The Trouble with Established Labour


Having attended a couple of quite lengthy births recently from the early stages, it has made me realise how vital support when needed through labour is, particularly for first time mums to be. Although women are often sent home in early labour to “await established labour” some form of support in labour from the beginning can definitely influence how well or otherwise a birth may unfold. Leaving this vital job to a lay person in most circumstances, ie her partner, can be an incredible responsibility. Even when they’ve attended good antenatal classes, like NCT, on the day, trying to determine when is the right moment to go into hospital or ask a midwife to attend is a difficult task. I would suggest its not always easy for midwives and we have the benefit of experience.

It seems “established labour” is the magic criteria by which women are deemed to be able to get the support of a midwife. Though there is a definition which is “regular, rhythmic contractions, at least 3 in 10 minutes, lasting 45 seconds or longer, with progressive cervical dilatation of 0.5cm per hour”, it is quite impossible to say when this is reached except with the benefit of hindsight.

Also there are many women who never experience contractions closer than every five minutes; many labours that plateau at points (dilatation stalls) and some even reverse (known as pasmo) where the cervix closes; and all these phenomena can be a part of a normal labour!

So when should women get a support from an experienced professional? The answer should surely be, WHEN THE WOMAN AND HER PARTNER NEED IT irrespective of contraction strength and frequency, cervical dilatation or any other arbitary criteria.

Ideally it should be at home, but again, wherever the woman feels safest; it needn’t involve regular clinical observations,if indeed any or any unnecessary poking and prodding around. Rather it should be about giving emotional support, practical measures to relieve pain, and in some cases it may be as simple as someone being “present” giving reassurance. I realise that having such a person there will cost money, but in the long term there will be savings in areas such as unnecessary hospital admissions, fewer interventions, less pain relief and therefore more normal births.

Perhaps the time has come for either creating the role of doulas within the NHS, or may be even better using student midwives in this capacity. It would form a great learning opportunity to observe normal birthing behaviours in women. In providing this support not only will it save money on costly interventions, but we may also start to breed a new generation of midwives who’s knowledge of what happens in labour, will make them less inclined to rely on clinical examinations to determine how well a birth is progressing.