Abstract

Background: 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 some evidence suggests that plateauing labour (slowing, stalling and pausing of labour processes) may represent a typical and physiological occurrence during normal childbirth. Therefore, this study aimed to explore what exactly midwives define as ‘physiological plateaus’ and which significance such plateaus may have for the labour trajectory and birth outcome. Methods: This study followed a constructivist grounded theory approach, assuming a position of ontological critical realism combined with epistemological constructivism. Twenty midwives across Australia participated in individual semi-structured interviews between September 2020 and February 2022. Midwives were eligible to participate if they had a midwifery qualification (any type, any country) and had experience with supporting women during normal childbirth (any birth setting). Interviews were transcribed and analysed using multiple, inductive and deductive, coding steps and constant comparative methods, resulting in a descriptive and explanatory grounded theory. This research was funded through an Australian Government Research Training Program Scholarship as part of MW’s PhD program. Ethical approval was obtained from Edith Cowan University’s Human Research Ethics Committee. Findings: This study found that physiological plateaus are common, can occur during the entire continuum of labour and birth, are typically followed by a self-resumption and acceleration of labour and result in good birth outcomes for mother and baby. The primary aetiology of physiological plateaus appears to be a self-regulation of the mother-baby-unit. Further, it was found that the conceptualisation of plateauing labour depends largely on health professionals’ philosophical assumptions around childbirth. Whereas the ‘Medical Dominant Paradigm’ frames plateaus as invariably pathological, the ‘Holistic Midwifery Paradigm’ acknowledges plateaus as a normal and valuable element of labour. Consequently, some midwives find themselves in a position of philosophical dissonance in their workplace, perceiving that physiological plateaus are misinterpreted as pathological and subsequently reverting to (overt and covert) juggling strategies aimed at protecting women from undue medical interventions. Conclusions: This study provides evidence that midwives’ unique holistic philosophy can have a direct positive impact on birth outcomes for mothers and babies, as it challenges narrow definitions of normality and adapts flexibly to women’s individual labour patterns, including patterns with physiological plateaus. The novel theory presented in this study emphasises the significance of physiological plateaus during labour and encourages a renegotiation of what can be considered healthy and normal during childbirth.