gms | German Medical Science

Background: In several studies the VE is identified as gold standard to assess birth progress and long-standing part of midwifery practice. It is often used more frequently than advised by guidelines, even though it is an intrusive intervention and carries multiple risks. Midwives are the primary intrapartum care providers and their practice can have a strong impact on the outcome of families, therefor it should be evidence-based. Guidelines function as orientation to reflect daily work and attitude but are often not followed by professionals. Consequently, it is crucial to understand the meaning of VE in practical work in order to support the guideline implementation.

Aim/Research question: Extracting the standing of vaginal examination (VE) in birth care provided by midwives in hospitals and taking this, other factors and barriers into account to evaluate the practicability of the recommendations regarding VE in the evidence-based S3-guideline Vaginal birth at term (2020) and deriving strategies to support the implementation and therefor evidence-based practice.

Methods: In-depth interviews were undertaken 2021 with eight midwives working in two hospitals in Berlin. A qualitative content analysis was performed.

Results: In general, midwives valued the VE as a diagnostic tool and source of information in moments of decisions, but questioned its importance in physiological, low-risk birth. They acknowledged it as an intrusive procedure with potential negative consequences. This study however identified the outstanding significance of a multitude of obstetric and external factors, which independently influenced the general standing and use of the VE on a high level and could lead to a shift of meaning. The external factor clinical setting with its inter- and monodisciplinary teamwork, standards and lack of resources stood out as barriers which have to be reduced to support the implementation process and minimize the use of VE. Therefor a large part of the conducted ten strategies addressed these problems.

Relevancy: This study gives a first impression of the standing of VE for clinical midwives in relation to guideline recommendations. It also highlights the relevancy of the individual process that has to be undertaken in each German hospital in order to implement the guideline successfully.

Recommendations/Conclusion: This study underlines the importance of reflecting the influence of various factors on the meaning of VE to promote evidence-based practice. It is necessary to analyze specific barriers of an institution which form the basis of strategies to optimize the guideline implementation.

Ethics and conflicts of interest: A vote on ethics was not necessary. The research was financed by own resources. There are no conflicts of interest.