Vaginal examination during normal labor : routine examination or routine intervention?

Despite a continuing lack of good quality studies of the effect of routine vaginal examination, it is often routinely used in clinical practice. Indeed, internationally respected authorities such as the U.K. National Institute for Health and Clinical Excellence (NICE) continue to recommend the offer of a vag- inal examination when a woman enters a hospital in suspected established labor and 4 hourly vaginal examinations as labor progresses. In this article, we explore historical and clinical drivers for the wide- spread implementation of routine vaginal examination in labor to predominantly assess the dilation of the cervical os and examine some of the reasons for continuing use of the procedure, current critiques of its routine use, and possible alternatives for assessing labor progress. We discuss the possibility that both covert and overt knowledge operate in the assessment of labor progress, and we consider the con- sequent potential for dissonance between what midwives actually do and what they record as having been done. The final discussion theorizes these findings and suggests alternative ways of framing labor progress for the future.