gms | German Medical Science

Background: Vaginal examinations during birth are a common aspect of birth management and an essential skill in midwifery practice. Particularly, since the implementation of the partograph as a basic means for the surveillance of birth progress, vaginal examinations have become a routine procedure. At the same time, a vaginal examination has an impact on the intimacy and privacy of a woman, which can be aggravating and painful, and may even cause traumas. From this point of view, any vaginal examination has to be considered as an intervention which requires a serious indication as well as careful practice.

Aims: The objective was to find out, how vaginal examinations are described in common German and English textbooks for midwifery education.

Methods: A literature search was conducted to get a general idea of research done on this topic. To find out how women experience vaginal examinations during birth the author carried out qualitative interviews with 10 women regarding their birth experiences and the way they perceived vaginal examinations during birth. An expert interview considers the subjective view of a midwife who is a professional researcher.

Results: The description of vaginal examinations in textbooks does not adequately address the intimate character of this intervention and fails to consider the psychosocial and communicative skills needed. An increasing number of scientific papers in English language can be found that critically question the paradigm of birth progress and its impact on birth monitoring and management. The interviews demonstrate, that women generally accept routine vaginal examinations during birth as necessary interventions. They do experience them, however, as aggravating and in some cases as painful. None of the women received adequate information regarding vaginal examinations in the sense of shared decision making. Repeated vaginal examinations convey a sense of time pressure to women in labour and cause disturbance of their labour process.

Conclusions: Vaginal examinations during birth are not harmless routine interventions. They leave an imprint on the birth experience, especially as they have a decisive influence on decisions regarding obstetric interventions. It is necessary to rethink the common practice of vaginal examinations and establish a more sophisticated and careful handling. Clear indications and contraindications for a vaginal examination should be established.