Failure to progress or just normal? The hidden knowledge of physiological plateaus in childbirth

Abstract

Research and anecdotal practice evidence demonstrate that slowing, stalling and pausing labour patterns can constitute 'physiological plateaus' rather than pathological processes. However, in the wider bio-medical discourse of childbirth, the notion of physiological plateaus is rarely discussed. We investigated what midwives consider as 'physiological plateau,' the significance such plateaus have for normal labour and birth, and why discourse on physiological plateaus is currently silenced from the larger childbirth debate. A constructivist grounded theory study was conducted. Interviewing 20 midwives in Australia between 2020 and 2022, we captured a range of experiences from various settings and geographical locations. Data analysis followed grounded theory methodology and resulted in a novel definition of physiological plateaus, as well as a theoretical explanation of the strategies midwives use to differentiate physiological plateaus from pathological processes, and how they respond to plateaus. This study has been funded by an Australian Government Research Training Program Scholarship and ethical approval has been granted. Midwives in this study understood physiological plateaus as a common phenomenon that can occur singularly or repeatedly throughout the entire continuum of labour and birth. The majority of physiological plateaus are thought to self-resolve and are conceptualised by midwives as a natural fluctuation of the labour pattern, requiring only minimal, if any, remedial action. Further, we found that knowledge of physiological plateaus is predominantly held, disseminated and applied in practice among midwives who practice/d in midwife-led models of care with a holistic childbirth philosophy. In contrast, physiological plateaus are said to be rarely observable in obstetrician-led models of care, where the bio-medical childbirth philosophy dictates a continuous progress of labour and where any plateauing of labour is therefore automatically framed as 'failure to progress.' Midwives' unique, holistic childbirth philosophy conceptualises a wide variety of individual labour patterns, including fluctuation and plateaus, as normal and results in good birth outcomes. Further, midwifery knowledge includes the ability to differentiate between physiological plateaus and pathological processes. Findings from this study suggest a need for renegotiating what can be considered 'normal' during childbirth, and a stronger emphasis on childbirth philosophy as a determinant of birth outcomes.