The Effective Labour Contraction

One of my failings as a midwife was my inability to assess the strength and effectiveness of a uterine contraction. This presented a problem in the hospital setting as midwives are often asked 'how strong are her contractions?' or 'is she having effective contractions?' I spent many hours as a student midwife with my hands on women's abdomens attempting to assess their contractions. Not only was I unsuccessful, but I was probably very irritating and disrupted physiology (apologies to those women). This post discusses whether it is possible to determine the effectiveness of contractions, and whether we need to.

The idea that birth should be efficient has its roots in the 17th century, when physicians used science to redefine birth. The body was conceptualised as a machine, and birth became a process consisting of stages, measurements, timelines, mechanisms, etc. This is still reflected in current textbooks, knowledge, and practice.

In the 1950s Emanuel Friedman created a graph of labour based on his research of 500 women having their first baby [1]. These women were subjected to rectal examinations every hour during their labour (you can apparently feel the cervix through the rectum). Most of the women in the study were sedated, and had medication (Pitocin) to speed up their labour and 55% had a forceps birth. The final graph is the basis for modern assessments of labour progress. However, there are variations between hospital policies regarding adequate progress. For example, a cervix can open 0.5 cm an hour in one hospital and be adequate, whereas in another it must open 1 cm per hour to be adequate. Now I could write an entire post (and might do so in the future) on the ridiculous notion that you can apply a graph to something as complex and unique as a birthing woman (edit: I wrote a book instead).

However, I think the evidence speaks for itself. More than half of all women who experience labour...

Continue reading this article on Dr. Rachel Reed's website here.