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Essential Midwifery
Practice:
Intrapartum Care
Edited by
Denis Walsh
RM, MA, PhD
Soo Downe
RM, BSc, PhD
A John Wiley & Sons, Ltd., Publication
Essential Midwifery Practice:
Intrapartum Care
Essential Midwifery
Practice:
Intrapartum Care
Edited by
Denis Walsh
RM, MA, PhD
Soo Downe
RM, BSc, PhD
A John Wiley & Sons, Ltd., Publication
This edition first published 2010
2010 Blackwell Publishing Ltd
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Library of Congress Cataloging-in-Publication Data
Intrapartum care / edited by Denis Walsh, Soo Downe.
p. ; cm. – (Essential midwifery practice)
Includes bibliographical references and index.
ISBN 978-1-4051-7698-9 (pbk. : alk. paper) 1. Midwifery. I. Walsh, Denis, 1955- II. Downe, Soo.
[DNLM: 1. Delivery, Obstetric – methods. 2. Labor, Obstetric. 3. Midwifery – methods.
WQ 415 E78 2010]
RG950.A2I+ 2010
618.2 – dc22
2009024487
A catalogue record for this book is available from the British Library.
Set in 10/12.5pt Palatino by Laserwords Private Limited, Chennai, India
Printed and bound in Malaysia
1 2010
Contents
Contributors vii
Introduction – Denis Walsh xi
Chapter 1 Evolution of Current Systems
of Intrapartum Care 1
Denis Walsh
Chapter 2 Debates about Knowledge
and Intrapartum Care 13
Soo Downe
Chapter 3 Childbirth Education: Politics, Equality
and Relevance 31
Mary Nolan
Chapter 4 Birth Environment 45
Denis Walsh
Chapter 5 Labour Rhythms 63
Denis Walsh
Chapter 6 Evidence for Neonatal Transition
and the First Hour of Life 81
Judith Mercer and Debra Erikson-Owens
Chapter 7 Midwifery Presence: Philosophy, Science
and Art 105
Holly Powell Kennedy, Tricia Anderson
and Nicky Leap
vi Contents
Chapter 8 Skills for Working with (the Woman in) Pain 125
Rosemary Mander
Chapter 9 Complementary Therapies in Labour:
A Woman-Centred Approach 141
Denise Tiran
Chapter 10 Midwifery Skills for Normalising Unusual
Labours 159
Verena Schmid and Soo Downe
Chapter 11 Psychology and Labour Experience: Birth
as a Peak Experience 191
Gill Thompson
Chapter 12 Sexuality in Labour and Birth: An Intimate
Perspective 213
Sarah Buckley
Chapter 13 Spirituality and Labour Care 235
Jenny Hall
Chapter 14 How Midwives Should Organise to Provide
Intrapartum Care 253
Chris McCourt
Chapter 15 Feminisms and Intrapartum Care 275
Mary Stewart
Chapter 16 Towards Salutogenic Birth in the 21st Century 289
Soo Downe
Index 297
Contributors
Tricia Anderson (1961–2007)
Former Senior Lecturer in Midwifery
Bournemouth University
Independent Midwife Practitioner
(all-round brilliant person who sadly died during the gestation
of this book)
Sarah Buckley
Author and General Practitioner
Email: sarahjbuckley@yahoo.com
Soo Downe
Professor of Midwifery Studies
Midwifery Studies Research Unit
University of Central Lancashire
Email: sdowne@uclan.ac.uk
Debra Erikson-Owens
Doctoral Student
University of Rhode Island College of Nursing Kingston
Email: deri7917@postoffice.uri.edu
Jenny Hall
Senior Lecturer in Midwifery
Faculty of Health & Social Care
University of the West of England
Email: halltribe@blueyonder.co.uk
Nicky Leap
Professor of Midwifery Practice Development & Research
Centre of Midwifery, Child & Family Health
University of Technology Sydney
Email: nicky.leap@uts.edu.au
viii Contributors
Rosemary Mander
Professor of Midwifery
School of Health
University of Edinburgh
Email: rmander@staffmail.ed.ac.uk
Chris McCourt
Professor of Anthropology and Women’s Health
Centre of Research in Midwifery & Childbirth
Faculty of Health & Human Sciences
Thames Valley University
Email: chris.mccourt@tvu.ac.uk
Judith Mercer
Clinical Professor
College of Nursing
University of Rhode Island
Email: jme3053u@postoffice.uri.edu
Mary Nolan
Professor in Perinatal Education
The University of Worcester,
Email: mlnolan@aned.fsnet.co.uk
Holly Powell Kennedy
Professor of Midwifery Yale School of Nursing
Yale University
Email: holly.kennedy@yale.edu
Verena Schmid
Midwife, Founder of Donna e Donna-Il Giornale delle Ostetriche
Florence
Email: verena@dinonet.it
Mary Stewart
Research Midwife
National Perinatal Epidemiology Unit
University of Oxford
Email: mary.stewart@npeu.ox.ac.uk
Gill Thompson
Research Assistant
University of Central Lancashire
Email: gill.thomson@blueyonder.co.uk
Contributors ix
Denise Tiran
Director, Expectancy Ltd
London
Email: root@expectancy.co.uk
Denis Walsh
Associate Professor in Midwifery
University of Nottingham
Email: denis.walsh@ntlworld.com
Introduction
Denis Walsh
This book is an attempt to bring together experts in their respective
fields to place in one volume, for the first time, a comprehensive
examination of normal birth practice. A glance through the Contents
pages will reveal the variety of perspectives included here. Soo and I
wanted to capture, as far as we could, a holistic overview of the current
state of knowledge and skills in the wonderful complexity of labour
and birthing. At the risk of overstating the significance of this particular
era of childbirth practice, we both feel a sense of crisis confronting
advocates of physiological birth. All over the planet, there appears to be
an exorable drift towards a technocratic model of birthing (Davis-Floyd
1992) and a marginalisation of the low-tech, non-hospital birth.
These chapters are intended to feed the soul of women, midwives
and other childbirth activists who still champion the experience of
drug-free, normal labour and vaginal birth.
In Chapter 1, I give an overview of the recent history and trends in
intrapartum practice and the philosophical models they are predicated
on. Soo Downe then examines the historical legacy of these models
in greater depth by explicating the struggle over ‘ways of knowing’
in childbirth. She contextualises the debate around childbirth in
broader theories of complexity and constructionist influences of the
postmodern era we live in.
In Chapter 3, Mary Nolan brings us up to date with the challenges
facing childbirth education. Adult learning styles must be adopted if
education is to be effective. The challenge of preparing childbearing
women realistically for the institutional birth environment most will
encounter is elaborated on before Nolan concludes by championing
education as a tool for change.
Change is a central focus to the next two chapters on birth environment and labour rhythms. Both are undergoing reform, though mostly
in birth centres and home-birth settings. These still only represent
xii Introduction
around 5% of births in the Western world, but their usage is increasing
slowly as policy makers strive to address soaring Caesarean sections
rates. Getting the birth environment right so that women can reconnect
with an ancient nesting instinct and accepting that normal labour
rhythms vary from woman to woman may reduce rates.
Judith Mercer and Debra Erikson-Owens discuss the exciting new
developments around the third and fourth stage of labour, highlighting
the significance of the intact cord after birth and the conditions necessary
for early post-natal bonding.
Against these clinical and environmental factors, Holly Powell
Kennedy, Nicky Leap and the late Tricia Anderson stress the
importance of attitude to the birth process in their inspiring thoughts
on midwifery presence. Linked to this is a need to view labour pain in
a new way as Rosemary Mander discusses in Chapter 8. She concludes
that labour pain can be transformatory.
Denise Tiran, the UK midwifery expert on complementary therapies
takes us through their relevance and application to labour care in the
next chapter before Verena Schmidt and Soo Downe in Chapter 10
overview unusual labours that are usually classed as abnormal. They
believe that many such births can be normalised with the appropriate
skills.
Gill Thompson, a psychologist, shares her important research with
women who experienced traumatic births followed by healing births
and tries to tease out the key elements that enable some women to
refer to birth as a ‘peak experience’. This is followed by one of the
international authorities on childbirth hormones, Sarah Buckley, who
addresses the rarely examined area of labour and sexuality.
Jenny Hall has had a long-standing interest in the spirituality of
birth and brings her wisdom in this area in Chapter 13. In another
under-researched area, Jenny discusses the relevance of the spirituality
to contemporary childbirth.
Midwifery organisational models for intrapartum care is the specialist
field of Chris McCourt, one of the original researchers on the One-toOne Midwifery Model at Queen Charlottes in London. She brings
her depth of knowledge to this vexed field with a clarity and vision.
Mary Stewart edited the visionary book on feminist perspectives on
childbirth (Stewart 2004) and brings aspects of this thinking up to date
in the penultimate chapter.
Soo Downe gathers up the interconnecting and overlapping threads
of all chapters in an articulation of a vision for birth in the 21st century in
the final chapter. Utilising her well-known application of salutogenesis,
she makes a clarion call for all stakeholders in maternity care to work
together to transform how birthing is done on our planet for the benefit
of mothers, babies and families.