Maternal consideration .pdf

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MIDWIFERY, 1986, 2, 93-97
© Longman Group I986

M a t e r n a l c o n s i d e r a t i o n s in t h e use
of pelvic e x a m i n a t i o n s in labour
K. Murphy, V. Grieg, J. Garcia and A. Grant

In a r a n d o m i s e d controlled trial involving 307 w o m e n m a t e r n a l discomfort
associated with a policy o f rectal examinations for routine m a n a g e m e n t in l a b o u r
was c o m p a r e d with t h a t associated with an alternative policy of using vaginal
examinations. T h e w o m e n , irrespective of p a r i t y showed a clear preference for the
vaginal e x a m i n a t i o n policy: 28% in the rectal e x a m i n a t i o n g r o u p c o m p a r e d with
only 11% in the vaginal e x a m i n a t i o n g r o u p described their examinations as "very
u n c o m f o r t a b l e ' . F u r t h e r m o r e , there was no evidence t h a t the vaginal e x a m i n a t i o n
policy was associated with an increased risk of m a t e r n a l or n e o n a t a l morbidity.
T h e c o n t i n u i n g use o f routine rectal e x a m i n a t i o n s in l a b o u r should be reassessed
and greater consideration given to m a t e r n a l feelings.

In 1894 two Germans, Kroenig and Ries (Peterson el al., 1965), independently introduced the
rectal examination in labour following evidence
produced by Semmelweis in 1847 that puerperal
infection was caused by the introduction of septic
material into the birth canal by the examining
hand of the birth attendant. By 1920 the practice
had become widespread and remained so until the
1950's when a series of historical control and nonrandomised, concurrent control trials, carried out
in the United States showed a similar incidence of
puerperal infection whether rectal or vaginal
Karl Murphy, MB, BCh, BAO, DCH, Senior House
Officer, National Maternity Hospital, Dublin 2. (Current
Address): Registrar, Queen Mary's Hospital,
Roehampton Lane, London.
Valerie Grieg, SRN, SCM, Chef Superintendent
Labour Ward, National Matermty Hospital, Dublin 2.
Jo Garcia, BA, MSc, Social Scientist, National
Perinatal Epidemiology Unit, Radcliffe Infirmary, Oxford,

examinations were employed during labour,
(Prystowsky, 1954; Manning, 1961; Bertelsen et
al., 1963; Slotnick et al., 1963; Jara et al., 1965;
Peterson et al., 1965). Over the next decade
vaginal examination was re-introduced and rectal examination fell into disuse. Its retention in
some obstetric centres, particularly in Ireland,
may be related to its incorporation into a welltried and successful hospital management policy
(O'Driscol and Meagher, 1980). Two of the three
large Dublin Maternity Hospitals perform rectal
examination as a routine in labour.
In this study we compared women's reactions
to rectal and to vaginal examinations during
Adrian Grant, DM, MRCOG, Epldemiologist, National
Perinatal EpJdemiology Unit, Radcliffe Infirmary, Oxford,
OX2 6HE.
Manuscript accepted 4th Nov. 1985

(Reprint requests to Karl Murphy)

OX2 6HE.


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