The Integrated Neurophysiology of Emotions during Labour and Birth: a Feminist Standpoint Exploration of the Women's Perspectives of Labour Progress

Within childbirth there is a common and widely known explanation of labour and birth which describes and defines the birth process as that of stages and phases. The boundaries between the stages and phases have been determined by cervical dilatation with time parameters set to measure progress. The measurement of cervical dilatation is determined by a health professional and has resulted in an apparent inability of women to determine themselves whether they are in labour and their closeness to the impending birth. The aims of this thesis were threefold; the first was to critically examine the knowledge base of labour progress, so that the influences on knowledge development were fully understood. Through exploring the historical and theoretical development I found that the current knowledge has come from a male understanding of female anatomy and observational data constructed within a discourse of male, medical, scientific superiority. The second aim of the thesis was to explore the perspectives of women who had experienced a spontaneous labour and birth in order to determine whether the discourse of labour as stages and phases resonated with them. This leads to the third aim of providing a description of the women’s voices and perspectives based on their experiential knowledge of spontaneous labour and birth. A critical feminist ontology and feminist standpoint methodology guided the research which used in-depth one-to-one interviews with 18 women who had experienced a spontaneous labour and birth. Early thematic analysis was developed further through feedback from the participants supporting a coconstruction of knowledge. Analysis revealed that women considered the stages and phases of labour to be an abstract concept which did not resonate with their experiences of labour and birth. An important aspect of labour was having support during the process, in terms of both emotional and physical support from midwives, partners, family and friends present during the labour and birth. Women’s perceptions were dominated by their feelings and a linear pattern of feelings was discerned consistently amongst the participants. The emotions of labour were an important finding in this research but during the feedback process the women requested a scientific foundation to support the findings. I therefore explored the recent advances in theoretical understanding of the role of emotion, cognition, physiology and behaviour. Contemporary theories define emotions and neurohormones as bi-directional and intricately linked to behaviour change and physiological adaptations. I argue that the feelings women have described give an indication of an underlying hormonal influence and a directing of behaviour, necessary for labour to move towards birth. The hormones involved in labour also support maternal behaviour and attachment to the baby. I suggest a new conceptual understanding of labour as the integration of the mind, body and behaviour in which the feelings and hormones that initiate and sustain labour to birth also support the necessary adaptation and transition to becoming a mother. This integrated neurophysiologic concept will help midwives and other health professionals involved in maternity to recognise emotions as a key to understanding physiological labour and birth. It has also highlighted the importance of emotional and physical support during labour. Further research is necessary to test the hypothesis that women experience a similar range of emotions at similar times during a spontaneous labour and birth and to what extent the described emotions resonate with other women’s experiences.