Failure to progress or just normal? A constructivist grounded theory of physiological plateaus during childbirth

Marina Weckend; Kylie McCullough; Christine Duffield; Sara Bayes; Clare Davison

doi:10.1016/j.wombi.2023.10.003

Failure to progress or just normal? A constructivist grounded theory of physiological plateaus during childbirth

Women Birth. 2024 Feb;37(1):229-239. doi: 10.1016/j.wombi.2023.10.003. Epub 2023 Oct 20.

Authors

Marina Weckend¹, Kylie McCullough², Christine Duffield³, Sara Bayes⁴, Clare Davison⁵

Affiliations

¹ School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia. Electronic address: m.weckend@ecu.edu.au.
² School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia.
³ School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia; Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
⁴ School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia; Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, VIC, Australia.
⁵ School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia; Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia.

PMID: 37867094
DOI: 10.1016/j.wombi.2023.10.003

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: Labour dystocia; Labour progress; Medical philosophy; Midwifery; Natural childbirth; Uterine inertia.

MeSH terms

Delivery, Obstetric / methods
Female
Grounded Theory
Humans
Labor, Obstetric* / physiology
Maternal Health Services*
Midwifery* / methods
Parturition
Pregnancy