By Lovetti Lafua
Nurse • Midwife • Biologist • Maternal Health Advocate • Human Optimization Researcher

What if “normal” isn’t actually normal?

What if some of the most deeply held beliefs in maternity care are based on averages rather than individuals? What if many of the interventions we consider necessary are sometimes the result of expecting women to fit a standardised model of care rather than recognising their unique physiology, culture, circumstances, and needs?

As a nurse, midwife, biologist, and maternal health researcher, these are questions I return to repeatedly. The more I learn, the more convinced I become that the future of maternity care lies not only in evidence-based practice but in truly individualised care.

Ironically, this realisation did not begin in a hospital, a research paper, or a university lecture.

It began with a conversation with my daughter.

A discovery that took four decades

For most of my life, I believed everyone experienced the world in a similar way to me.

When people spoke, I often saw colours, shapes, symbols, and patterns. Certain words carried specific colours. Seasons had visual identities. Time itself felt colourful and structured. Fast conversations could be overwhelming because my mind was processing images and symbols alongside the spoken words.

One day, during a casual conversation, my daughter paused and said:

“Mum, that sounds like synaesthesia.”

I had never heard the word before.

After researching it, I discovered that synaesthesia is a neurological phenomenon in which stimulation of one sense automatically triggers experiences in another. Some people see colours when they hear music. Others associate numbers with personalities or letters with colours.

For more than forty years, I had assumed my experience was normal simply because it was my experience.

That discovery was both surprising and humbling.

And it led me to ask an important question:

If it took me over four decades to realise that my own reality was not universal, how many assumptions do we make in healthcare about what is “normal” for women and babies?

The danger of averages

Modern healthcare depends on research, and rightly so. Evidence-based practice has saved countless lives and improved maternal outcomes worldwide.

However, evidence is often derived from population averages.

An average can guide us.

But an average should never define every individual.

In maternity care, we have sometimes confused the two.

For decades, labour was commonly assessed using expectations based on the work of Emanuel Friedman, who proposed predictable patterns of cervical dilation. This influenced the widespread belief that women should dilate at approximately 1 centimetre per hour during active labour.

Women who progressed more slowly were often diagnosed with “failure to progress” and became more likely to receive interventions such as augmentation, instrumental birth, or caesarean section.

However, more recent research has challenged this assumption.

Studies led by Zhang and colleagues demonstrated that labour progression is often far more variable than previously believed. Healthy women can experience labour patterns that differ significantly from traditional expectations while still achieving safe vaginal births (Zhang et al., 2010).

Recognising this variation has influenced modern recommendations from the World Health Organization (WHO), which acknowledges that labour does not follow a single universal timeline.

This raises an important question:

How many women have been labelled abnormal simply because they did not conform to an average?

Every woman is her own science

One of the greatest lessons I have learned throughout my career is that every woman arrives with her own biology, history, culture, beliefs, strengths, fears, and expectations.

No two women are identical.

Women differ in:

Pelvic anatomy

Uterine structure

Hormonal responses

Pain perception

Cultural beliefs

Family support systems

Nutritional traditions

Birth expectations

Previous birth experiences

Yet many healthcare systems continue to rely heavily on standardised pathways.

Guidelines are valuable.

Protocols are valuable.

Research is valuable.

But none of these should replace seeing the woman in front of us.

Individualised care does not reject science.

It applies science wisely.

Reimagining postpartum care

The same principle applies after birth.

Around the world, many cultures have developed postpartum traditions designed to support recovery, bonding, rest, nutrition, and community care.

In many African, Asian, Middle Eastern, and Latin American communities, postpartum recovery is viewed as a protected period requiring family involvement, nourishment, warmth, and emotional support.

While not every tradition should be adopted without evaluation, many deserve respectful consideration rather than dismissal.

Research increasingly shows that social support, maternal rest, emotional connection, and community involvement play important roles in maternal mental health and wellbeing.

What if culturally sensitive postpartum care became the norm rather than the exception?

Could we reduce maternal stress?

Could we strengthen breastfeeding outcomes?

Could we decrease rates of postpartum depression and anxiety?

Could we improve family wellbeing?

I believe the answer may often be yes.

Beyond evidence-based care

Evidence-based care remains essential.

But perhaps we need to broaden our understanding of what evidence-based truly means.

Evidence should include not only large-scale studies but also clinical wisdom, cultural understanding, lived experience, and respectful listening.

Women are not statistics.

They are individuals.

The best maternity care combines scientific evidence with compassionate, personalised care.

Not either-or.

Both.

Ubuntu and the future of maternity care

There is an African philosophy that has guided communities for generations:

Ubuntu.

“I am because we are.”

This simple statement captures a profound truth.

A mother does not exist in isolation.

A baby does not exist in isolation.

Families do not exist in isolation.

When we support mothers, we support families.

When we support families, we strengthen communities.

When we strengthen communities, we create healthier societies.

Perhaps the future of maternity care is not found in asking women to fit our systems.

Perhaps it lies in creating systems that honour the uniqueness of every woman.

My experience with synaesthesia taught me that what feels normal to one person may be entirely different for another.

Birth has taught me exactly the same lesson.

And perhaps that lesson is one of the most important lessons maternity care still has to learn.

“You are not a statistic; you are an individual with a unique biological blueprint. Learn how to prepare for a birth that honors your science in my evidence based courses.”
Explore Individualized Birth Preparation Click Here

References

World Health Organization. (2018). WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience.

Zhang, J., Troendle, J., Mikolajczyk, R., Sundaram, R., Beaver, J., & Fraser, W. (2010). The natural history of normal labour and delivery. Obstetrics & Gynecology, 115(4), 705–710.

Buckley, S. (2015). Gentle Birth, Gentle Mothering.

Davis, E., & Pascali-Bonaro, D. (2010). Orgasmic Birth.

Gaskin, I. M. (2003). Ina May’s Guide to Childbirth.

About the Author

Lovetti Lafua (Temu Loveth Igho, RN, RM, BSc Biology) is a Maternal Health Researcher, Registered Nurse, Registered Midwife, educator, and advocate for individualised maternity care. Her work focuses on improving outcomes for women and newborns through evidence-informed, culturally responsive, and person-centred approaches to pregnancy, birth, and postpartum care.