The experience of labour: using ethnography to explore the irresistible nature of the bio-medical metaphor during labour.

Objective: taking evidence provided by an ethnographic study based on women's experiences of pregnancy and childbirth, and using ritual theory in the analysis of the relationship between the medical metaphor, inherent in contemporary birth settings, and the views and expectations of childbirth which the women bring with them to that setting.

Design: small scale qualitative study using ethnographic research techniques.

Setting: GP surgeries, two consultant-led, hospital-based antenatal units, labour suites and postnatal wards, plus the homes of the women involved from the north east of England.

Participants: 40 primigravid women providing two sample groups. Half of the women were actively involved in antenatal class programmes run by the National Childbirth Trust and the NHS and the other half did not attend any antenatal classes.

Main Findings: within the sample there was a clear cultural diversity which carried significant implications on how the women assembled their understanding of pregnancy and birth antenatally. However, this division lost clarity at the onset of labour, rendering delivery experiences more similar than might have been expected. Ritual theory offers significant insight into this phenomenon, analysing birth as a rite of passage provided a necessary tool to explain why this pattern emerged in the data.

Key Conclusions And Implications For Practice: cultural diversity suggests an element of caution should be used when advocating the notion of 'informed choice' across the board, sensitivity to existing cultural values is imperative. Despite an emphasis on informed choice, midwifery practice continues to offer the medical metaphor as the dominant cultural prop in the labour ward.