Research Article| Volume 26, ISSUE 1, P49-54, March 2013

The frequency and reasons for vaginal examinations in labour



      Vaginal examinations (VEs) in labour are a routine part of intrapartum care. Current UK guidelines recommend that VEs are offered to women at regular intervals of not less than 4 h and only performed when justifiably necessary. However, justification may be interpreted differently by different midwives. This study aimed to investigate (i) the number of VEs performed in relation to length of labour and (ii) the reasons given by midwives for performing the VE.


      This study recruited a group of women (n = 144) admitted in either spontaneous labour or for induction of labour from one NHS hospital in Scotland. The number of VEs performed, the reason provided by the midwife for its need and the length of labour were all recorded.


      The number of VEs carried out (mean 2.9, SD 1.5, range 1–7) increased as length of time in labour in hospital increased. Approximately half the sample (52%) had 3 or more VEs during labour. Almost 70% of women had more VEs than expected when the criteria of 4 hourly VEs was applied. The most common reason given by midwives for performing a VE was to assess labour progress and to assess the commencement of labour.


      Despite maternity care policy to limit interventions in normal labour, we found that a substantial number of women received more VEs than was consistent with adherence to guidelines. However, until further research is conducted to validate other measures of labour progress, the number of VEs undertaken during labour is unlikely to decrease.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Phelps J.Y.
        • Higby K.
        • Smyth M.H.
        • Ward J.A.
        • Arredondo F.
        • Mayer A.
        Accuracy and intraobserver variability of simulated cervical dilatation measurements.
        Am J Obstet Gynecol. 1995; 173: 942-945
        • McKay S.
        • Roberts J.
        Obstetrics by ear: maternal and caregiver perceptions of the meaning of maternal sounds during second stage labour.
        J Nurs Midwifery. 1990; 35: 266-273
        • Baker A.
        • Kenner A.N.
        Communication of pain: vocalization as an indicator of the stage of labour.
        Aust N Z Obstet Gynaecol. 1993; 33: 384-385
        • Buchmann E.J.
        • Libhaber E.
        Accuracy of cervical assessment in the active phase of labour.
        Br J Obstet Gynaecol. 2007; 144: 833-837
        • Neilson J.P.
        • Lavender T.
        • Quenby S.
        • Wray S.
        Obstructed labour.
        Br Med Bull. 2003; 67: 191-204
        • Ying Lai C.
        • Levy V.
        Hong Kong Chinese women's experiences of vaginal examinations in labour.
        Midwifery. 2002; 18: 296-303
        • Murphy K.
        • Grieg V.
        • Garcia J.
        • Grant A.
        Maternal considerations in the use of pelvic examinations in labour.
        Midwifery. 1986; 2: 93-97
        • Clement S.
        Unwanted vaginal examinations.
        Brit J Midwifery. 1994; 2: 368-370
        • Seaward P.G.
        • Hannah M.E.
        • Myhr T.L.
        • Farine D.
        • Ohlsson A.
        • Wang E.E.
        • et al.
        International multicenter term PROM study: evaluation of predictors of neonatal infection in infants born to patients with premature rupture of membranes at term.
        Am J Obstet Gynecol. 1998; 179: 635-639
        • Imseis H.M.
        • Trout W.C.
        • Gabbe S.G.
        The microbiologic effect of digital cervical examination.
        Am J Obstet Gynecol. 1999; 180: 578-580
        • Dixon L.
        • Foureur M.
        The vaginal examination during labour: is it of benefit or harm?.
        N Z Coll Midwifery. 2010; 42: 21-26
        • Warren C.
        Why should I do vaginal examinations?.
        Pract Midwifery. 1999; 2: 12-13
        • Cheyne H.
        • Hundley V.
        • Dowding D.
        • Bland J.M.
        • McNamee P.
        • Greer I.
        • et al.
        Effects of algorithm for diagnosis of active labour: cluster randomised trial.
        BMJ. 2008; 337: 1396-1400
        • World Health Organisation
        Safe motherhood – care in normal birth: a practical guide.
        WHO, Geneva1997 (Available at) ([accessed 26.01.12])
        • Royal College of Obstetricians and Gynaecologists
        Intimate examinations: report of a working party.
        RCOG Press, London1997
        • Shepherd A.
        • Cheyne H.
        • Kennedy S.
        • McIntosh C.
        • Styles M.
        • Niven C.
        The purple line as a measure of labour progress: a longitudinal study.
        BMC Pregnancy Childbirth. 2010; 10: 54
      1. National Institute for Health and Clinical Excellence 2007 clinical guideline 55: intrapartum care. [accessed 03.11.11].

        • UK Clinical Standards Advisory Group
        Women in normal labour. Tindall VR.
        HMSO, London1995
      2. Information and statistics division Scotland. [accessed 12.11.11].

      3. Stuart M. Midwives’ discources on vaginal examination in labour. PhD thesis. University of West of England; 2008.

        • World Health Organisation
        Preventing prolonged labour: a practical guide. The partograph. Part I: principles and strategy.
        WHO, Geneva1993 (Available at) ([accessed 26.01.12])
        • Enkin M.
        • Keirse M.
        • Neilson J.
        • Crowther C.
        • Duley L.
        • Hodnett E.
        • et al.
        A guide to effective care in pregnancy and childbirth.
        University Press, Oxford2000
        • Hobbs L.
        Assessing cervical dilatation without VEs.
        Pract Midwifery. 1998; 1: 34-35
        • Sookhoo M.L.
        • Biott C.
        Learning at work: midwives judging progress in labour.
        Learn Health Soc Care. 2002; 1: 75-85
        • Tuffnell D.J.
        • Bryce F.
        • Johnson N.
        • Lilford R.J.
        Simulation of cervical changes in labour: reproducibility of expert assessment.
        Lancet. 1989; 334: 1089-1090
        • Huhn K.A.
        • Brost B.
        Accuracy of simulated cervical dilatation and effacement measurements among practitioners.
        Am J Obstet Gynecol. 2004; 191: 1797-1799
        • Bryne D.L.
        • Edmonds D.K.
        Clinical method for evaluating progress in first stage of labour.
        Lancet. 1990; 335: 122
        • Fraser D.
        • Cooper M.
        Myles textbook for midwives.
        15th edition. Churchill Livingstone, Edinburgh2009
      4. Henderson C. MacDonald S. Mayes midwifery. 13th edition. Balliere Tindall, London2004
        • Wickham S.
        Assessing cervical dilatation without VEs: watching the purple line.
        Pract Midwifery. 2007; 10: 26-27
        • Devane D.
        Sexuality and midwifery.
        Br J Midwifery. 1996; 4: 413-416
        • Lewin D.
        • Fearon B.
        • Hemmings V.
        • Johnson G.
        Women's experiences of vaginal examinations in labour.
        Midwifery. 2005; 21: 267-277
        • Bergstrom L.
        • Roberts J.
        • Skillman L.
        • Seidel J.
        “You’ll feel me touching you sweetie”: vaginal examinations during the second stage of labor.
        Birth. 1992; 19: 10-18
        • Downe S.
        • Dykes F.
        Counting time in pregnancy and labour.
        in: McCourt C. Childbirth, midwifery and concepts of time. Berghahn Books, 2009
        • Walsh D.
        Assessing women's progress in labour.
        Br J Midwifery. 2000; 8: 449-457