Midwifery (RM)
Vaginal Examination During Labour
Vaginal examination during labour assesses cervical dilatation and effacement, membranes, presenting part, position, station, moulding, caput, and pelvic findings. It is performed only when clinically indicated, with consent, privacy, infection prevention, and careful interpretation.
Purpose
- Assess labour progress and fetal descent
- Identify presentation, position, membranes, and abnormalities
- Guide safe decisions about ongoing management or referral
Indications
- Assessment of labour progress at clinically appropriate intervals
- A change in maternal or fetal condition
- Suspected rupture of membranes, abnormal presentation, or imminent birth
Equipment
- Private labour room and drapes
- Sterile or appropriate examination gloves
- Lubricant, light, pads, and waste receptacle
- Hand-hygiene supplies
- Partograph or labour record and documentation materials
Preparation
- Review previous examination and fetal status; explain why this examination is needed now.
- Ensure privacy, suitable lighting, and an emergency escalation pathway.
Procedure steps
- Explain the indication, procedure, sensations, benefits, and right to stop; obtain consent.
- Review maternal and fetal status, contractions, membranes, bleeding, and previous findings.
- Provide privacy, position comfortably, and use a chaperone or support person according to preference and policy.
- Perform hand hygiene and use appropriate gloves and clean technique.
- Inspect externally, then gently assess cervix, dilatation, effacement, membranes, presenting part, position, station, moulding, caput, and liquor when present.
- Avoid unnecessary repeated examinations and stop if severe pain, bleeding, distress, or unexpected resistance occurs.
- Communicate findings and interpret them with contractions, fetal heart, and overall condition.
- Update the partograph or labour record and escalate slow progress, malpresentation, cord presentation, or fetal compromise.
- Dispose of materials safely, remove gloves, perform hand hygiene, and restore comfort.
- Document indication, consent, findings, time, response, plan, and communication.
Precautions
- Do not perform routine repeated examinations without indication.
- Use aseptic technique and avoid examination with unexplained bleeding until appropriate assessment.
- Stop and escalate suspected cord prolapse, abnormal presentation, severe pain, or fetal compromise.
- Respect refusal and explain alternatives or consequences.
Aftercare
- Explain findings and next steps.
- Monitor maternal and fetal wellbeing after the examination and provide hygiene support.
Nursing considerations
- Correlate findings with the full labour picture rather than using dilatation alone.
- Use respectful communication and preserve dignity.
Patient education
- Explain that examinations may be limited to those needed for safe care and that the woman can ask to pause.
- Report increasing pain, bleeding, pressure, fluid, or reduced fetal movement.
Documentation
- Record time, indication, consent, cervix, membranes, presenting part, position, station, caput, moulding, liquor, fetal status, and plan.
- Update the partograph accurately.
References and further reading
Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.
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