Onset of labour: women’s experiences and midwives’ assessments in relation to first stage duration

Groß, Mechthild M.; Burian, Rosemarie; Frömke, Cornelia; Hecker, Hartmut; Schippert, Cordula; Hillemanns, Peter

doi:10.1007/s00404-009-0990-7

Cited by 49 publications

(41 citation statements)

References 12 publications

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“…The range of the latent phase duration in the present study is also in line with Gross et al's observational study that women, regardless of parity, had a first stage of labor ranging between 48 minutes and 9.6 days. More research is needed about the latent phase and the classifications traditionally set by Friedman and the Swedish classification code as used in the present study.…”

Section: Discussionsupporting

confidence: 92%

“…More research is needed about the latent phase and the classifications traditionally set by Friedman and the Swedish classification code as used in the present study. Gross et al compared women's own description with midwives' diagnosed onset and concluded that irregular pain, watery fluid loss, and time between onset described by women and professionals were associated with the duration of the first stage. Therefore, the authors suggested that women's own perceptions of labor onset should be considered when determining the length of the first stage of labor.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of Prolonged Latent Phase and Labor Outcomes: Review of Birth Records in a Swedish Population

Ängeby¹,

Wilde‐Larsson²,

Hildingsson³

et al. 2018

J Midwife Womens Health

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Introduction:The prevalence of a prolonged latent phase of labor has been described as ranging from 5% to 6.5% in previous research. The aim of this study was to describe the prevalence of the prolonged latent phase of 18 hours or more, based on women's report, in women intending vaginal birth and who had spontaneous onset of labor. An additional aim was to compare the incidence of obstetric interventions, and the labor and neonatal outcomes in women with and without a prolonged latent phase. Methods:A descriptive and comparative study was performed in a mid-sized hospital in western Sweden. The sample consisted of 1343 birth records of women who intended vaginal births and who had spontaneous onset of labor at 37 or more weeks' gestation during a one-year period (2013)(2014). Background characteristics, obstetric interventions, and labor and neonatal outcomes were compared between women with latent phases lasting less than 18 hours and 18 hours or more, based on women's self-report. Odds ratios with 95% confidence intervals were calculated for the different exposure variables.Results: A prolonged latent phase lasting 18 hours or more occurred in 23% of all births analyzed (n = 1343). A prolonged latent phase was more common among nulliparous women (29.2%) but also common for multiparous women (17%). Nulliparous and multiparous women who experienced a prolonged latent phase were more often exposed to amniotomy during latent phase. For nulliparous women, the adjusted odds ratio (aOR) was 11.57 (95% confidence interval [CI], 5.25-25.51) and for multiparous women the aOR was 18.73 (95% CI, 9.06-38.69). Similarly, amniotomy during active phase was more common for both nulliparous and multiparous women who experienced a prolonged latent phase (aOR, 4.05; 95% CI, 2.53-6.47 and aOR, 3.93; 95% CI, 2.43-6.37, respectively). Women with latent phases of 18 hours or more, more often experienced augmentation of labor during all phases, especially during latent phase. For nulliparous women, the aOR was 10.13 (95% CI, 2.82-36.39) and for multiparous women, aOR was11.9 (95% CI, 3.69-38.71). A prolonged latent phase was associated with more instrumental vaginal births for multiparas (aOR, 2.58; 95% CI, 1.27-5.26) and emergency cesarean regardless of parity (nulliparous women: aOR, 3.21; 95% CI, 1.08-9.50 and multiparous women: aOR, 3.93; 95% CI, 1.67-9.26).Discussion: Based on women's self-report, the prevalence of a prolonged latent phase in women at term who planned a vaginal birth and had spontaneous onset of labor was higher than previously reported. Women with a prolonged latent phase were more likely to receive obstetric interventions. Assisted vaginal birth was more common for nulliparous women with prolonged latent phase and emergency cesarean occurred more frequently for both nulliparous women and multiparous women with a prolonged latent phase.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Prevalence of Prolonged Latent Phase and Labor Outcomes: Review of Birth Records in a Swedish Population

Ängeby¹,

Wilde‐Larsson²,

Hildingsson³

et al. 2018

J Midwife Womens Health

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“…The clinical diagnosis of labour onset usually involves the assessment of contraction pattern and cervical dilatation [41]. However, this evaluation can conflict with women’s own perceptions regarding the onset of their labour [42, 43], causing distress [44–48]. Contradictory perceptions of progress can also occur during the expulsive phase of labour when women experience an uncontrollable urge to push [49].…”

Section: Discussionmentioning

confidence: 99%

Women’s descriptions of childbirth trauma relating to care provider actions and interactions

Reed

Sharman

Inglis

2017

BMC Pregnancy Childbirth

203

154

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BackgroundMany women experience psychological trauma during birth. A traumatic birth can impact on postnatal mental health and family relationships. It is important to understand how interpersonal factors influence women’s experience of trauma in order to inform the development of care that promotes optimal psychosocial outcomes.MethodsAs part of a large mixed methods study, 748 women completed an online survey and answered the question ‘describe the birth trauma experience, and what you found traumatising’. Data relating to care provider actions and interactions were analysed using a six-phase inductive thematic analysis process.ResultsFour themes were identified in the data: ‘prioritising the care provider’s agenda’; ‘disregarding embodied knowledge’; ‘lies and threats’; and ‘violation’. Women felt that care providers prioritised their own agendas over the needs of the woman. This could result in unnecessary intervention as care providers attempted to alter the birth process to meet their own preferences. In some cases, women became learning resources for hospital staff to observe or practice on. Women’s own embodied knowledge about labour progress and fetal wellbeing was disregarded in favour of care provider’s clinical assessments. Care providers used lies and threats to coerce women into complying with procedures. In particular, these lies and threats related to the wellbeing of the baby. Women also described actions that were abusive and violent. For some women these actions triggered memories of sexual assault.ConclusionCare provider actions and interactions can influence women’s experience of trauma during birth. It is necessary to address interpersonal birth trauma on both a macro and micro level. Maternity service development and provision needs to be underpinned by a paradigm and framework that prioritises both the physical and emotional needs of women. Care providers require training and support to minimise interpersonal birth trauma.

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“…Not surprisingly the timing of self‐diagnosis of the onset of labor varies greatly among women, and also differs from the midwives' assessments. Our research team has shown that nulliparas who identify sleep alterations as the first sign of labor perceive that their labor started an average of 11.5 hours earlier than the midwife's assessment (10). In contrast, women whose labor started with watery fluid loss or contractions had greater congruence with the midwife's assessment.…”

Section: “Listening To Women's Self‐diagnosis Of Labor Onset”mentioning

confidence: 96%

Roundtable Discussion: Early Labor: What's the Problem?

Janssen

Nolan

Spiby

et al. 2009

Birth

Self Cite

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In places where hospital birth is the norm, one of the major contemporary challenges to the organization of intrapartum care is posed by women who are not in established labor. In the United Kingdom, these women have been given a special name, "Category X," and they can account for a substantial percentage of admissions (1). These women are not deemed to be in need of hospital care, but the women themselves may feel otherwise as they struggle to understand the sensations they are experiencing. Until relatively recently, little research effort was expended on early and latent phase labor, reflecting, perhaps, the assumption that it is just a gentle and relatively straightforward preamble to the "real thing" that can easily be dealt with by keeping mobile, leaning over furniture, or doing the ironing. Because early labor is not seen as needing a health professional's input, the message is that it is unimportant. However, emerging evidence is challenging that view. Four large randomized controlled trials have recently evaluated interventions related to early labor care (2-5), stimulated by concerns that included repeated visits to the labor ward and the impact of early admission with the potential for a cascade of interventions. These trials, and other research reporting women's own perspectives on labor onset, reflect growing awareness that this stage of labor merits consideration in its own right. An International Early Labor Research Group has formed who will develop the evidence base in this important part of childbearing. The group represents varied disciplines including midwifery, psychology, epidemiology, antenatal education, and service user representatives. Members of this group are among those who have contributed to this Roundtable Discussion. The contributions draw attention to the complexities of early labor and its importance for childbearing women, their caregivers and companions. We might reasonably hypothesize that a woman's experience of early labor sets the scene for what follows, and it is clear that this is an area worthy of considerable further research.

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Onset of labour: women’s experiences and midwives’ assessments in relation to first stage duration

Abstract: The perceptions of women in labour are as important as perinatal factors in determining the duration of the first stage of labour and should be taken into account in intrapartum care.

Cited by 49 publications

References 12 publications

Prevalence of Prolonged Latent Phase and Labor Outcomes: Review of Birth Records in a Swedish Population

Prevalence of Prolonged Latent Phase and Labor Outcomes: Review of Birth Records in a Swedish Population

Women’s descriptions of childbirth trauma relating to care provider actions and interactions

Roundtable Discussion: Early Labor: What's the Problem?

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