From MIDWIFERY MATTERS, Issue No. 101, Summer 2004
Midwifery formulae:The sod's laws
of midwifery?
Debbie Patrick
AS A MIDWIFE working on a busy delivery suite, opportunities to stand back and
muse on the ebb and flow of midwifery activity are comparatively rare. However,
on occasion, some everyday occurrence just jumps out and make you think a bit.
I was recently working with a student midwife, we were expecting a woman in
labour and saw her walk slowly up the corridor towards us, taking several pauses
as contractions delayed her progress. As the student showed her to her room,
another midwife and I exchanged glances and grinned at each other, with a, "better
be getting your delivery pack ready," look.
1. Number of pauses taken by labouring woman walking down delivery suite corridor
= the greater the woman's cervical dilatation.
(can also apply to number of pauses/curses heard during a phone conversation).
Sure enough, the woman gave birth a short while later. Not rocket science
you cry, every experienced midwife knows that! Yes, but how do we know? Along
with many midwives, I had been both enthralled and horrified at the observations
of midwives everyday practice described by Hunt and Symonds (1995), but was
particularly struck by how the midwives could tell the progress of labour by
observing a woman's behaviour. Midwives, particularly those with over five years
clinical experience, are amazingly good at identifying the less well documented
signs of progress in labour without relying on vaginal examination -the burping,
hiccoughing, restlessness of transition, the crying out for mum and shunning
of physical touch. We also seem able to detect intuitively when progress in
labour is not so straightforward, often without being able to articulate a specific
cause. We appear to see and get to know these intuitive feelings about progression
of labour better if we observe them in a one-to-one situation, such as working
in a midwife led unit or at home births. However, most midwives develop them
over time wherever their experience is gained (Patrick, 2002). We also try and
pass these 'midwifery formulae' on to the next generation, the midwifery students
and medical students, so that they may also recognise that the linear progress
of 1cm of cervical dilatation an hour proposed by Studd and Duiagnan (1972)
is something that simply does not often happen in spontaneous, unmedicated labour.
Well, we try to but........
2. Presence of student midwife/doctor during labour = increased risk of operative
birth.
There also appears to be a further midwifery formula, whereby merely having
a student midwife or medical student working with you, (particularly if they
are desperate to attend a birth having been 'unlucky' in the past), virtually
guarantees that any woman they follow ends up with an operative birth. It matters
not a jot how straightforward the woman's obstetric history may appear to be,
the lack of 'risk factors', the previous totally straightforward births she
may have had, how much the student is involved in their care, something always
seems to happen. An example of this also happened to me recently, where I was
foolish enough to comment to the student midwife I was working with how straightforwardly
women can often labour in the birthing pool, with unexpected progress, only
to assist the women we had been attending out of the pool a few minutes later
following a placental abruption! (all ended well by the way, but on 'dry land').
These midwifery 'sod's laws' got me thinking along the lines of other types
of occurrences that could be potentially expressed as a sort of 'midwifery formula',
and I'm sure there are many others that could be articulated! This observation
leads on from the last one:
Presence of woman in labour in the birthing pool = increased midwifery feelgood factor on the delivery suite.
Is this just relief that at least one woman is labouring 'normally' (whatever that is) in a mixed midwife/consultant led unit?!
REFERENCES
Hunt S, Symonds A (1995). The social meaning of midwifery, Macmillan, London.
Patrick D L (2002) The midwives and mothers intuition in labour study: Is instinct
extinct on the 21st century delivery suite? Unpublished Master of Science in
Midwifery dissertation, University of Nottingham, 2002.
Studd J and Duiagnan N (1972). 'Graphic records in labour', British Medical
Journal, 4, 837, November 18 1972, 426.
LW updated February 4, 2005