We’re developing a high fidelity simulator prototype to enhance the training of healthcare professionals in performing intrapartum vaginal examinations (VEs).  The simulator will use virtual reality technologies, enabling clinicians to learn and practice the procedure in a safe and relaxed environment. 3D visualisations will allow students to become more familiar with the anatomy they will be examining and provide a unique opportunity for students to visualise how an expert performs the examination. Moreover, haptic (touch) feedback will allow the simulation of a range of scenarios reflecting the real-world variations that occur.

An intrapartum vaginal examination is a pelvic examination performed to determine the progress of labour. A midwife or doctor will gently insert their fingers into the vagina to check how far the cervix (neck of the womb) has opened (dilated). They will also feel the position of the baby’s head. The information gathered from this examination helps the midwife and doctors to determine whether labour is progressing as expected or if there are any signs of complications that may require extra care. You should always be advised by your midwife or doctor why they are offering a vaginal examination and what it will involve. The examination should only be carried out if you agree to it. After the examination the midwife or doctor should explain to you what the examination showed.

This information is based on the NICE guidelines, for more information please visit https://www.nice.org.uk/guidance/cg190/ifp/chapter/Care-during-labour.

It is acknowledged that these examinations can be very distressing for a woman as many find them painful, may by embarrassed or feel the examination is invasive.  The current NICE guidelines recommend that a vaginal examination is performed every 4 hours during labour, as long as it is deemed necessary and will provide additional clinical information to inform decisions.   In reality, 70% of women have more than the recommended number of examinations and it is thought that not all of those performed are necessarily recorded.

In addition to causing distress, there is an increased risk of infection for both mother and baby with the number of examinations, especially after the rupture of membranes. Vaginal examinations are used to determine the progress of labour and inform the birth plan, however there is evidence that the results of an examination are not reliable (19% accuracy).

Students currently practice vaginal examinations in real clinical scenarios, increasing the number of examinations that women are exposed to as a more experienced clinician may need to repeat the procedure to verify the findings. Examinations can be even more uncomfortable for the patient if the student is nervous and unsure of the procedure.

It can be hypothesised that improving clinical training can lead to increased reliability in determining the progression of labour and provide clinicians with greater confidence in their skills. This can result in fewer examinations being performed and therefore a reduction in distress experienced by patients.

Simulation can optimise limited resources, address ethical concerns, reduce anxiety and alleviate patient safety issues by offering the opportunity to learn and develop skills in a safe environment without causing distress to patients. Virtual reality simulators enable visualisation in addition to haptic (touch) feedback of normally unsighted examinations, improving the understanding between the trainer and student of what is being felt during the examination.