The Detour of an Obstetric Technology: Active Management of Labor Across Cultures

Abstract

Active management of labor (AML) is an obstetric technology developed in Ireland in the 1970s to accelerate labor in nulliparous women. This technology achieved rapid success in Great Britain and in English-speaking countries outside America, which adopted it before many other states around the world. In this article, I explore AML's technical and social characteristics when it was first designed, and then examine its local inflections in a Jordanian and a Swiss maternity hospital to shed light on the ways its transnational circulation modifies its script. I argue that its application is shaped by local material constraints and specific sociocultural configurations, gender regimes, and hospital cultures. Finally, I make a comparative analysis of AML practices in these two settings and in the foundational textbook to disentangle the technical and sociocultural components modeling its local applications.

Cervical dilatation over time is a poor predictor of severe adverse birth outcomes: a diagnostic accuracy study

“…In an attempt to optimise intrapartum care, several organisations recommend the use of the WHO partograph to guide labour monitoring and management 24. The ‘one‐centimetre per hour rule’, as illustrated by the partograph alert line, has also (formally or informally) been used to prompt labour interventions in many settings around the world 4, 25. Global efforts to promote the use of the partograph in the last three decades have been met with mixed results.…”

“…24 The 'one-centimetre per hour rule', as illustrated by the partograph alert line, has also (formally or informally) been used to prompt labour interventions in many settings around the world. 4,25 Global efforts to promote the use of the partograph in the last three decades have been met with mixed results. Although most healthcare providers working in maternity settings know about the partograph, it is frequently used retrospectively for recording purposes instead of providing prospective support for clinical decision making.…”

Adjusting the analytical aperture: propositions for an integrated approach to the social study of reproductive technologies

“…Technologies and their routines are defined and embedded within the epistemic values and normative frameworks of the biomedical practitioners that develop and provide them and the national governmental, international bodies and commercial entities that regulate access to them. The cultural scripts of developers shape what the technologies can be and do, yet these in-built precepts about technologies are not necessarily or neatly replicated in local practices and experiences (Maffi 2016 ; Franklin and Inhorn 2016 ). Rather, the provision and use of technologies, as many have argued, are heterogeneous and fluctuating (Hardon and Moyer 2014 ; Beaudevin and Pordie 2016 ; Maffi 2016 ; Sanabria 2016 ).…”

“…The cultural scripts of developers shape what the technologies can be and do, yet these in-built precepts about technologies are not necessarily or neatly replicated in local practices and experiences (Maffi 2016 ; Franklin and Inhorn 2016 ). Rather, the provision and use of technologies, as many have argued, are heterogeneous and fluctuating (Hardon and Moyer 2014 ; Beaudevin and Pordie 2016 ; Maffi 2016 ; Sanabria 2016 ).…”

Conceiving of risk in childbirth: obstetric discourses, medical management and cultural expectations in Switzerland and Jordan

“…Giving birth in government facilities means to go through crowded maternity wards with no companion where the staff is constantly under pressure and often shows indifferent or even cruel behaviours (Alzyoud et al, 2018), while private clinics generally ensure a better medical follow up and satisfactory bed care as well as the possibility to have a companion during labour and birth. Technological interventions are much more frequent in private facilities although several routine interventions are also common in government maternities such as acceleration of labour (Khresheh, Homer, & Barclay, 2009;Maffi, 2016) In the 2000s, the United States Agency for International Development (USAID), in collaboration with the MOH, launched several programmes to improve the standards of antenatal and postnatal care and of the family planning service. These programmes not only have made a strong contribution to the standardisation and bureaucratisation of the MCH services, but have also introduced or reinforced biomedical concepts of childbirth, women's health, sexual relationships, hygiene, and related phenomena.…”