Are you Listening to me? Interactions between mothers and midwives when labour begins: when normal birth becomes traumatic

 'Why is it when you are in labour, no-one gives a shit? If you are more than 4cm you're fine but if you are 0-4cm you are a massive pain in the bum and no-ne cares. Why is that? It's atrocious really. (Jan Interview) The... [ view full abstract ]

 'Why is it when you are in labour, no-one gives a shit? If you are more than 4cm you're fine but if you are 0-4cm you are a massive pain in the bum and no-ne cares. Why is that? It's atrocious really. (Jan Interview)

The problem of diagnosing 'active' labour is that objective assessment of cervical dilatation and assessing behavioural cues via telephone or face to face, do not always accord with a mother's lived experience of labour. Mothers are often told it is in their best interests to stay at home longer. As a result, some mothers are left feeling neglected after reporting significant pain, and some mothers go on to either arrive late in advanced labour, or give birth unexpectedly away from their chosen place of birth. These mothers are denied the pain relief and support and fatal surveillance that they had been assured of throughout pregnancy and this is a safety and quality issue. My research set out to explore these issues and I chose feminist participatory action research (FPAR) for its collaborative and emancipatory potential to raise awareness and empower both mothers and midwives. After a series of separate interviews and focus groups I brought participants together in a one day workshop to consider preliminary findings and seek a way forward and make recommendations. Data was analysed using the feminist interpretive method  known as the The Listening Guide. not only are there four readings of the transcripts, seeking different aspects through each reading, but I also included a critically reflexive fifth reading of myself. Findings showed that many mothers have lost confidence in their own potential and seek midwifery support at this vulnerable time in labour.  However there are mothers who know they are in labour but are turned away based on the '4cm rule' and it is these mothers who go on to give birth unexpectedly out of hospital, at home, on the toilet or even in subzero temperatures in the garden. Whereas mothers decision making is embodied, midwives decision making is more contingent. In times of high activity and stress, they act as organisational gate keepers to a restricted service and are not always responding to the expressed needs of mothers. to complete the hermeneutic circle that results in forging new horizons of knowledge, I used cognitive dissonance theory to explicate how midwives and mothers experience 'becoming  other' when they are caught in the 'in labour' 'not in labour' discourse.