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.
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
What time are babies most likely to be born?
What is a labour plateau?
Vaginal examination resources
Resources for questioning vaginal examination
Transvaginal examination – the need for care
When the simplest ideas are the best…
When is consent not consent?
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.
Cervical wisdom resources
Hands-off midwifery and the art of balance
Assessing cervical dilatation without VEs: Watching the purple line
Evidence for the purple line…
Cervical dilation is (now mathematically shown to be) unpredictable
What is cervical recoil?
Stepping Stones and Cervical Wisdom
Defining active labour
Women’s experiences, labour progress and physiological birth
The most important thing women can do for themselves in the quest for a normal birth?
Who is most at risk of caesarean section?
The Rhombus of Michaelis
Women’s experiences of augmentation of labour
And lastly, a few labour-related tips and midwifery wisdom:
The importance of everyday birth wisdom
Let there be mood lighting…
Eight ways of promoting active birth through bedlessness…
A Tribute to Tricia’s Lab Cats
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
Want to stay up to date and get regular updates on birth-related research and thinking sent free to your inbox?