Failure to progress or just normal? A constructivist grounded theory of physiological plateaus during childbirth
Journal article
Weckend, Marina, McCullough, Kylie, Duffield, Christine, Bayes, Sara Jayne and Davison, Clare. (2024). Failure to progress or just normal? A constructivist grounded theory of physiological plateaus during childbirth. Women and Birth. 37(1), pp. 229-239. https://doi.org/10.1016/j.wombi.2023.10.003
Authors | Weckend, Marina, McCullough, Kylie, Duffield, Christine, Bayes, Sara Jayne and Davison, Clare |
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Abstract | Background and problem: During childbirth, one of the most common diagnoses of pathology is ‘failure to progress’, frequently resulting in labour augmentation and intervention cascades. However, failure to progress is poorly defined and evidence suggests that some instances of slowing, stalling and pausing labour patterns may represent physiological plateaus. Aim: To explore how midwives conceptualise physiological plateaus and the significance such plateaus may have for women’s labour trajectory and birth outcome. Methods: Twenty midwives across Australia participated in semi-structured interviews between September 2020 and February 2022. Constructivist grounded theory methodology was applied to analyse data, including multi-phasic coding and application of constant comparative methods, resulting in a novel theory of physiological plateaus that is firmly supported by participant data. Findings: This study found that the conceptualisation of plateauing labour depends largely on health professionals’ philosophical assumptions around childbirth. While the Medical Dominant Paradigm frames plateaus as invariably pathological, the Holistic Midwifery Paradigm acknowledges plateaus as a common and valuable element of labour that serves a self-regulatory purpose and results in good birth outcomes for mother and baby. Discussion: Contemporary medicalised approaches in maternity care, which are based on an expectation of continuous labour progress, appear to carry a risk for a misinterpretation of physiological plateaus as pathological. Conclusion: This study challenges the widespread bio-medical conceptualisation of plateauing labour as failure to progress, encourages a renegotiation of what can be considered healthy and normal during childbirth, and provides a stimulus to acknowledge the significance of childbirth philosophy for maternity care practice. |
Keywords | Natural childbirth; Labour progress; Uterine inertia; Labour dystocia; Midwifery; Medical philosophy |
Year | 01 Jan 2024 |
Journal | Women and Birth |
Journal citation | 37 (1), pp. 229-239 |
Publisher | Elsevier Science BV |
ISSN | 1878-1799 |
Digital Object Identifier (DOI) | https://doi.org/10.1016/j.wombi.2023.10.003 |
Scopus EID | 1-s2.0-S1871519224X00025 |
Web address (URL) | https://www.sciencedirect.com/science/article/pii/S1871519223002962?via%3Dihub |
Open access | Published as ‘gold’ (paid) open access |
Research or scholarly | Research |
Page range | 11 |
Publisher's version | License File Access Level Open |
Output status | Published |
Publication dates | |
Online | 23 Jan 2024 |
Publication process dates | |
Accepted | 09 Oct 2023 |
Deposited | 11 Mar 2024 |
Additional information | © 2023 The Authors. Published by Elsevier Ltd on behalf of Australian College of Midwives. |
This is an open access article under the CC BY license | |
Place of publication | Netherlands |
https://acuresearchbank.acu.edu.au/item/903wv/failure-to-progress-or-just-normal-a-constructivist-grounded-theory-of-physiological-plateaus-during-childbirth
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Publisher's version
OA_Bayes_2024_Failure_to_progress_or_just_normal.pdf | |
License: CC BY 4.0 | |
File access level: Open |
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