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Dear Soo, Interesting topic. In the Netherlands, the partogram was introduced not so long ago. Not all midwives use it yet and if they do, maybe not for all labours. The partogram used in the Netherlands has a section for the latent phase and the active phase of labour. VE's that are not recorded on this are those that are performed when women are not considered to be in labour yet. For example: contractions more than 5 minutes apart and maybe still irregular. I agree that during the second stage midwives may not record all of their 'quicky VE's'. I think the decision to intervene is mainly based on dilatation, although descent of the foetal head, moulding and caput succedaneum may play a role as well. Good luck and best wishes, Ank. ________________________________ Van: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] Namens Jette Aaroe Clausen Verzonden: dinsdag 2 augustus 2011 10:47 Aan: [log in to unmask] Onderwerp: SV: query about the use of vaginal examination in labour and/or the use of the partogramme Sorry, I mean of course that "always' is a phrase that one should use with caution... ________________________________ Fra: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] På vegne af Jette Aaroe Clausen [[log in to unmask]] Sendt: 2. august 2011 10:42 Til: [log in to unmask] Emne: SV: query about the use of vaginal examination in labour and/or the use of the partogramme "Never say never' is always a phrase that one should use with caustion. In my exsperience there are always more variations in the world, than we imagine. I have, as you, the same exsperience of VE as being used without the partogramme. In fact that was the way I was thought midwifery in the mid 1980's. We described our findings in the woman's hospital notes. As hospitals has become centralised, and small units has been closed, VE in combination with partograms has become more in widespread use in Denmark. I am sure that there are places that still uses VE without partograms, especially in places that subscribe to a non interventionist obstetrics. Unfortunately I have not a recent update on all Danish labor wards. You do not say if you look at both first and second stage labour. The partogram is first used when the woman is in established labour. Hospitals that have an admission unit, will sometimes use the partogram first, when the woman has been admitted into the labour ward (i.e. is in established labour). From my observations in a recent fieldstudy, I think that more VE are done in the second stage of labour than what is recorded in the woman's hospital notes. As to the second part of your question, I think that the whole obstetric situation and the who situation are taken into account. Jette Aaroe Clausen Denmark ________________________________ Fra: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] På vegne af Briege Lagan [[log in to unmask]] Sendt: 2. august 2011 10:34 Til: [log in to unmask] Emne: Re: query about the use of vaginal examination in labour and/or the use of the partogramme Hi Soo In units where I work as bank midwife to maintain my clinical skills, the partogram is only commenced when the woman is in established labour. When the woman is in early labour a partogram would not be used and yet VE's would still be performed to assess progress. In answer to your second question, in essence yes it would be used in a decision on whether to intervene but the overall clinical picture/history (past and present obstretric) would also be incorporated into the decision. Briege Dr Briege M Lagan RM, PhD EUROmediCAT Research Fellow Room 12L10C Institute of Nursing Research University of Ulster Jordanstown Campus Newtownabbey County Antrim BT37 0QB Northern Ireland Tel: 44 (0)2890368318 Fax: 44 (0)2890368341 Email: [log in to unmask] ________________________________ From: Soo Downe <[log in to unmask]> To: [log in to unmask] Sent: Tue, 2 August, 2011 8:34:00 Subject: query about the use of vaginal examination in labour and/or the use of the partogramme Dear all We are completing a protocol for a review on the value of the vaginal examination as a measure of progress in labour. We have been advised that the VE is never used without the partogramme (and without attention to all the elements on the partogramme). From our clinical experience, we are not sure that this is the case - we have practical experience of the VE being used as a measure of progress in labour without reference to the partogramme (even where it is part of the routine recording process) but our experience may well be very limited. We would be very interested in your experience in the following areas: 1. In your experience, is vaginal examination ever used on its own, without using a partogramme? 2. Where the partogramme is used as a record, are all the elements of it usually used in a decision on whether to intervene? Many thanks for your advice All the best Soo