Communication in Labour module

In response to Tom Whipple’s article in ‘The Times’:

Tom Whipple is a writer who concluded his article on the question whether sex is healthy (well, the case was more specific) on the conclusion that we don’t know — but that we can conclude that if we have sex, we should make sure to get pregnant in order to avoid cancer. (Argument spelled out here.) Which I found almost as funny as Philomena Cunk. You have to consider his tongue-in-cheek approach. Of course, I would never advise to speak to expectant mothers about Heidegger or Sartre during labour.

But it seemed helpful to consider some communication issues outside of the situation, by giving midwives an opportunity to watch mini lectures (around 3 min.). The lectures consider some reasons as to why communication is so important. In a situation where the perspective come far apart, successful communication depends on taking the perspective of the other.

This requires the kind of moves that philosophers undertake more regularly: reflection, a close description of the moods involved, and an examination of the different communicative relations involved. These latter are particularly volatile since birth usually involves the presence of a person very close and one or more people who are normally strangers: healthcare professionals, especially midwives. In fact, in this situation, midwives come close to taking the role of angels, making the impossible possible, as you can see me explain here. I wanted midwives to be aware of their enormous significance, and of how much it matters what they say and do.

It seems helpful for ‘Better Births’ – to cite a title which the Royal College of Midwives currently uses for its initiative – to improve communication between midwives and parents. For improving such communication, it is helpful to understand the perspective of the other better. I have therefore utilised phenomenological descriptions of emotions around birth to tease out how the experience is strange, even uncanny. In terms of emotions, this means that it causes anxiety not only because it involves pain (that’s one of many relevant dimensions) but also because it involves unknowns on so many levels. Since the ‘when’ is a major unknown, the questions of ‘where’, how’, ‘with whom’, etc. all fall in place with the ‘when’ which can undermine all previous planning. And at any point of the process, things can and often do change. It is an overall uncanny situation also because it is inconceivable. We know it’s possible (just as we know that we are all going to die eventually), but we cannot actually imagine that it is possible, based on our experience of our body.

Communication in labour is an enormous challenge for the midwife because she encounters a person radically disorientated by the uncanny situation, and also physically disorientated because their body has turned into a whale-like substance that does not want to respond to the order to move in the previously familiar ways. In fact, the body is such that you don’t really know how you would be able to bring it into a bathtub, for example, except with help.

So, the woman is in dire need of help from those around her, yet seriously incapacitated in terms of communication. Speaking during strong labour is very difficult and can be disruptive to the process. It is thus even more crucial for the midwife to communicate also for the woman, asking her to nod, etc.

Various different modes of communication are discussed in the module, such as persuasive communication: what could be the best ways of persuading a woman to change position if her situation is such that she simply doesn’t want to be a body? What information during and on the process seems crucial to convey, and how to ask whether the mother needs information?

And whether she wants to talk. Because birth defies the basic rules of politeness. The midwives who were attending my homebirth were perfectly competent, friendly, and polite; yet their repeated question, every five minutes, ‘how are you doing?’ was annoying under the circumstances. Because I didn’t want to have to come back to the realm of words, and I especially didn’t want to think about how to not give the same answer each time.

It is an extraordinary situation, and it doesn’t hurt to emphasise this over and over again. It is also a situation which psychological research has shown to be crucial for at least certain dimensions of the later relationship between mother/parents and child.

It is a situation that creates tremendous challenges to communication and yet depends so heavily on it. Which is why communication without words is crucial. See my ’10 points of advice for becoming parents’ on how crucial massage is, for example. If midwives encourage and teach partners to give massage as a matter of cause, I think lots of the relational conflict between partners that is so apparent and disturbing in many episodes of ‘One Born Every Minute’ could also be reduced.

For midwives, the crucial concept that carries through the module is responsivity[i]. Responsivity means to ask and observe. It means to be aware of the enormous differences between personalities, circumstances, and cultures, and therefore observe the patient closely. And ask – but also be aware that continuous or repeated asking might be bothersome.

 

[i] Bernhard Waldenfels investigates this concept in various of his writings, leaning in on Maurice Merleau-Ponty and Emmanuel Levinas.

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