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Excerpt: Time and Midwifery Practice

The International Day of the Midwife (5 May) has been celebrated every year since 1992, recognizing the vital role midwives play in reproductive care. This year’s theme, Follow the Data: Invest in Midwives, focuses on coming together as a global midwife community to advocate for investment in quality midwifery care around the world, improving sexual, reproductive, maternal, newborn, child and adolescent health in the process. To learn more and get involved, visit the International Confederation of Midwives’ official site.

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Excerpt of “Time and Midwifery Practice” by Trudy Stevens
Edited by Christine McCourt
Read full chapter here

Concepts and Uses of Time

Time is often thought to be a universal concept, one of the few immutable truths that help provide stability in an increasingly complex world. Nevertheless, many writers have shown this assumption to be fundamentally incorrect (Thompson 1967; Whitrow 1989; Priestley 1964; Hall 1959). Diverse notions about time have been identified, and the ways it is constructed, used and interpreted may hold widely differing connotations, both between and within societies (Griffiths 1999). The ways in which time is conceptualized and used can communicate powerful messages. In English, time has been externalized, made tangible, a commodity that can be ‘bought’ and ‘sold’, ‘saved’, ‘measured’, ‘wasted’, or ‘lost’. It is compartmentalized, allocated for work, leisure and sleep, and it is used sequentially; it is valued objectively and personally, carefully guarded, and individuals becoming angry if ‘their’ time is unnecessarily wasted (Hall 1959, 1976), ideas that, it will be seen, are interwoven within hospital work. An understanding of how time was conceived within the hospital and within caseload practice reveals underlying notions that influence the nature of the services provided. However, as both were situated within the durée (Giddens 1987) of daily life, this must first be addressed.

The way time is conceived of and used in modern society has been strongly shaped by the influences of religion and technology. JudaeoChristian beliefs stress the notion of irreversible time; ‘switched on’ at creation and to be ‘turned off’ in the future. Meanwhile, the Protestant work ethic (Weber 1976), placed a high value on the industrious use of time for spiritual rather than material rewards. Such notions, reinforced by puritan preachers and social reformers, were subsequently internalized during the Victorian era (Thompson 1967), promoted with the ‘professionalization’ of midwifery (Heagerty 1997), and remain in the ideas of some that nursing and midwifery are vocational work. As discussed in Chapter 1 (this volume), the industrial revolution had a profound effect, with time’s ‘inexorable passage’ being stressed by mechanization that altered the rhythm of people’s lives, negating seasonal or cosmological distinctions of time and reducing the element of personal control over work. The need for the synchronization of labour meant increasing attention was given to time, with people being paid by the hour not the task. Work itself became a distinct period of time, and time became a currency not to be ‘passed’ but ‘spent’ (Thompson 1967). Today, universal education inculcates a time discipline on all. ‘Economic’ time tends to dominate life, patterning its stages through infancy, learning, earning, retirement, each year (work and holidays) and each day, clearly dividing it into work and personal time – mentally if not physically. Diaries are no longer used to record events but to remind and structure them. The upsurge in the use of the Filofax and personal organizers, and development of various training courses, suggests that ‘time management’ has become an economy in itself. However, such concepts and their consequences are not universal and less industrial societies have been shown to hold very different notions of time. For all practical purposes ‘task-orientated’ time is the major framework (Giddens 1987; Priestley 1964); work is adjusted to the task not the time spent, and there is minimal demarcation between labour and social activities.

Although occurring in societies dominated by culturally specific notions about time, childbirth carries its own (universal) time – a physiological time. The mother commonly ‘slows up’ towards the end of pregnancy and may experience changes in sleep patterns. To a greater or lesser extent the expectant mother is being eased into having to use her time in a different way to meet the demands of a newborn that has yet to be socialized into a ‘daily routine’. Labour commences with no reference to what may be socially convenient, and the woman is delivered into motherhood at a pace over which she has minimal conscious control. For millennia, ‘traditional’ birth attendants have supported and accompanied women during this transition, rarely attempting to control or subvert the timing of events that were physiologically inherent. This situation has changed radically in many societies (Davis-Floyd and Sargent 1997). In an age where time has become inherently scheduled and commodified, it is not surprising to find such control being extended to the arena in which childbirth is now placed.

Ideas about time are not homogenous to a society as individuals may favour particular notions. Also, in complex post-industrial society, people move between models during their daily life, being forced to acknowledge different attitudes and concepts relating to time simultaneously. For example: the demands for strict time control placed on factory workers contrasts with the generally more relaxed demands of family life; a similar difference was noted in my study within the hospital, between delivery unit and maternity ward. However, the dominant ideas become embedded within the culture of each society, both reflecting and influencing the ways in which people think and behave. This may have serious ramifications as concepts about time are relative to societies, dictating how individuals conceive their world and relate to each other. Problems occur when different sets of ideas about time clash – as when individuals move between countries or, as it is argued here, models of midwifery practice – forming the basis for ‘cross-cultural’ misunderstandings.

The ways in which ideas about time and its use can be internalized and affect behaviour have been most clearly developed by Hall (1959, 1969, 1976) and are helpful in understanding the different nature of caseload and hospital midwifery practice. Drawing from a number of disciplines, theoretical stances and empirical studies, Hall considered the notion of time and the ways this may influence a society. Using a comparative framework, he developed a thesis suggesting that time is not only a ‘silent language … speaking more plainly than words’ (1959: 23), as well as something which structures behaviour and judgements made about that behaviour (1969), but it also influences cognition and the manner in which societies relate to their physical world (1976). His ideas offer invaluable insights into ways of considering social situations. For example, the ‘task-orientated time’ of pre-industrial societies is closely related to Hall’s notion of polychronic time. This is characterized by several things happening at once and Hall stresses the involvement of people rather than adherence to pre-set schedules (1976). These characteristics may be seen to apply to caseload midwifery.

Modern post-industrial ideas of time are summed up in his notion of monochronic time, and Hall (1976) stressed how use of this directly affects attitudes and behaviour. Undertaking activities separately and sequentially implies implicit and explicit scheduling. This involves according priority to people and functions, and so forms a classificatory system ordering life which is so integrated that it appears logical and natural, although it is not inherent in natural rhythms. Prioritization implies a valuation, and thus the use of time acquires an implicitly recognized code: for example, a call at 2 a.m. has more serious connotations than one at 2 p.m. The segregation of activities enables total concentration but ‘decontextualizes’ them and people may become disorientated if they undertake several activities at once. Relationships are intensified but then temporally limited, as in business meetings or hospital appointments, which are private but of fixed duration. Failure to observe time limits implies an intrusion on another’s schedule, and may be considered ill mannered or egocentric. Such ideas resonate strongly with the hospital maternity service and help explain negative reactions observed in my study towards caseload practitioners who worked within a polychronic timeframe.

In appreciating the changes faced by the caseload practitioners, an understanding of the way time was conceived and used within the hospital is important. Having come from this system the midwives would have internalized it to some extent. However, they were forced to rethink and develop different ways of using time in caseload practice.

Read the full chapter and see references for “Time and Midwifery Practice,” here.

Edited by Christine McCourt
Foreword by Ronnie Frankenberg


“In this fascinating, scholarly, and readable book the authors take us into our familiar worlds and make them strange, with the result that we can see clearly, with fresh, critical, and creative eyes, what goes on in our everyday world. Each of the chapters helps us see how differently time can be experienced and framed.” · Anthropology in Action


Christine McCourt studied for her degree and doctorate in social anthropology at the London School of Economics. Her doctoral work, an ethnographic study of the closure of a long-stay psychiatric hospital, was explicitly intended to be ‘applied anthropology’. From 2006 to 2010 she was Professor of Anthropology and Health, at Thames Valley University and she is now Professor of Maternal and Child Health at City University London. Her research and teaching is mainly focused on culture and organisation of biomedicine, maternal and infant care, and social and cultural issues affecting women’s health.

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