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Lacking confidence in performing VEs and explaining the findings

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Lacking confidence in performing VEs and explaining the findings

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Lack of support from practice supervisors in facilitating opportunities

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Women declining due to the need for the PS to repeat the VE

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Working with different practice supervisors each shift means that they may not be aware of your learning needs or confidence levels

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Concerned about making mistakes or misleading the women

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Seek out intrapartum spokes to build confidence on intrapartum VEs

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Expressing need to gain experience with VEs to your practice supervisor at the start of each shift

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Being proactive in seeking opportunities for VE experience, asking the PS and the woman whether you can perform the VE when required

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Seek opportunities to practice skills in clinical skills labs

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Seek out experience when on the antenatal ward or community placements to build confidence and experience with antenatal VEs

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The Effect of Simulation Teaching Method on Midwifery Students' Knowledge and Skills of Vaginal Examination in Labor: A Randomized Controlled Study

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This RCT found that student midwives' knowledge and accuracy of determining cervical dilation and cervical effacement and fetal descent was significantly after student midwives completed clinical simulation teaching.

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Roosevelt, Diebel and Zielinski (2018) book "Midwifery" addresses the difficulty STMW's have with gaining experience in performing VE's in practice and the long term repercussions this has on students e.g. stress that they will not feel competent with this skill before they qualify.

This book highlights the importance of students advocating for themselves in clinical practice, to gain this exposure.

For example, having good communication with their supervisor- that it is one of their learning needs so they are more likely to get exposure to this skill.

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seek out experiences of speaking to women regarding VE's for example what Vaginal Examination entails (explaining dilatation and effacement) and consent to perform VE's.

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ward activity- This can make you reluctant to ask midwives if you can perform a VE due to the work load that midwife has. This can make you feel like they may not have time to supervise you performing a VE followed by themselves repeating the examination.

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Confidence in ability as this is a new and developing skill- students may feel that asking is a burden to the woman and their supervisor and may feel that this is inappropriate for certain VE indications such as emergencies requiring delivery imminence assessment

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This literature review highlights how midwifery students may have improved confidence with VEs with proper training of how to gain informed consent for this procedure. This review also demonstrated how negative experiences of vaginal examination are linked with their overuse, and how positive experiences can be achieved with good communication skills and continuity of carer. This evidence therefore implicates a need for student midwives to have good knowledge of vaginal examinations through theory teaching, and be shown evidence-based ways of gaining informed consent. Student midwives may also greatly benefit from using their student caseload as an opportunity to perform VEs, as they are able to build a continuity of carer relationship.

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6.34 undertake vaginal examination with the woman’s consent

from the standards of proficiency for midwives, which are outcomes midwives must possess at time of registration

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Use continuity of care caseload as an opportunity to do vaginal examinations, as having that longer term relationship with a woman may give the student more confidence to communicate and gain informed consent in this situation.

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negative experiences for example feeling put on the spot by supervisors with questions you are unsure about, concern that you are taking too long as vaginal examinations are often uncomfortable for the woman and therefore not fully completing the examination

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ensure that the woman has good counselling for the examination, including advice on using analgesia such as gas and air and asking your supervisor to coach the woman through the examination to support you to effectively use opportunities to complete vaginal examinations and gain communication skills.

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1.8.9

When conducting a vaginal examination:

be sure that the examination is necessary and will add important information to the decision-making process

recognise that a vaginal examination can be very distressing for a woman, especially if she is already in pain, highly anxious and in an unfamiliar environment

explain the reason for the examination and what will be involved

ensure the woman's informed consent, privacy, dignity and comfort

explain sensitively the findings of the examination and any impact on the birth plan to the woman and her birth companion(s)

advise the woman that she can decline the examination before it starts, or ask to stop at any stage during the examination. [2014, amended 2023]

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1.3.2 Advise women that additional resources to help them plan their place of birth are available on the tools and resources page for this guideline and the NHS website. [2023]

1.3.5 Discuss with women the following information, including local statistics, about all local birth settings, and update them if this changes during their pregnancy:

access to medical staff (obstetric, anaesthetic and neonatal)

availability of birthing pools

access to pain relief, including Entonox (a 50:50 mixture of oxygen and nitrous oxide) and medicines (for example, pethidine, diamorphine, patient-controlled analgesia and regional analgesia)

the likelihood of being transferred to an obstetric unit (if this is not the woman's chosen place of birth), the reasons why this might happen, the time it may take, the delay in obstetric or neonatal care this may cause, and how her birth companion will travel; refer to table 1 if no local data is available.

More information on transfer to an obstetric unit for different groups of women is included in table 2 and table 4. [2014, amended 2023]

Main reason for transfer to an obstetric unit for each woman (there may be more than 1 reason)

From home (n=3,529)

From a freestanding midwifery unit (n=2,457)

From an alongside midwifery unit (n=4,401)

Source: Birthplace in England research study, 2011.

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This guideline covers the care of women and their babies during labour and immediately after birth. It focuses on women who give birth between 37 and 42 weeks of pregnancy ('term'). The guideline helps women to make informed choices about where to have their baby and about their care in labour.

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concerns about difference of opinion with results, as the assessment may be varied due to different practitioners completing it.

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first we established ground rules for our group

we then identified the problem of lacking confidence in performing VEs through group discussion, making sure to actively listen to eachother and not jump to giving advice

following this, we allocated different roles to each member of the group to allow reflection and questions to be asked around this problem

from these conversations, we developed an action plan to address confidence with performing and explaining vaginal examinations

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This study found that student midwives who performed a VE using the DOPS method led to students correctly identifying the findings of the VE. The DOPS method is as follows:

1. Observing the desired skill within the prescribed time (1 min for vaginal examination and giving feedback in 5 min (while reviewing the items in the evaluation)

2. Repeating the desired skill after 1 day and emphasizing the strengths and weaknesses of the student in that skill

3. Repeating the desired skill after at least 1 week and emphasizing the strengths and weaknesses of the student.

This demonstrates the importance of continuity of PS when improving VEs for students - it also gives time to complete feedback

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The effect of direct observation of procedural skills... : Journal of Education and Health Promotion

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S) on midwifery students’ clinical skills. MATERIALS AND METHODS: This is a quasi-experimental, two-group study conducted as a pre- and post-study on midwifery students in 2017–2018. Cluster and randomized sampling method was used. The processors involved in this study were three main skills of vaginal examination, pelvic examination, and vaginal delivery. The DOPS method was used to assess the practical skills in the interventional group during three times the process at day, 1 day, and at least 1 week later; the usual logbook method was used in the control group. Two groups were evaluated at the end of the midwifery course by Comprehensive Final Midwifery checklist. The tools were checked for validity and reliability, and data were analyzed using descriptive and analytical statistics. RESULTS: There was no statistically significant difference between the two groups in terms of important demographic variables such as age, grade, marital status, and initial assessment score (P > 0.05). The mean of final scores in the normal delivery, vaginal examination, and pelvimetry was statistically significantly higher in the interventional group (P < 0.001). On the other hand, the functional field of the students in the interventional group was statistically significantly improved in normal delivery and pelvimetry (P < 0.05), and this difference was not significant in the vaginal examination. In addition, the mean scores of students before and after the DOPS method were statistically significantly different in every skill in Comprehensive Final Midwifery checklist (P < 0/05). CONCLUSIONS: The DOPS assessment methodology is not only a useful tool of clinical evaluation, but also an effective tool for clinical learning of students. For this purpose, it is suggested that educational members of midwifery take enough time to design DOPS method in the same process.…