Part I.1 -- Ordinary times
While the video-taped labor can be considered to be one event hospital labor--, it is powerfully organized by two set of scenes that segment it into marked and unmarked times. At regular intervals all involved perform "The Contraction." At less regular intervals, all perform "The Medical Visit." In between much can happen that is relatively less scripted. In our case this consists mostly of talk interpreting what happened in the earlier marked time, what might happen next, and can range over a whole set of other topics and activities, from phone calls to the woman's mother to check on the children, to discussion about the research, etc. There is very little ambiguity about the onsets and endings of the marked times as one can clearly see all participants rearrange themselves to their appointed places. It is common sense that contractions start in the woman's body and thus are guided by its own rhythms. These Contractions, however, are social events that use various cues from this body as they are made public whether by the woman or by the mechanical monitor. Most importantly the physical contraction can be overridden, particularly by The Medical Visit, and fail to become an inter- actional event. Furthermore, as the labor progresses and the epidural anesthetics has arguably (and there is much argument about this) taken effect, the woman is made to be less and less central as the initiator of the public performance of the Contraction. Instead the monitor, or more precisely the reader of the monitor (doctor, nurse, and particularly husband) take it upon themselves to challenge the interpretation of the contraction for interactional purposes.
 One contraction at its peak:
Husband and wife look at each other. He tells her to "breathe." She puffs audibly |
 One Medical Visit
Doc.: "OK" |
The Contraction, as it can be summarized, starts with some brief display (a groan and/or grimace) expanded into a request by Lonnie that her hands be held by her husband most typically, but also by the researcher, and once or twice by the nurse. She holds hands for the duration while the other participants focus on her; they tell her to breathe and, more and more often as the labor progresses, they give her reports on the strength of the contraction and the likely moment of its end.
For purposes of this argument, we assume here that muscular contractions proceed on their own bio-chemical rhythms. Interactional Contractions can be interrupted by Medical Visits that occur on a socio-cultural rhythm (Fig. 4). The anesthesiologist coming to start the epidural, the obstetrician coming to give internal examinations to establish the progression of the labor, all can insist that they proceed with their procedures in disregard with the interactional requirements of the Contraction.
Medical Visits too have their pattern, with a moment of chitchat between doctor and Lonnie as he enters the room (and after he has glanced at the monitor), followed by a brief explanation of what is to be done, followed the procedure itself, and ending with a brief report.
To talk about "patterns" however is too vague. It must be clear that the above summaries are not "averages." Nor are they quite "what happens when nothing else happens," repetitively or mechanistically. Rather they are what people explicitly hold each other accountable for, particularly when something else is happening, which is almost in every case. Indeed one could say that most of the talk and movement performed by the people over the course of the labor consists of stage directions or justifications for behavior thereby made exceptional. The most visible of these are repeatedly performed by Lonnie as she specifically calls on her husband to come and hold her hand. Quite often he is not "right there" when interactional space is available for the Contraction and she specifically reminds him of his obligations as she moves her hands or notices his yawns and asks "are you bored?". We could talk of such moments as of "negotiations" to stress the relative uncertainty of all the participants about what is happening or is going to happen who knows that the husband is not actually moving away for good? In many ways, however, the overall frame, the pattern, or what we will call the "canonical form" for the scene is not of particular concern. The apparent paradox is that this form is not the subject of negotiations: it is always already there in the very local negotiations that it allows and indeed requires. It is very much "taken for granted," the unchallenged "common sense."
These comments were necessary to clarify the forthcoming discussion about various properties of the (taken for granted, common sense) canonical Contraction. One of these properties consist in it being an occasion for talk about pain in the context of the "strength" of the physical contraction. This talk , interestingly, is specifically open to negotiation. As mentioned earlier, at these times Lonnie is but one of the "accountable" participants. She is given a voice but her voice is only one among the many who can discuss her pain, the strength of the contraction and what to do about it if anything. At these times Lonnie's body may be the focus of attention but it is not particularly "her" body: she has no privileged right to give it voice. The official arbiter is the monitor as interpreted in terms of the epidural received earlier. "Everyone" (in the formal sense that every one does and every one is heard no one is shut up, no one withdraws from offering interpretations) is entitled to offer a potentially authoritative interpretation of the strength of the contraction, the pain involved, and the possible need for more anesthetics. Note that the medical personnel are not given routine precedence, though it may have the final word since only they may actually administer the anesthetics. The epidural was initially performed at the repeated request of Lonnie over the whole course of pre-natal visits and the first stages of the labor and she is allowed to suggest that the procedure should be repeated as it may not be working as advertised. In other words no one is given overriding expertise not even the woman. This contrasts obviously with the Medical Procedures which are only performed by the designated specialist or, less obviously, with various times when husband and wife deal with family business in a kind of temporary interactional bubble partially constructed by the withdrawal of the medical personnel from an area in which they do not assert authority.
