Understanding and engaging with vocalisations during labour and birth: A qualitative interview study of midwives' experiences and approaches.

Background: Spontaneous vocalisations are a common reaction to pain. During childbirth, birthing women often produce vocalisations that shift in tone and intensity in response to the demands and dynamic process of childbirth. Research has shown that midwives can distinguish between different vocalisations; however, the embodied, experiential, and tacit knowledge underpinning this skill remains largely under-researched. Objective: To explore and analyse midwives' experiences and approaches with vocalisations during labour and birth. Methods: This study employed a constructionist approach within an explorative qualitative design to explore and analyse midwives' experiences and approaches to vocalisations during labour and birth. The study was conducted throughout Germany. Nineteen midwives with experience as the primary healthcare provider for birthing women in free-standing birth centres, hospital labour wards, or at home births participated in the study. Semi-structured interviews were conducted between October 2024 and February 2025. Data were analysed using reflexive thematic analysis according to Braun and Clarke. Results: Four themes were generated through iterative engagement with the data. These are: (1) Developing and training auditory skills: learning to listen and attune to birth sounds; (2) Recognising nuances of childbirth sound patterns; (3) Combining childbirth vocalisations, sensory perceptions and embodied cues; and (4) The multi-faceted nature of working with sound. The data showed that midwives developed their auditory skills over time, either through deliberate engagement with vocalisations or with guidance from colleagues and mentors. Integrating birthing women's vocalisations added depth to midwives' assessments and provision of care. While several midwives described how they intentionally worked with vocalisations as a component to accompany and support labour, others noted that they rarely made use of vocalisations. When midwives reported that they worked with vocalisations, they described using them to support well-being and physiological processes during childbirth. Conclusion: Vocalisations are an integral part of labour and birth. The findings highlight that understanding and interpreting these sounds can serve as a meaningful component for supporting well-being, physiology as well as recognising physiological processes and deviations from these during childbirth. Incorporating training in auditory perception into midwifery education would prepare students in their practice-based skills and support non-technological approaches.