Internal examinations in labor
Nobody has ever tested whether the routine is necessary.
Progress in labor is usually assessed by an internal examination every four hours or so. It is one of the most invasive routine practices in maternity care, and the evidence behind it is close to nonexistent.
A Cochrane review found only 4 trials in the entire literature comparing methods of assessing progress, covering 744 women and babies. No trial has ever compared routine examinations with not performing them. The one study comparing routine four-hourly examinations with examining only when indicated found more labor augmentation in the routine group (relative risk 2.55). The reviewers' conclusion was that they cannot be certain which method is most effective or acceptable.
What this does and does not meanIt does not mean examinations are useless. Knowing dilatation genuinely informs decisions. It means the schedule is convention, that each examination requires your consent every time, and that "we need to check you" is not the same as "this examination will change what we do."
Reasonable requests"Ask me each time." "Tell me what you expect to learn and what would change." "I would like fewer of these unless something changes." All are legitimate.
Where this comes from:
174. Moncrieff G, Gyte GML, Dahlen HG, Thomson G, Singata-Madliki M, Clegg A, et al. Routine vaginal examinations compared to other methods for assessing progress of labour to improve outcomes for women and babies at term. Cochrane Database Syst Rev. 2022;(3):CD010088.
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This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.