Physiology's role in labour assessment
A closer examination of the physiological and behavioural signs exhibited by women to facilitate assessment of labour progress
This article considers the importance of observing the physiological and behavioural cues exhibited by women during advanced labour to facilitate labour assessment. In-depth knowledge of labour physiology is important as it enables midwives to systematically anticipate, gather and interpret these cues while considering possible differential diagnoses. As a clinical midwife and educationalist, I have observed and participated in various care practices over the years within different birth environments. I have reflected upon how we can be instrumental in both supporting and impeding the physiological process of labour through the consequences of our actions.
The detrimental impact that routine intrapartum interventions can have upon the hormonal processes that support labour has been well-documented. Sara Buckley (2015) has written extensively about the importance of protecting the hormonal blueprint of labour through the avoidance of unnecessary intervention (see https://www.nationalpartnership.org/our-work/resources/health-care/maternity/hormonal-physiology-of-childbearing.pdf for an in-depth review).
As midwives, we are presented with a dichotomy within practice where we must endeavour to facilitate the physiological processes that support normal birth while staying alert for the presence of risk factors and instigating timely responses to ensure safe care. It is important we intervene only when clinically indicated. However, making this judgement can be difficult, especially when working in an environment where routine intervention is common. Intervening too soon can disrupt the physiological process of labour predisposing mother and infant to unnecessary risk and morbidities while intervening too late may also have detrimental consequences.
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