It is 2:13am on a busy labour ward. A nulliparous woman has been pushing for an hour when the fetal heart rate suddenly drops to 60 beats per minute. The registrar quickly dons a pair of sterile gloves and performs a vaginal examination. The cervix is fully dilated, the fetal head is low, and delivery appears achievable with vacuum assistance. The gloves are removed.

The registrar steps away to call the consultant. As the team assembles, another pair of sterile gloves is opened. The consultant performs a confirmatory examination, agrees with the assessment, and removes the gloves. The vacuum pack is opened. The registrar scrubs their hands with alcohol rub and dons a third pair of sterile gloves. The cup is applied, traction is performed, and the baby is delivered within minutes.

Three pairs of sterile gloves have been used by two clinicians during a single emergency operative vaginal birth. Had the consultant requested a further examination, had the cup detached and required reapplication, or had the birth proceeded to theatre for caesarean birth, additional gloves would have been opened.

The gloves were worn for a combined total of only a few minutes. Yet each pair represents a journey spanning thousands of kilometres, from raw material extraction and manufacture, through sterilisation, packaging, and transport, to eventual disposal as clinical waste.

Throughout this scenario, each clinician’s gloved hands enter the same non-sterile birth canal. The distinction between sterile and non-sterile gloves is therefore not intuitively obvious, raising an important question: what additional clinical benefit does sterility provide in operative vaginal birth, and does that benefit justify its environmental cost?

In operative obstetrics, where urgency and patient safety rightly dominate decision-making, such consumables are rarely considered. However, when multiplied across hundreds of thousands of births each year globally, these seemingly insignificant items contribute substantially to the environmental footprint of maternity care.

What Does the Evidence Say?

For caesarean birth, sterile gloves are unquestionably required because the procedure breaches the abdominal wall and enters the normally sterile peritoneal cavity. The same principle does not apply to vaginal birth. During labour, clinicians repeatedly place gloved hands into the birth canal, an environment that is heavily colonised by maternal vaginal and enteric flora. The gloves themselves therefore do not maintain a sterile field, rather, they function primarily as a barrier protecting both the patient and clinician from blood and bodily fluid exposure.

Over the past two decades, multiple studies have examined whether sterile gloves reduce maternal or neonatal infection compared with clean, non-sterile gloves during vaginal procedures. Randomised trials have found no significant differences in rates of postpartum endometritis, maternal fever, neonatal sepsis, or other infectious complications when clean gloves are used for vaginal examinations during labour.^1,2

The principle extends beyond routine vaginal examinations. There is similarly no convincing evidence that sterile gloves improve outcomes for uncomplicated vaginal birth, operative vaginal birth, or repair of first- and second-degree perineal tears, provided standard infection prevention measures, including hand hygiene and the use of clean gloves, are followed.³ Consequently, the European Association of Perinatal Medicine now recommends that non-sterile gloves be used for vaginal examinations and uncomplicated vaginal procedures.³

This evolution is not unique to obstetrics. For many years, traumatic wounds in emergency departments were routinely sutured using sterile gloves. Subsequently, randomised control studies demonstrated no reduction in wound infection compared with clean examination gloves, leading to widespread adoption of non-sterile gloves for simple wound closure in many healthcare systems.⁴ Obstetrics now faces similar opportunity to align practice with evidence.

The Impact of Using Sterile Gloves

In Australia and Aotearoa New Zealand, approximately 50,000 operative vaginal births are performed annually. If only two or three pairs of sterile gloves are used during each birth, well over 100,000 pairs of sterile gloves are consumed annually for operative vaginal delivery alone. When routine vaginal examinations throughout labour are also considered, the number of sterile gloves used across maternity services becomes enormous.

The environmental burden of a sterile glove extends far beyond the latex or nitrile from which it is manufactured. Production requires extraction of raw material, energy-intensive manufacturing, sterilisation (typically using gamma irradiation or ethylene oxide), multiple layers of packaging, and global transport, before eventual disposal as regulated clinical waste. Each step consumes energy and generates greenhouse gas emissions.⁵

Fig. 1. The journey of a sterile glove.⁵

Life cycle assessment demonstrates that a pair of sterile gloves has almost 12 times the carbon footprint of a pair of non-sterile gloves, largely because of additional manufacturing, packaging, and sterilisation processes.⁶ Sterile gloves also generate substantially more waste by weight due to their individual wrappers and protective packaging.

Fig. 2. Carbon footprint comparison for sterile and non-sterile gloves.⁷

The financial implications are equally striking. Replacing sterile gloves with clean examination gloves for appropriate vaginal procedures has been estimated to reduce glove-related costs by more than 90%.²

Importantly, gloves are only one example of the cumulative effect of low-value consumables. Modern obstetric care relies on thousands of single-use items, each selected for understandable reasons but rarely reconsidered once embedded into routine practice. As healthcare increasingly recognises its responsibility to reduce environmental harm, identifying practices where evidence supports lower-impact alternatives represents one of the most achievable opportunities for sustainable care.

Ultimately, sustainability in obstetrics is not about asking clinicians to do less. It is about asking whether every intervention, including the gloves we wear, provides sufficient clinical value to justify its environmental and financial cost. Where evidence demonstrates equivalent patient outcomes, choosing the lower-impact option becomes another component of high-quality, evidence-based maternity care.