ABSTRACT
For midwives who quali fied from the 1970s onwards, the linkage of the words ‘labour’ and ‘pro gress’ is axio matic. In fact, a defining feature of the last fifty years of labour care has been the preoccupation with the pathology of labour length, so much so that it has become an or tho doxy in intrapartum approaches across the world. In the vast majority of hos pital birth, pro gress is assessed by vaginal examination and the pro ced ure has become syn onym ous with con tempor ary labour care. This norm ative mindset is so power ful that few midwives have had the oppor tun ity to observe labours where no vaginal examinations occur. As practitioners of childbirth, we are blinded to some extent by the era we live in. It is difficult for us to appreciate that for millions of years, childbirth was not so obsessed with labour duration. Gaskin (2003) reminds us of that in her uncovering of the word ‘pasmo’, meaning labour stopped and everybody went home until it started again. She discovered it in a nineteenth century Portuguese textbook of midwifery. In this chapter, I will examine the origins of the ‘labour pro gress’ mental ity and trace the influences of this approach through to the late 1990s when a backlash began to be felt. Alongside the clinical imperative around length of labour, I will argue, sits an organ isa tional imperative that is about getting women through a large hos pital sys tem. I will examine the segmenting of labour into phases (latent, active) to show how the biomedical definitions have caused midwives much anguish as they constantly care for women who don’t fit the ideal template. I critique the traditional cervicograph (graphic repres enta tion of cervical dilatation over time) element of the partogram, almost uni ver sally used across the Western world, and examine research into al tern ative labour curves that challenge the linear notion of progression.
