Academic Division of Midwifery, B Floor, East Block, Queens Medical Centre, NG7 2UH Nottingham, UK.
Midwifery. 2013 Jan;29(1):3-9. doi: 10.1016/j.midw.2012.07.005. Epub 2012 Sep 1.
This paper explores perceptions of time and experience in midwifery with particular reference to the concept of early labour. Health professionals and lay people are used to describing labour in terms of 'stages' which correspond to agreed notions of progress based on physiological features. However the understanding of labour which underpins them is not a static entity but is a product of a particular era and set of circumstances which are primarily socially rather than biologically mediated.
The research uses a historical methodology to describe understanding of, and strategies around, the management of early labour. It includes a variety of source material, including midwifery and obstetric textbooks, midwifery casebooks, books of advice to women and the oral testimony of midwives and mothers.
Twentieth century Britain. The twentieth century was a period of significant philosophical and concrete change in maternity in Britain, with occupational hegemony developing around both midwifery and obstetrics, and with the concomitant institutionalisation of labour and birth.
Mothers, midwives and doctors.
The evidence suggests that during the first half of the twentieth century early labour was not seen as a discrete period within the first stage of labour with specific features or associated issues. Instead it was a private and individual experience, which rarely involved the presence of either doctors or midwives. Women, and those around them, made the decision about what early labour meant and how they should respond to it. The development of divisions in labour and notions of what constituted 'normality' or 'abnormality' as regards the length of each stage, based on time and clinical features, developed as the setting for labour and birth moved from home to hospital in the second half of the twentieth century. Labour became more described and more proscribed, with a rash of textbooks aimed at both midwives and doctors, and with the growing visibility of the entire process of labour through the use of technological surveillance and through the fact that women labouring on a hospital bed were observable in a way that women labouring at home were not.
To look for historical strategies around the management of entities such as early labour is to assume, ahistorically, that similar beliefs and issues existed in an earlier period, and that there perhaps existed strategies for management which could profitably be rediscovered for use in current maternity care. The evidence suggests that such divisions were not described or managed features of labour before the second half of the twentieth century. The use of history does, however, give insights into breaks and continuities in beliefs and practice over time, and demonstrates that beliefs about stages of labour and their management are, like other aspects of maternity, multi-faceted and complex in both origin and effect.
本文探讨了助产士对时间和经验的看法，特别是对早期劳动的概念。医疗保健专业人员和非专业人士习惯于根据生理特征，用“阶段”来描述分娩。然而，支撑这些阶段的对分娩的理解并不是一个静态的实体，而是特定时代和一系列主要是社会而不是生物中介的环境的产物。
本研究采用历史方法描述了对早期劳动管理的理解和策略。它包括各种来源的材料，包括助产士和产科教科书、助产士案例书、妇女建议书籍以及助产士和母亲的口述证词。
二十世纪英国。二十世纪是英国产妇护理发生重大哲学和具体变革的时期，助产士和产科都发展了职业霸权，随之而来的是劳动和分娩的制度化。
母亲、助产士和医生。
证据表明，在 20 世纪上半叶，早期劳动并不被视为第一产程中的一个独特阶段，具有特定的特征或相关问题。相反，它是一种私人的、个体的体验，很少涉及医生或助产士的存在。女性及其周围的人决定早期劳动意味着什么，以及他们应该如何应对。基于时间和临床特征，劳动各个阶段的长度方面的分工和“正常”或“异常”的概念的发展，随着劳动和分娩的环境从家庭转移到 20 世纪下半叶的医院而发展。劳动变得更加描述性和规定性，针对助产士和医生的教材大量涌现，通过使用技术监测，以及在医院病床上劳动的女性可以被观察到，而在家里劳动的女性则不能，使得整个劳动过程变得越来越可见。
寻找管理早期劳动等实体的历史策略，就是假设在更早的时期存在类似的信念和问题，并且可能存在可以为当前产妇护理重新发现和利用的管理策略。证据表明，在 20 世纪下半叶之前，这些分工并不是劳动的描述或管理特征。然而，历史的使用确实提供了对随着时间的推移信念和实践的中断和连续性的见解，并表明对劳动阶段及其管理的信念与其他产妇方面一样，在起源和效果上都是多方面和复杂的。
