Women’s experiences with vaginal examinations during labor in the Netherlands

Abstract

Introduction: Vaginal digital examination (VE) is a routine medical procedure during labor to assess the start and progression of labor. This study explores women’s experiences with VE’s during labor in the Netherlands.

Methods: An exploratory anonymous online survey was distributed among Dutch women who underwent a trial of labor and gave birth to a living term child in the previous six months. Unadjusted odds ratios are calculated to establish associations between women’s characteristics and reporting a negative experience with VE's.

Results: Of the 159 women who met the inclusion criteria, 56 women (35.2%) reported a negative experience with the VE. These women reported more pain, embarrassment, not being able to relax, not feeling respected and not feeling the possibility to stop the examination. The odds of reporting negative experiences increased by giving birth in hospital, an instrumental delivery, more examinations, more different caretakers performing the examination and caregivers not introducing themselves before the examination. About 41.7% of the women reported being examined more often than advised in national and international guidelines (every two to four hours).

Discussion: Although our study is limited, it shows that experiences with the VE during labor can be negative and should be considered carefully. We promote research of and teaching the use of additional noninvasive methods to assess progression of labor in daily clinical practice. We conclude that the number of VE’s during labor should be restricted as much as possible. VE’s should only be performed in the interest of the woman in labor, after her informed consent and preferably performed by as few different caregivers as possible.

Keywords:

• Childbirth
• midwifery
• psychological well-being
• vaginal examination
• women’s health

Acknowledgements

We would like to thank all the women who participated in our research.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Current knowledge on the subject

• During labor, vaginal digital examination (VE) is an established medical intervention to determine the start of the active phase of labor and monitor its progression.

• For women in labor, a VE can be positive and motivating when it confirms that labor is progressing, but it can also be experienced as disturbing, invasive and embarrassing.

• In the Netherlands, gynecological teaching associates train medical students to perform the examination in a respectful way with emphasis on professional behavior and communication skills.

What this study adds

• This study reports the experiences of a convenience sample of Dutch women with VE during labor.

• After a successful spontaneous vaginal (home) delivery, women are less likely to experience the VE during labor negatively.

• In almost half of the labors, VE’s were performed more often than advised in protocols and guidelines.