An observational study using audio-video recording to assess care given to vaginal examinations during labour

Vaginal examinations are intimate and potentially embarrassing experiences, particularly so during childbirth, where they are a common procedure. Few investigations of vaginal examination procedures in labour have been undertaken, yet it carries risk of emotional trauma and infection, a potentially avoidable cause of perinatal mortality. As part of our ongoing investigation of care in labour we undertook a detailed analysis of vaginal examinations during labour. Informed consent was obtained for observation of direct care of 20 mothers in labour by audio-video recording, within a single delivery room. A protocol was developed from professional guidelines to assess quality of care during vaginal examinations with emphasis on dignity, hygiene, contamination and communication. Experienced clinicians performed the examinations. On average a vaginal examination was undertaken every 2 hours with a total of 59 examinations (minimum one to maximum eight) during 123 hours of labour. Table I summarises the findings. No vaginal examination conformed to the 'ideal' model. Mothers were exposed unnecessarily during the procedure, with only 11 examiners using simple measures to maintain the mother's dignity. There was a lack of basic hygiene standards, with contamination of the room post-examination. Points will be illustrated with video clips.