| Summary: | Vaginal examination is a common and routine aspect of midwifery practice that is used to . determine the presentation and position of the fetus and to measure cervical dilatation in order to assess progress in labour. It is known that the procedure may be problematic. The available literature focuses on the accuracy or otherwise of estimates of cervical dilatation and the potential for vaginal examination to result in post-traumatic stress disorder, particularly for women who have experienced sexual abuse. However, no research has previously been undertaken to explore midwives' accounts of the procedure. This PhD uses the work of Foucault, in particular his writing on surveillance, to identify midwives' discourses on vaginal examination and to explore these within the context of knowledge and power. Qualitative research methods and a methodology of critical ethnography were used to identify the discourses, underpinned by postmodern and feminist principles. In total, sixteen midwives and ten pregnant women were recruited to the study and data were analysed thematically using ethnographic principles. The findings from this PhD confirm that vaginal examination is problematic. In addition, the research demonstrates that midwives experience vaginal examination as a form of surveillance and modify and monitor their behaviour in response to this scrutiny. Midwives described the punitive nature of this surveillance and, in response, hid and obfuscated some of their behaviour. The implications of practitioners acting in this way are profound for both midwives and the women in their care. Further work is needed to explore how the culture of the maternity services can be improved to support more transparent and open practice. The findings demonstrate the multi-faceted nature of knowledge within the context of vaginal examination and raise important issues for policy and practice about the ways in which midwives use this knowledge, particularly in relation to recording their clinical findings. Midwives in this study stated that during their training they did not feel equipped for the physical and emotional realities of vaginal examination. Further research is needed to improve the preparation of students for this particularly intimate aspect of body work. Finally, this study demonstrates that midwives exert a form of power that can best be described as matriarchal. This concept has not previously been identified in the midwifery literature and is worthy of further exploration.
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