'Just slow everything down': Playing for time in midwifery practice

Introduction: The way time is approached in midwifery practice is capturing interest, particularly in research that emphasises the cultural nature of birth. Just as the cyclical rhythms of agriculture were replaced by standardised factory rhythms after industrialisation, birth has now been categorised by external frameworks that confine the distinctive unpredictability of labour.

Aim: To investigate the personal, social, cultural and institutional influences on women in deciding whether or not to use epidural analgesia in labour.

Methods: This presentation is based on ethnographic doctoral research. The focus took the research into a hospital labour ward, where other birth practices were also observed. Data was comprised of field notes, interviews, and policy documents. The study was underpinned by critical medical anthropology, which acknowledges systems of power, and informed our analytic approach.

Results: Our focus here is on the surveillance of the labour process, the primary mechanism of which was the Patient Journey Board, which included detailed information about the progress of every woman admitted to the labour ward. Reminiscent of Foucault's panopticon – his symbolic representation of the way in which people are disciplined to conform – the midwives’ practice was influenced by this abstract surveillance. Although such surveillance might mitigate near-misses in other hospital environments, arguably it does not support the facilitation of normal birth. Techniques of resistance were also revealed as midwives discussed feeling constrained by the arbitrary temporal demands of the institution, against which they struggled to give women more time.

Conclusion: The result of these practices was that the needs of the institution frequently came before the needs of the women, despite that the principle of ‘woman-centred care’ rests at the heart of midwifery philosophy. Recognition of the role time plays in labour could lead to new approaches in reducing unrealistic institutional demands on women's labouring bodies.