Just go with your body? A conversation analytic study of the transition from first to second stage of labour in UK Midwife-led care

Background Previous studies illustrate the variable status of women’s first reported bodily sensations of pushing during labour, which are often disregarded in favour of ‘objective’ forms of measurement. Specifically, early conversation analytic informed studies have demonstrated the operation of a ‘no pushing rule’ until full dilation is confirmed by vaginal examination. The aim of the present study is to illustrate how sensations of ‘pushing’ are managed in interactions between women and midwives in a contemporary setting. Methods We audio/video recorded the labours of 37 women in two midwife-led units in England. Qualitative analysis, based on conversation analysis, focused on a subset of 28 recordings that featured discussion of transition from first to second stage of labour. The interactions between midwives, labouring women and their birth partners were transcribed and analysed using conversation analysis. Results Midwives generally encouraged women to push when they reported the urge to do so. Nonetheless, midwives did not just rely on women’s reported bodily sensations. Urges to push were tracked in relation to visible signs of progress. If these signs did not align within an expected amount of clock time, concerns were raised over progress and vaginal examinations were positioned as clinically useful to establish cervical readiness for second stage. Discussion Contrasting with earlier studies, midwives in our dataset tolerated uncertainty about cervical dilation. Nevertheless, labour progress was closely monitored against clock time. We suggest that a watching and waiting, or a ‘pushing until proven otherwise’ rule, is central to management of (transition to) second stage.