This post offers a summary of labour progress resources that are freely available on my website.
Labour progress is most frequently assessed by vaginal examination. However, there is very little evidence about the effectiveness or acceptability of vaginal examination.
A 2022 Cochrane review looked at whether routine vaginal examinations for assessing labour progress are effective and acceptable to women, and to compare the use of these examinations to other methods of assessing labour progress.
When researchers looked for studies that had considered this question, they only found, “four studies, with data for 744 women and babies.” (Moncrieff et al 2022).
Moncrieff et al (2022) found that, “Overall, the evidence was uncertain or very uncertain due to the study methods and the inclusion of small numbers of women and babies.”
This tells us that there is very little evidence relating to vaginal examination, which is one of the most routine screening tests used on women in labour.
Little evidence to support vaginal examination
Here are the authors’ conclusions:
“Based on these findings, we cannot be certain which method is most effective or acceptable for assessing labour progress.
Further large-scale RCT trials are required. These should include essential clinical and experiential outcomes. This may be facilitated through the development of a tool to measure positive birth experiences.
Data from qualitative studies are also needed to fully assess whether methods to evaluate labour progress meet women’s needs for a safe and positive labour and birth, and if not, to develop an approach that does.”
So, as is so often the case, the current approach is not supported by evidence. We need to look more carefully at what is happening in maternity care if we want to give good care to women, babies and families.
Beyond vaginal examination
There are quite a few other ways of assessing progress in labour. Some of these involve machine technology. For example, some clinicians and researchers are evaluating the use of ultrasound. There is currently little to no evidence on this either.
Some approaches involve less technology. For instance, experienced midwives can often assess labour progress by observing the woman’s behaviour and the sounds she makes. it is sometimes possible to see physical marks on some women, for instance the purple line. But it is important to note that there also isn’t much research into these approaches.
There is lots that we don’t know.
But here are a few blog posts and articles explaining what we do know.
The timing of birth
Vaginal examination resources
Midwifery alternatives to vaginal examination
Some of these blog posts discuss alternatives to vaginal examination. Some question the ideas that underpin it, and explain why we need alternative approaches, more research and different ways of thinking.
Women’s experiences, labour progress and physiological birth
Midwifery wisdom
And lastly, a few labour-related tips and midwifery wisdom:
You’ll find more on this, and many other topics, in my upcoming book on midwifery knowledge.
I’ll be sharing more details in September, and my email subscribers always get the earliest, juiciest, and most extensive details!
If you’re not on my email list and would like to be, sign up here, and then check for the confirmation email.
The reference for the Cochrane review mentioned above is: Moncrieff G, Gyte GML, Dahlen HG et al (2022). Routine vaginal examinations compared to other methods for assessing progress of labour to improve outcomes for women and babies at term. Cochrane Database of Systematic Reviews 2022, Issue 3. Art. No.: CD010088. DOI: 10.1002/14651858.CD010088.pub3.
You can see the review at https://www.cochrane.org/CD010088/PREG_routine-vaginal-examinations-labour
About the Author: Dr Sara Wickham is an author, speaker, and researcher specialising in pregnancy, birth and maternity care. Her work focuses on evidence-based, woman-centred information and informed decision-making, drawing on more than 30 years of midwifery knowledge and experience.
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