Why are we still adhering to strict timelines in labour and birth?

Greetings to you all and apologies for the delay in writing in my blog. Life has been busy lately and I have just completed a new course called Matrix Re-imprinting, which is a follow on from EFT (emotional freedom technique) which is even more effective in dealing with past trauma. I intend to use this technique as part of my post traumatic stress disorder therapies for women with previous birth trauma experiences to help them release and heal those memories, and enable them to look forward to their next pregnancy and birth in a positive way.

This article I have written follows on nicely as unnecessary intervention in labour may lead to more complications in childbirth.

The natural rhythms of labour and birth have long been forgotten and ignored as pioneers of modern medicine designed graphs and charts, to enable them to vigilantly measure labour progress and cervical dilatation within estimated time frames introduced from the mid 1950’s.

The need for these measurements became necessary once childbirth was taken from the home environment into a hospital setting especially after the Peel report in 1970 which advocated hospitals as the safest place for women to give birth. Busy labour suites required a conveyor belt kind of efficiency to deal with the large numbers of women passing through their doors. The partogram was designed as an action plan if the progress of labour did not follow the time-line guide. This lead to the aggressive active management of slow labour protocols designed by O’Driscoll and Meagher in 1986. These partograms have been modified slightly but are still in use today in labour suites.

The main measurement of labour progress remains performing a vaginal examination to ascertain cervical dilatation according to partogram guidelines. This has led to more frequent examinations for women which are uncomfortable and may be an invasion of privacy. Thankfully, the frequency of these examinations has been reduced, as the time line of labour is slightly more flexible today.

Long forgotten skills and techniques for monitoring the progress of labour without intervention are being re-instated by midwives and birth attendants in many natural birth situations. One of these includes observing the ‘purple line’, which runs from the distal margin of the anus up between the buttocks until it reaches the natal cleft, which is a sign of full cervical dilatation. I remember observing this line myself on many an occasion. Research indicates that up to 89% of women develop this sign during labour. Another technique possibly originating in Peru found that birth attendants felt for the appearance a ridge running from between the eyes up to the hairline on the forehead as labour progressed. There are many more intuitive techniques handed down through the generations, which are in danger of being lost completely, as midwifery skills are lost in a high tech world of labour and birthing.

There is now a backlash from women, midwives, and supporters of home birth and birth centres, who argue that normal labour does not necessarily follow the division of labour into the various timed stages to be adhered to regardless of individual labour patterns and rhythms.

Many first time labouring women experience a long latent phase and this time is best spent at home in their own environment, with assessment by their community midwife or at an early labour assessment unit if home assessment is not possible. This allows women to labour without intervention in the nurturing environment of their own home with their own comforts.

The desire of women and midwives to return to normal patterns of labour based on an individual woman and to discard the timed assembly line birth, embraces the old way of ‘being with women’ during labour. As Nicky Leap suggests, “the less we do, the more we give”.