Physiological birth in the year 2001 is abnormal birth.

Soo Downe.
Principal Lecturer (research), Department of Midwifery Studies, University of Lancashire.

Debates about the nature of physiological birth have been ongoing since at least the 1950s (Montgomery 1958). Midwives claim that they are the experts in normality, but the meaning of this claim is unclear. There is no evidence that a consistent approach to childbirth has been taken by women or by clinicians at any one time or place. It appears that a number of discourses have always run in parallel to each other, with clinical practice shifting depending on which group has the strongest voice at any one time. The current rhetoric of choice would tend to suggest that all these competing voices could comfortably coexist in contemporary maternity care. This cannot be the case in the absence of good evidence on the nature of physiological birth, and on the kinds of normalising influences expert midwifery can provide.

While there have been a number of reports on the subject of normal labour over the last five years (Clinical Standards Advisory Group 1995, World Health Organisation 1997; Royal College of Midwives 1997; Troop 1999) they appear to have had little impact on the professional and public discussion of the nature of birth today. Indeed, despite the fact that they were all published within a few years of each other, they take very different approaches to the subject. This suggests that the area is in need of investigation.

This presentation will explore definitions of normal birth from a variety of perspectives. Evidence from two published surveys of the nature of birth in the late twentieth century will be presented, followed by new evidence from a study carried out recently by the author and her colleagues. The possible implications of the findings will be discussed, followed by proposals for a new research and practice orientation to the subject of physiological labour and birth based on the concept of salutogenesis proposed by Aaron Antonovsky (1993).It is hoped that this will provide the necessary impetus to the research community working in the area to take up the challenge set by the obstetrician Thaddeus Montgomery almost 50 years ago when he stated:

It is amazing how little of fact is known about the simplest phases of reproduction. The field for research here is wide open. (706)

Antonovsky A. The implications of salutogenesis - an outsider's view. In:Turnbull et al (Eds) Cognitive coping: families and disability.
Clinical Standards Advisory Group (UK). Women in normal labour. London:HMSO 1995
Royal College of Midwives (UK). Debating midwifery: normality in midwifery. London: Royal College of Midwives; 1997.
Troop P, Goldacre M, Mason A, Cleary R, editors. Health Outcome Indicators: normal pregnancy and childbirth. Report of a working group to the Department of Health. Oxford: National Centre for Outcomes Development; 1999
World Health Organisation: Department of Reproductive Health and Research. Care in normal birth: a practical guide. WHO:Geneva; 1997
Montgomery T. Physiologic considerations in labour and the puerperium. Am J Obstet Gynaecol Oct 1958 p706-14