Normality for Labour and Births | Masterly inactivity

Masterly inactivity

“The perfect practitioner appears to do nothing, yet nothing is left undone.”
Lao Tzu

A normal labour unfolds in its own time, which often means that it involves a great deal of waiting. And masterly inactivity is really the art of waiting. Which, of course, doesn’t mean doing nothing. Instead it means carrying out all of your professional responsibilities and clinical requirements properly and effectively - but without giving the impression of ‘busyness’ or constant activity. It can make a big difference to the progress of labour if your presence is calm, confident and unobtrusive.

The key to masterly inactivity is your own attitude. Do you feel the need to be constantly doing things, or can you feel comfortable with periods of doing nothing? Being able to switch off our need to fill time in some way or another, either with activity or thoughts, is a skill that needs to be developed through practice. But if you can learn to quieten yourself, becoming present and ‘centred’ in the moment, you can become a powerful influence in helping her to go within herself.

Masterly inactivity is also about using your senses to the full to be aware of subtle changes in her body and feelings. Using your eyes, ears, nose and hands can allow you to enhances detection of subtle indications that may be too feint to be picked up by only clinical assessments. Observation can help you avoid too much intrusive examination or monitoring - but, as in everything, balance is important. Clinical examination and technology have a valuable role used in conjunction with your senses, experience and intuition.

Being aware of what she is feeling includes paying attention to her rhythms - the ‘tides’ of going inwards and coming outwards that are so characteristic of labour. Wherever possible, try to fit the most obtrusive of your activities around the times when she is most engaged with the outside world: when she is hungry, needs to empty her bladder or wants to talk. Use the moments when she is most withdrawn for activities like writing up your notes.

Finally, don’t make the mistake of thinking that a normal physiological labour does not need the involvement of a midwife. The involvement of a midwife with a labouring woman gives her the confidence and conditions in which she can have a normal birth. But ‘involvement’ doesn’t always mean activity – just being present can be a powerful form of involvement with a labouring woman. And it can be just as exhausting!

Tips and tricks

Learn to use your intuition - intuition is an acquired response based on past experiences. It is a valid kind of knowledge. The most difficult part of using intuition is our need to explain what we do to ourselves in a logical way.

If you get a feeling that something is right or wrong, test it - if we can’t explain a feeling to ourselves, we often doubt its validity. Instead of doing this, look at what your feeling prompts you to do and consider whether this is a reasonable, defensible and appropriate action in the circumstances. If it is, do it!

Masterly inactivity is caught, rather than taught - if you want to acquire it, shadow a midwife who is experienced in physiological labours. When the opportunity arises you can - without disturbing the woman or environment - ask her what she was seeing, hearing, sensing, smelling or feeling and why she acted in the way she did.

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Masterly inactivity

Tips and tricks

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