such as a speculum.[3]
It is alleged that VEs are used as an unnecessary procedure by which healthcare providers demonstrate that they are in control of both the woman in labour and the process of labour.[8,9]
Improving Vaginal Examinations Performed by Midwives healthcare providers; the reasons given by healthcare providers for performing VEs; the usage of verbal and physical strategies to distance oneself from VEs, and the healthcare provider’s distrust that a woman will dilate on her own without medication.[8,9,10,11]

Summary

Introduction

Avaginal examination (VE) is an extremely intimate examination which is performed regularly and accepted as a routine procedure by midwives during labour.[1,2] A VE can be performed digitally, or by using instruments such as a speculum.[3]. During the process of undergoing a VE, some women have reported feelings of powerlessness, physical pain, unsympathetic attitudes on the part of the healthcare provider and difficulty obtaining adequate information about the procedure.[7,8,9] It is alleged that VEs are used as an unnecessary procedure by which healthcare providers demonstrate that they are in control of both the woman in labour and the process of labour.[8,9] This is evidenced by the frequency of VEs performed by Improving Vaginal Examinations Performed by Midwives healthcare providers; the reasons given by healthcare providers for performing VEs; the usage of verbal and physical strategies to distance oneself from VEs, and the healthcare provider’s distrust that a woman will dilate on her own without medication.[8,9,10,11] A VE is an interesting procedure which represents a structured interaction in which ‘private areas’ no longer remain private; this raises problematic issues of the body and of being touched.[10,12] Midwives need to consider how they discuss VEs with women during pregnancy and labour, so that they can inform them of their purpose and rationale, and provide sensitive woman-centred care so that patients can be involved in decisions about how and when VEs should be performed.[10,13] The purpose of this literature review is to explore the use of VEs during labour and to discuss important interventions that midwives can adopt in order to provide sensitive and appropriate care during this intimate examination

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Discussion

Conclusion