Hello, I am a 3rd year student midwife at Bangor University. I am currently planning my research proposal which involves assessing current literature and research about a topic in which I am interested in. I have chosen to further look into the routine use of Vaginal Examinations (VE) as a measure for assessing progress in labour and the evidence which supports this practice. Vaginal examinations have become a routine intervention in labour as a means of assessing labour progress (Dahlen et al. 2014). Midwives and obstetricians conduct VE’s at regular intervals during a woman’s labour. They are either conducted alone or as a component of the partogram with the aim is to assess if labour is progressing physiologically, and to provide an early warning of slow progress.Abnormally slow progress can be a sign of labour dystocia or prolonged labour, which is associated with maternal and fetal morbidity and mortality due to infection, increased risk of fetal distress and increased risk of postpartum haemorrhage. However, over-diagnosis of a prolonged labour can lead to complications due to unnecessary intervention (Downe, et al. 2013).NICE (2014) currently recommend that vaginal examinations should be offered to women at regular intervals of not less than 4 hourly intervals and only performed when justifiably necessary, although it is this justification that varies among midwives.According to Dixon et al. (2010), a vaginal examination is an important skill that can support midwives to interpret labour rhythms and deviations from the normal physiological process. However, they also argue that a vaginal examination is an invasive procedure which can be very distressing and painful for some women as well as feelings of losing control, vulnerability and previous experiences of sexual abuse arising. There are several other measures for assessing progress that can be observed, confirming normality and indicating progress in labour. These include:Assessing maternal behavior through 1:1 care, listening for changes in her breathing, noises and posture.Assessing the Thomboid of Michalis which is where a bulge appears between the sacrum and the ilea becoming increasing visible when the fetus head descends.Observing for any further “shows” which is often noted towards the end of the first stage of labour (Jackson et al. 2014).Observing for a purple line which appears from the woman’s anal margin and extends to the top of her bottom which indicates progressAnd finally, an abdominal palpation could be performed to assess position and fetal descent as well as to assess any increased strength or frequency of contractions (Walsh, 2012). Therefore, in my opinion it can be argued that vaginal examinations are a core skill of the midwife but must only be performed when absolutely necessary, clinically indicated and justification of the intervention documented as well as gaining the woman’s informed consent. Questions to consider:- What are your thoughts about the use of VE in labour?- How reliable do you think VE are in assessing progress?- Do you have any experiences with other means of assessing labour?- What are women’s experiences of having a VE in labour?- Are midwives informing women of the alternatives to VE?- How would you feel if a woman declines a VE?- Do you think more research needs to be carried out on the routine use of VE in labour? References:- Dahlen,H., Downe, S., Duff, M. and G. Gyte. (2014). Vaginal examination during labour: Routine examination or routine intervention? Midirs Midwifery Digest, 24 (1) pp.67-76.- Dixon, L., & Foureur, M. (2010). The vaginal examination during labour: Is it of benefit or harm? New Zealand College of Midwives Journal 42, 21-26.- Downe,S., Gyte, G.M.L., Dahlen, H.G. & Singata, M. (2013). Routine vaginal examinations for assessing progress of labour to improve outcomes for women and babies at term (Review). The Cochrane Library, (7) pp. 1-42.- Jackson, K., Marshall, J. E., & Brydon, S. (2014). Physiology and care during the first stage of labour. IN J. Marshall & M. Raynor (Eds). Myles Textbook for Midwives (pp. 327 – 366).- National Institute for Health and Care Excellence. [NICE]. (2014). Intrapartum care for healthy women and babies NICE guidelines [CG190]. Retrieved from: https://www.nice.org.uk/guidance/cg190- Walsh, D. (2012). Evidence and Skills for Normal Labour and Birth: A Guide for Midwives. (2nd edition). Oxon: Routledge.