Marina Weckend

About

Sometimes during labour and birth, things seem to slow down, or plateau for a while (for example, intense and regular labour surges might space out and get weaker, or even disappear altogheter).

In contemporary maternity care, such plateaus are usually interpreted as unhealthy (pathological), and women who experience plateaus commonly receive a medical treatment called 'augmentation' to speed things up again. Despite being associated with a range of unwanted side-effects, labour augmentation is very common in clinical birth settings. However, new evidence shows that plateaus can occur naturally during labour and help keeping mum and baby strong and healthy during childbirth.

This is why I am researching physiological plateaus, througout my doctoral studies, and beyond. This reseach helps to clarify the difference between pathologically slow labour and physiological plateaus, which can help to prevent unnecessary and harmful interventions and contribute to improve the health and wellbeing of mothers, infants, and families.

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What happens if things slow down during childbirth? Our recently published research shows how midwives and obstetricians interpret healthy plateaus during labour and birth.

Background: Physiological plateaus (slowing, stalling, pausing) during normal labor and birth have been reported for decades, but have received limited attention in research and clinical practice. To date, heterogeneous conceptualizations and terminology have impeded effective communication and research in this area, raising concern as to whether some physiological plateaus might be misinterpreted as dystocia. To address this issue, we provide a point of orientation, mapping contemporary concepts, and terminologies of physiological plateaus during normal labor and birth.

Methods: We conducted a scoping review, considering published and unpublished reports of physiological plateaus, reported in any language, between 1990 and 2021. Database searches of CINAHL, EMBASE, Emcare, MIDIRS, MEDLINE, Scopus, and Open Grey yielded 1,953 records, with an additional 35 reports identified by hand searching. In total, 43 reports from eleven countries were included in this scoping review.

Results: Conceptualizations of physiological plateaus are heterogeneous and can be allocated to six conceptual groups: cervical reversal or recoil, plateaus, lulls during transition, "rest and be thankful" stage, deceleration phase, and latent phases. Across included material, we identified over 60 different terms referring to physiological plateaus. Overall, physiological plateaus are reported across the entire continuum of normal labor and birth.

Conclusions: Physiological plateaus may be an essential mechanism of self-regulation of the mother-infant dyad, facilitating feto-maternal adaptation and preventing maternal and fetal distress during labor and birth.

In this article, I explore norms around what is considered "normal" during healthy childbirth, and how these norms affect our everyday practice. 

Objective: In this scoping review, contemporary concepts and definitions of phenomena during normal labor and birth, wherein the process appears to plateau (slow, stall, or pause) but remains within physiological limits, will be mapped.

Introduction: During labor and birth, it is frequently perceived as pathological if contractions, cervical dilation, or fetal descent plateau. However, there is evidence to suggest that some plateaus during labor may be physiological, and a variety of concepts and terms refer to this phenomenon. Where a physiological plateau is perceived as pathological arrest, this may contribute to undue interventions, such as augmentation of labor. Therefore, it is important to advance understanding of physiological labor patterns, including potentially physiological labor plateaus.

Inclusion criteria: Publications mentioning any plateaus of the processes of normal human labor and birth will be considered. This may also include phenomena where labor is perceived to “reverse,” for example, a closing cervix or a rise of the presenting fetal part. Publications where plateaus are defined as pathological will be excluded.

Methods: All types of evidence, published and unpublished, will be considered. The search strategy will be applied to the databases MEDLINE, Embase, MIDIRS, Emcare, CINAHL, and Scopus, and will be limited to the past 30 years. Gray literature will be searched via Open Grey, reference list screening, and contacting authors. Data extraction will comprise information on concept boundaries, terminology, precedents, consequences, concept origin, and types of evidence that report this phenomenon. Results will be presented in tabular, diagrammatical, and narrative manner.

In contemporary maternity care, it is commonly expected that women demonstrate what is considered continuous progress of labour until birth. According to this paradigm, if a woman’s labour slows down or stalls, clinicians are quick to diagnose failure to progress and may offer augmentation. However, there is considerable evidence that labour may slow, stall, pause or even reverse on a number of occasions throughout the continuum of healthy labour and birth without constituting pathology. Findings from existing research indicate that physiological plateaus may be a healthy mechanism of self-regulation of the mother-infant-dyad. Further, such plateaus may be fairly commonly observed, particularly in non-clinical birth settings. This presentation aims to provide an overview of existing evidence about physiological plateaus, discuss varying concepts and terminology and stimulate debate about the implications of physiological plateaus on maternity care practice.

This Pecha Kucha presentation at the Australian College of Midwives National Virtual Conference provides a brief introduction into the notion of physiological plateaus versus a paradigm of linear labour progression, hightlights the significance of physiological plateaus for healthy childbirth and illustrates how different types of physiological plateaus can be distinguished based on causative mechanisms.

This presentation at the Normal Labour and Birth Research Conference introduces the notion of physiological plateaus versus a paradigm of linear labour progression, provides an overview of existing evidence and promotes further research in this area.