Vaginal Examinations in Labour: What They Are, Why They’re Offered, and What Your Choices Are.

If you are preparing for birth, chances are someone has mentioned vaginal examinations in labour, sometimes called VEs or “internal examinations”.

For many parents, they are just presented as something that routinely happens during labour. But in reality, vaginal examinations are far more nuanced than that.

They can sometimes provide useful information. They can also feel uncomfortable, emotionally difficult, or lead to decisions that deserve careful thought.

And importantly, they are always your choice.

As an antenatal educator with nearly 20 years’ experience supporting families across West Lothian and Central Scotland, one of the biggest things I see is parents assuming they either have to agree to vaginal examinations or believing they are the only way labour can be assessed.

Neither is true.

So let’s break down what vaginal examinations actually are, why they are performed, what the research says, and how you can make informed decisions during labour.

What Is a Vaginal Examination in Labour?

A vaginal examination is when a midwife or doctor places two gloved fingers into the vagina to assess the cervix and the baby’s position during labour.

They may be checking:

• how open the cervix is (dilation)

• how thin or stretchy the cervix feels

• whether labour appears established

• the position of the baby

• how low the baby’s head is in the pelvis

• whether the waters have broken

• how labour appears to be progressing

NHS guidance describes vaginal examinations as one method used to assess labour progress and cervical change.

Why Are Vaginal Examinations Offered During Labour?

In UK maternity care, vaginal examinations are commonly offered because they may help staff assess how labour is progressing and guide decision-making.

They may be suggested:

• when you arrive at hospital or birth centre

• if it is unclear whether labour is established

• approximately every four hours in established labour

• before induction procedures such as breaking the waters

• before starting or increasing an oxytocin drip

• if there are concerns labour has slowed

• if there are concerns about baby’s position

• if there is uncertainty about whether you are ready to push

The important word here is offered.

According to NICE guidance on intrapartum care, vaginal examinations should be offered respectfully, explained properly, and only carried out with consent.

That is very different from “you have to”.

Are Vaginal Examinations Necessary?

Sometimes they are genuinely useful. Sometimes they are less useful than they are presented to be.

A vaginal examination gives information about one specific moment in time. It does not accurately predict exactly how long labour will last or how close birth is, and this matters because labour is not linear.

You can be 3 cm dilated and give birth a few hours later.

You can be 8 cm dilated and still labour for quite some time.

This is one of the reasons I often encourage parents in my antenatal classes not to emotionally attach themselves too strongly to numbers. Labour is about far more than centimetres.

What Does the Research Say About Vaginal Examinations?

This is where things get interesting.

A 2022 Cochrane Review on routine vaginal examinations in labour found that there is actually limited high-quality evidence comparing routine vaginal examinations with other ways of assessing labour progress. The review concluded that there is not enough evidence to confidently say one approach is superior.

In other words:

Vaginal examinations may provide useful clinical information, but research has not clearly shown that routinely performing them improves outcomes for mothers or babies compared with other methods of assessing labour progress.

That surprises many parents, because in practice, VEs are often presented as central to labour care.

However, experienced midwives assess labour in many ways beyond cervical dilation alone.

These include:

• contraction pattern and intensity

• behaviour and emotional changes

• breathing and vocalisation

• movement and positioning

• how the woman is coping physically and emotionally

• pressure sensations

• spontaneous pushing urges

• changes in appearance or behaviour

• overall clinical picture

Good labour care is not simply about measuring centimetres.

What Are the Benefits of Vaginal Examinations?

There absolutely can be benefits.

1. They Can Help Confirm Labour Progress

A VE may show whether the cervix is changing and whether labour appears established.

2. They Can Help Guide Decisions

If induction, augmentation or other interventions are being discussed, a VE may provide information that helps guide next steps.

3. They May Help Identify Baby’s Position

Sometimes labour feels prolonged or intense because baby is in a less favourable position.

4. They May Reassure Some Parents

Some people genuinely find reassurance in having a clearer idea of what may be happening physically.

5. They Can Be Helpful Before Certain Procedures

For example, before breaking the waters or using forceps or ventouse, an examination may be clinically important.

What Are the Risks or Downsides of Vaginal Examinations?

This is the part that often gets skipped over.

Although vaginal examinations are common, they are still intimate procedures and can have both physical and emotional downsides.

1. They Can Be Uncomfortable or Painful

Some people find vaginal examinations mildly uncomfortable.

Others find them very painful, especially during contractions or if feeling tense or frightened.

2. They May Feel Emotionally Difficult

For some parents, especially those with previous trauma, anxiety, or difficult past medical experiences, VEs can feel exposing, vulnerable or distressing.

3. They May Increase Infection Risk

The infection risk is generally low when good hygiene is used, but repeated vaginal examinations after the waters have broken are associated with increased infection risk.

4. They Can Accidentally Rupture the Membranes

Occasionally, the waters may break unintentionally during an examination.

5. The Information Can Affect Confidence

Hearing “you’re only 3 cm” after many hours of labour can feel incredibly discouraging, even when labour is progressing normally.

I have seen parents completely lose confidence because of how results were communicated.

6. They May Contribute to a Cascade of Intervention

If labour is labelled as “slow”, this may lead to discussions around:

• breaking the waters

• oxytocin drips

• continuous monitoring

• epidural

• assisted birth

• caesarean birth

That does not mean interventions are always wrong, but it does mean that how labour is assessed matters.

Can You Refuse a Vaginal Examination?

Yes.

You can accept one.

Decline one.

Delay one.

Ask questions first.

Or change your mind halfway through.

According to Birthrights UK, all examinations and procedures in labour require informed consent. You never need to agree simply because someone has suggested it.

Questions You Can Ask Before Agreeing to a VE

One of the most powerful things you can do in labour is ask:

• “What information are you hoping to gain from this?”

• “How will this change the plan?”

• “What happens if I say no?”

• “Are there other ways to assess progress?”

• “Can we wait and reassess later?”

• “Is this urgent or routine?”

They are informed questions and informed decision-making is a huge part of positive birth experiences.

How to Make Vaginal Examinations More Comfortable

If you do choose to have a VE, there are things that may help.

You can ask for:

• clear explanations beforehand

• privacy

• fewer people in the room

• your birth partner beside you

• the examination to pause or stop at any time

• no examination during contractions

• slow communication

• extra lubrication

• gas and air if available

• the same midwife where possible

You can also ask staff not to announce cervical dilation immediately if you feel it may affect your mindset.

What About Birth Plans?

This is something worth thinking about before labour starts. Many parents include preferences around vaginal examinations in their birth plans.

For example:

“Please explain why any vaginal examination is being recommended and how the information may affect my care. I would like to give consent each time.”

Or:

“I would prefer to keep vaginal examinations to a minimum unless clinically necessary.”

Or:

“I may find vaginal examinations difficult due to previous experiences. Please discuss them sensitively and gain clear consent before proceeding.”

Birth preparation is not about planning a “perfect birth”, It is about understanding your options so you can make decisions with confidence.

Vaginal Examinations and Birth Preparation: What Really Matters

One of the biggest myths in antenatal education is that labour progress is only about cervical dilation. It is not. Labour is physical, emotional, hormonal and deeply individual.

Good preparation means understanding:

• how labour physiology works

• how environment affects labour

• how stress and adrenaline can impact progress

• what interventions are available

• what your choices are

• how to communicate with confidence

• how your birth partner can support decision-making

Confident birthing is not about blindly saying yes or no to procedures. It is about understanding why things are being offered and feeling able to make informed decisions in the moment.

FAQs About Vaginal Examinations in Labour

Can I refuse a vaginal examination in labour?

Yes. Vaginal examinations are optional and require your consent.

How often are vaginal examinations offered in labour?

NICE guidance suggests they may be offered approximately every four hours in established labour, or sooner if clinically indicated or requested.

Are vaginal examinations painful?

Some people find them mildly uncomfortable while others find them painful. Your experience may depend on positioning, relaxation, labour intensity and previous experiences.

Can labour progress without vaginal examinations?

Yes. Labour can often be assessed using multiple signs and observations, not just cervical dilation.

Do vaginal examinations increase infection risk?

Repeated examinations after the waters have broken may increase infection risk, particularly if labour is prolonged.

Final Thoughts

Vaginal examinations are neither inherently “good” nor “bad”. They are one tool. Sometimes they provide genuinely useful information. Sometimes they may not change anything at all.

Antenatal Classes in West Lothian, Edinburgh and Central Scotland

Inside my antenatal classes at Birth Prep with Joy, we talk honestly about labour, interventions, decision-making and how to navigate maternity care without fear or overwhelm.

Parents tell me again and again that what helped most was not memorising facts.

It was understanding how birth actually works, what their options were, and how to feel calmer and more confident when decisions arose.

I support expectant parents across:

• West Lothian

• Linlithgow

• Livingston

• Edinburgh

• Glasgow

• Falkirk

• Central Scotland

• and online

through evidence-based antenatal education that is practical, balanced, inclusive and non-judgemental.