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Nyman V, Svensson A, Hansson M, Johnsson A. Women's experiences of remote video calls with a labour ward midwife during early labour. Women Birth 2024; 37:101620. [PMID: 38704959 DOI: 10.1016/j.wombi.2024.101620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND In an increasingly strained maternity care system with a shortage of midwives and great demands for service, pregnant women in their early labour are at risk of receiving insufficient support. Women make calls and visit the labour ward on multiple occasions before being admitted. A video call with a labour ward midwife during early labour is an unknown practice but could support pregnant women and their partners during this uncertain period. AIM The study aimed to describe women's experiences of remote video calls with a labour ward midwife during early labour. METHODS A qualitative study comprising nine semi-structured interviews followed by an inductive thematic analysis was conducted. RESULTS The results revealed that video calls prepared women and their partners by means of practical support. They received an assessment of early labour and the interaction with labour ward midwives prepared them for the impending birth. The participants reported feeling secure and strengthened by being met at their current stage of labour. Furthermore, they found the service accessible, easy to use and emphasised the need for increased availability and continuity. CONCLUSION This study highlights the positive impact of video calls in early labour when conducted by competent labour ward midwives. The perceived accessibility and ease of use e-health system underscore a demand for extended availability. These findings indicate the potential benefits of integrating video calls in labour care to enhance support, security, accessibility and overall satisfaction for pregnant women and their partners.
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Affiliation(s)
- Viola Nyman
- Department of Health Sciences, University West, Trollhättan, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Research and Development, NU-Hospital Group, Trollhättan, Sweden.
| | - Ann Svensson
- School of Business, Economics and IT, University West, Trollhättan, Sweden.
| | - Malin Hansson
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Region Västra Götaland, Research and Development Primary Healthcare, Sweden.
| | - Anette Johnsson
- Department of Health Sciences, University West, Trollhättan, Sweden.
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Basavaraj C, Grant AD, Aras SG, Erickson EN. Deep Learning Model Using Continuous Skin Temperature Data Predicts Labor Onset. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.25.24303344. [PMID: 38464102 PMCID: PMC10925356 DOI: 10.1101/2024.02.25.24303344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background Changes in body temperature anticipate labor onset in numerous mammals, yet this concept has not been explored in humans. Methods We evaluated patterns in continuous skin temperature data in 91 pregnant women using a wearable smart ring. Additionally, we collected daily steroid hormone samples leading up to labor in a subset of 28 pregnancies and analyzed relationships among hormones and body temperature trajectory. Finally, we developed a novel autoencoder long-short-term-memory (AE-LSTM) deep learning model to provide a daily estimation of days until labor onset. Results Features of temperature change leading up to labor were associated with urinary hormones and labor type. Spontaneous labors exhibited greater estriol to α-pregnanediol ratio, as well as lower body temperature and more stable circadian rhythms compared to pregnancies that did not undergo spontaneous labor. Skin temperature data from 54 pregnancies that underwent spontaneous labor between 34 and 42 weeks of gestation were included in training the AE-LSTM model, and an additional 40 pregnancies that underwent artificial induction of labor or Cesarean without labor were used for further testing. The model was trained only on aggregate 5-minute skin temperature data starting at a gestational age of 240 until labor onset. During cross-validation AE-LSTM average error (true - predicted) dropped below 2 days at 8 days before labor, independent of gestational age. Labor onset windows were calculated from the AE-LSTM output using a probabilistic distribution of model error. For these windows AE-LSTM correctly predicted labor start for 79% of the spontaneous labors within a 4.6-day window at 7 days before true labor, and 7.4-day window at 10 days before true labor. Conclusion Continuous skin temperature reflects progression toward labor and hormonal status during pregnancy. Deep learning using continuous temperature may provide clinically valuable tools for pregnancy care.
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Affiliation(s)
- Chinmai Basavaraj
- Department of Computer Science, The University of Arizona, Tucson, AZ, USA
| | | | - Shravan G Aras
- Center for Biomedical Informatics and Biostatistics, The University of Arizona Health Sciences, Tucson, AZ, USA
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Grylka-Baeschlin S, Hundley V, Cheyne H, Gross MM, Janssen PA, Spiby H. Early labour: An under-recognised opportunity for improving the experiences of women, families and maternity professionals. Women Birth 2023; 36:481-482. [PMID: 37723026 DOI: 10.1016/j.wombi.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Affiliation(s)
- Susanne Grylka-Baeschlin
- Research Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland.
| | - Vanora Hundley
- Centre for Midwifery, & Women's Health, Bournemouth University, England, UK
| | - Helen Cheyne
- Midwifery and Allied Health Professions Research Unit, University of Stirling, Scotland, UK
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Patricia A Janssen
- School of Population and Public Health, University of British Columbia, Canada
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, UK
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Stone NI, Downe S. Women's experience of early labour in a free-standing birth centre: Midwifing embodied labour. Women Birth 2023; 36:538-545. [PMID: 36906450 DOI: 10.1016/j.wombi.2023.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
ISSUE Women who present at hospital labour wards in early labour must often meet measurable diagnostic criteria before admission. BACKGROUND Early labour is a phase of neurohormonal, emotional, and physical changes that are often not measurable. When admission to birthplace is based on results of diagnostic procedures, women's embodied knowledge may be disregarded. AIM To describe the early labour experience of women with spontaneous onset of labour in a free-standing birth centre, as well as midwifery care when women arrived in labour. METHODOLOGY An ethnographic study was conducted in 2015 in a free-standing birth centre after receiving ethics approval. The findings for this article were drawn from a secondary analysis of the data, which included interview data with women and detailed field notes of midwives' activities related to early labour. FINDINGS The women in this study were instrumental in the decision-making process to stay at the birth centre. Observational data showed that vaginal exams were rarely conducted when women arrived at the birth centre and were not a deciding factor in admission. DISCUSSION The women and midwives co-constructed early labour based on the lived experience of women and the meaning that this experience held for both. CONCLUSION Given the growing concern about the need for respectful maternity care, this study provides examples of good practice in listening to women, as well as an illustration of the consequences of not doing so.
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Affiliation(s)
- Nancy Iris Stone
- Evangelische Hochschule Berlin, Department of Midwifery Sciences, Teltower Damm 118-122, 14167 Berlin, Germany.
| | - Soo Downe
- School of Community Health & Midwifery, University of Central Lancashire, Preston PR1 2HE, UK
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Grylka-Baeschlin S, Mueller AN. Symptoms of onset of labour and early labour: A scoping review. Women Birth 2023; 36:483-494. [PMID: 37059644 DOI: 10.1016/j.wombi.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/05/2023] [Accepted: 03/30/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Early labour care often insufficiently addresses the individual needs of pregnant women leading to great dissatisfaction. In-depth knowledge about symptoms of onset of labour and early labour is necessary to develop women-centred interventions. QUESTION OR AIM To provide an overview on the current evidence about pregnant women's symptoms of onset of labour and early labour. METHODS We conducted a scoping review in the five databases PubMed, Web of Science, CINHAL Complete, PsychInfo and MIDIRS in May 2021 and August 2022 using a sensitive search strategy. A total of 2861 titles and abstracts and 290 full texts were screened independently by two researchers using Covidence. For this article, data was extracted from 91 articles and summarised descriptively and narratively. FINDINGS The most frequently mentioned symptoms were 'Contractions, labour pain' (n = 78, 85.7 %), 'Details about the contractions' (n = 51 articles, 56.0 %), 'Positive and negative emotions' (n = 50, 54.9 %) and 'Fear and worries' (n = 48 articles, 52.7 %). Details about the contractions ranged from a slight pulling to unbearable pain and the emotional condition varied from joy to great fear, showing an extraordinary diversity of symptoms highlighting the very individual character of early labour. DISCUSSION A comprehensive picture of varying and contradicting symptoms of onset of labour and early labour was drawn. Different experiences indicate different needs. This knowledge builds a good basis to develop women-centred approaches to improve early labour care. CONCLUSION Further research is necessary to design individualised early labour interventions and evaluate their effectiveness.
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Affiliation(s)
- Susanne Grylka-Baeschlin
- Research Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, CH-8400 Winterthur, Switzerland.
| | - Antonia N Mueller
- Research Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, CH-8400 Winterthur, Switzerland
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Gehling H, Edmonds JK, Zinsser LA, Gross MM. Describing the transition from late pregnancy into early labour - A prospective cohort study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100895. [PMID: 37597272 DOI: 10.1016/j.srhc.2023.100895] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/12/2023] [Accepted: 07/31/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE The time between self-assessed first symptoms and clinical confirmation of labour onset is marked by uncertainty, particularly for primiparas. Accordingly, primiparas often seek professional care to confirm their perceptions of labour onset. This paper describes the transition into early labour among primiparas considering their level of certainty in labour onset and their perception of labour onset symptoms prior to birth. METHODS A prospective exploratory cohort study was conducted in Germany between July 2020 - March 2021 among a convenience sample of 69 primiparas. Respondents recorded in a non-validated questionnaire their perceptions of nine symptoms and degree of certainty about labour onset every day from 37 weeks gestation. Descriptive analysis included certainty in labour onset and dedicated symptoms in relation to days before birth. RESULTS The participants (n=69) reported a little certainty of labour onset up to 32 days before birth and most of them became certain up to four days before birth. Associated symptoms were regular and irregular pain, symptoms of vaginal loss and emotional symptoms. Gastrointestinal symptoms and nausea were not indicated by a majority. Uncertainty of labour onset, however, was indicated up until the day of birth. CONCLUSION Although interpretation is based on a small sample size, primiparas are able to self-diagnose labour onset and report connected symptoms up to four days before birth. We suggest calling this time between self-diagnosis of labour onset and confirmed labour onset based on clinical parameters the transition into early labour.
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Affiliation(s)
- Hanna Gehling
- Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany.
| | - Joyce K Edmonds
- Connell School of Nursing, Boston College, Maloney Hall, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.
| | - Laura A Zinsser
- Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany.
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany.
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Erickson EN, Gotlieb N, Pereira LM, Myatt L, Mosquera-Lopez C, Jacobs PG. Predicting labor onset relative to the estimated date of delivery using smart ring physiological data. NPJ Digit Med 2023; 6:153. [PMID: 37598232 PMCID: PMC10439919 DOI: 10.1038/s41746-023-00902-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023] Open
Abstract
The transition from pregnancy into parturition is physiologically directed by maternal, fetal and placental tissues. We hypothesize that these processes may be reflected in maternal physiological metrics. We enrolled pregnant participants in the third-trimester (n = 118) to study continuously worn smart ring devices monitoring heart rate, heart rate variability, skin temperature, sleep and physical activity from negative temperature coefficient, 3-D accelerometer and infrared photoplethysmography sensors. Weekly surveys assessed labor symptoms, pain, fatigue and mood. We estimated the association between each metric, gestational age, and the likelihood of a participant's labor beginning prior to (versus after) the clinical estimated delivery date (EDD) of 40.0 weeks with mixed effects regression. A boosted random forest was trained on the physiological metrics to predict pregnancies that naturally passed the EDD versus undergoing onset of labor prior to the EDD. Here we report that many raw sleep, activity, pain, fatigue and labor symptom metrics are correlated with gestational age. As gestational age advances, pregnant individuals have lower resting heart rate 0.357 beats/minute/week, 0.84 higher heart rate variability (milliseconds) and shorter durations of physical activity and sleep. Further, random forest predictions determine pregnancies that would pass the EDD with accuracy of 0.71 (area under the receiver operating curve). Self-reported symptoms of labor correlate with increased gestational age and not with the timing of labor (relative to EDD) or onset of spontaneous labor. The use of maternal smart ring-derived physiological data in the third-trimester may improve prediction of the natural duration of pregnancy relative to the EDD.
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Affiliation(s)
- Elise N Erickson
- College of Nursing / College of Pharmacy, The University of Arizona, Tucson, AZ, USA.
- Midwifery Division, School of Nursing, Oregon Health & Science University, Portland, OR, USA.
| | | | - Leonardo M Pereira
- Department of Obstetrics & Gynecology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Leslie Myatt
- Department of Obstetrics & Gynecology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Clara Mosquera-Lopez
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Peter G Jacobs
- Artificial Intelligence for Medical Systems (AIMS) Lab, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
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Primiparous women's expectations and experiences of early labour: A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 36:100839. [PMID: 36933331 DOI: 10.1016/j.srhc.2023.100839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/22/2023] [Accepted: 03/07/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVES To gain a deeper understanding of primiparous women's preparation for early labour as well as their expectations and experiences of symptoms of onset of labour. METHODS A qualitative study using focus group discussion was conducted with n = 18 first-time mothers within the first six months of giving birth. Discussions were transcribed verbatim and coded and summarised into themes by two researchers using qualitative content analysis. RESULTS The statements of the participants revealed four themes: 'Preparing for the unpredictable', 'Expectations and reality', 'Perception and wellbeing' and 'Experiencing the beginning of birth'. Many women could not distinguish the preparation for early labour from that for the whole birth. Relaxation techniques to prepare for early labour were found to be very helpful. For some women, it was a big challenge that expectations often did not correspond to the experienced reality. Pregnant women faced many different physical and emotional symptoms of onset of labour with striking variability. Emotions ranged from positively excited to having fears. Not being able to sleep for hours was a huge problem for the labour process of some women. While early labour at home was experienced positively, early labour in hospital was sometimes difficult, because women had the feeling of being in the second rank. CONCLUSION The study clearly identified the individual character of experiencing onset of labour and early labour. The variety of experiences highlighted the need for individualised, woman-centred early labour care. Further research should investigate new paths for assessing, advising, and caring for women during early labour.
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Association of labour duration in spontaneous deliveries with low neonatal Apgar scores and foetal acidosis: the Japan Environment and Children's Study. Sci Rep 2022; 12:21519. [PMID: 36513654 PMCID: PMC9747973 DOI: 10.1038/s41598-022-24359-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
This study evaluated the association between labour duration (LD) and incidence of low neonatal Apgar scores and foetal acidosis. Data of 37,682 women with full-term singleton spontaneous vaginal deliveries from the Japan Environment and Children's Study were analysed. Women were classified according to the median LD as nulliparous (< 10 or ≥ 10 h) or multiparous (< 5 or ≥ 5 h) and further into five subcategories: nulliparous (< 10.0, 10.0-12.9, 13.0-15.9, 16.0-18.9, and ≥ 19 h) and multiparous (< 5.0, 5.0-7.9, 8.0-10.9, 11.0-13.9, and ≥ 14.0 h). Multiple logistic regression models were used to determine odds ratios (ORs) for outcomes in women with over-median LD. Over-median LD exhibited no statistically significant association with low neonatal Apgar scores. The adjusted ORs for both umbilical artery (UmA-pH) < 7.2 and < 7.1 were increased in nulliparous women with over-median LD, whereas only the adjusted OR for UmA-pH < 7.2 was increased in multiparous women with over-median LD. Moreover, this association manifested as a plateau in nulliparous women with LD ≥ 13 h and without dose-dependent association in multiparous women.
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Grylka-Baeschlin S, Gross MM, Mueller AN, Pehlke-Milde J. Development and validation of a tool for advising primiparous women during early labour: study protocol for the GebStart Study. BMJ Open 2022; 12:e062869. [PMID: 35760537 PMCID: PMC9237887 DOI: 10.1136/bmjopen-2022-062869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Pregnant women experience early labour with different physical and emotional symptoms. Early admission to hospital has been found to be associated with increased intervention and caesarean section rates. However, primiparous women often contact the hospital before labour progresses because they encounter difficulties coping with symptoms of onset of labour on their own. An evidence-based instrument for assessing the individual needs to advise primiparous women during early labour is currently missing. The study aims to develop and validate a tool to inform the joint decision for or against hospital admission. METHODS AND ANALYSIS A scale development and validation study will be conducted including following steps: (1) Generation of a pool with 99 items based on a scoping review and focus group discussions with primiparous women, (2) Assessment of content and face validity by an expert panel and item reduction to 32 items, (3) Multicentre data collection in six study sites in Switzerland, with application of the preliminary tool and the validation items with a target sample size of approximately n=400 women and (4), item reduction using exploratory factor analysis, factor loading and item-to-item correlation. Internal consistency of the tool will be assessed using Cronbach's alpha and convergent validity computing correlations of items of the tool with the German versions of the Childbirth Self-Efficacy Inventory and the Cambridge-Worry Scale. Analyses will be performed using Stata V.17. ETHICS AND DISSEMINATION Ethical approval was obtained by the Ethics Committees Zurich and Northwestern and Central Switzerland (BASEC-Nr. 2021-00687). Results will be disseminated at the final study conference, at national and international congresses and by peer reviewed and not peer-reviewed articles in scientific and professional journals. Approved and anonymised data will be shared. The dissemination of the findings will have a contributable impact on clinical practice, scientific discussions and future research. TRIAL REGISTRATION NUMBER DRKS00025572, SNCTP000004555.
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Affiliation(s)
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Antonia N Mueller
- Research Institute of Midwifery, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Jessica Pehlke-Milde
- Research Institute of Midwifery, Zurich University of Applied Sciences, Winterthur, Switzerland
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Tilden EL, Phillippi JC, Carlson N, Dissanayake M, Lee CS, Caughey AB, Snowden JM. The association between longer durations of the latent phase of labor and subsequent perinatal processes and outcomes among midwifery patients. Birth 2020; 47:418-429. [PMID: 32687226 PMCID: PMC7755745 DOI: 10.1111/birt.12494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/28/2020] [Accepted: 05/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVE To evaluate the association between the duration of the latent phase of labor and subsequent processes and outcomes. METHODS Secondary analysis of prospectively collected data among 1,189 women with low-risk pregnancies and spontaneous labor. RESULTS Longer latent phase duration was associated with labor dystocia (eg, nulliparous ≥ mean [compared with < mean] aOR 3.95 [2.70-5.79]; multiparous ≥ mean [compared with < mean] aOR 5.45 [3.43-8.65]), interventions to ameliorate dystocia, and epidurals to cope or rest (eg, oxytocin augmentation: nulliparous > 80th% [compared with < 80th%] aOR 6.39 [4.04-10.12]; multiparous ≥ 80th% [compared with < 80th%] aOR 6.35 [3.79-10.64]). Longer latent phase duration was also associated with longer active phase and second stage. There were no associations between latent phase duration and risk for cesarean delivery or postpartum hemorrhage in a practice setting with relatively low rates of primary cesarean. Newborns born to multiparous women with latent phase of labor durations at and beyond the 80th% were more frequently admitted to the NICU (≥80th% [compared with < 80th%] aOR 2.7 [1.22-5.84]); however, two-thirds of these NICU admissions were likely for observation only. CONCLUSIONS Longer duration of the spontaneous latent phase of labor among women with low-risk pregnancies may signal longer total labor processes, leading to an increase in diagnosis of dystocia, interventions to manage dystocia, and epidural use. Apart from multiparous neonatal NICU admission, no other maternal or child morbidity outcomes were elevated with longer duration of the latent phase of labor.
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Affiliation(s)
- Ellen L. Tilden
- Department of Nurse-Midwifery, Oregon Health & Science University School of Nursing, Portland, Oregon, USA,Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Mekhala Dissanayake
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Aaron B. Caughey
- Department of Nurse-Midwifery, Oregon Health & Science University School of Nursing, Portland, Oregon, USA,Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jonathan M. Snowden
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA,School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, USA
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Hundley V, Downe S, Buckley SJ. The initiation of labour at term gestation: Physiology and practice implications. Best Pract Res Clin Obstet Gynaecol 2020; 67:4-18. [DOI: 10.1016/j.bpobgyn.2020.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/10/2020] [Accepted: 02/13/2020] [Indexed: 11/16/2022]
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Tilden EL, Phillippi JC, Ahlberg M, King TL, Dissanayake M, Lee CS, Snowden JM, Caughey AB. Describing latent phase duration and associated characteristics among 1281 low-risk women in spontaneous labor. Birth 2019; 46:592-601. [PMID: 30924182 PMCID: PMC6765461 DOI: 10.1111/birt.12428] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/24/2019] [Accepted: 03/07/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent research suggests that latent phase of labor may terminate at 6 rather than 4 centimeters of cervical dilation. The objectives of this study were to: (a) characterize duration of the latent phase of labor among term, low-risk, United States women in spontaneous labor using the women's self-identified onset; and (b) quantify associations between demographic and maternal/newborn health characteristics and the duration of the latent phase. METHODS This prospective study (n = 1281) described the duration of the latent phase of labor in hours, stratified by parity at the mean, median, and 80th, 90th, and 95th percentiles. The duration of the latent phase was compared for each characteristic using t tests or Wilcoxon rank-sum tests and regression models that controlled for confounders. RESULTS In this sample of predominantly white, healthy women, duration of the latent phase of labor was longer than described in previous studies: The median duration was 9.0 hours and mean duration was 11.8 hours in nulliparous women. The median duration was 6.8 hours and mean duration was 9.3 hours in multiparous women. Among nulliparous women, longer duration was seen in women whose fetus was in a malposition. Among multiparous women, longer durations were noted in women with chorioamnionitis and those who gave birth between 41 and 41 + 6 weeks' gestation (vs between 40 and 40 + 6 weeks' gestation). CONCLUSIONS The latent phase of labor may be longer than previously estimated. Contemporary estimates of latent phase of labor duration will help women and providers accurately anticipate, prepare, and cope during spontaneous labor.
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Affiliation(s)
- Ellen L Tilden
- Department of Nurse-Midwifery, Oregon Health & Science University School of Nursing, Portland, Oregon
- Department of Obstetrics and Gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | | | | | - Tekoa L King
- Department of Obstetrics and Gynecology, University of California, San Francisco, California
| | - Mekhala Dissanayake
- Department of Obstetrics and Gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
| | | | - Jonathan M Snowden
- Department of Obstetrics and Gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon
| | - Aaron B Caughey
- Department of Nurse-Midwifery, Oregon Health & Science University School of Nursing, Portland, Oregon
- Department of Obstetrics and Gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon
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Edmonds JK, Zabbo G. Women's Descriptions of Labor Onset and Progression Before Hospital Admission. Nurs Womens Health 2017; 21:250-258. [PMID: 28784206 DOI: 10.1016/j.nwh.2017.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/08/2017] [Indexed: 10/19/2022]
Abstract
We conducted a cross-sectional, descriptive, qualitative study, set in a postpartum unit, of 21 nulliparous women who spontaneously went into term labor at home. Our aim was to characterize symptoms of labor onset and progression to active labor before hospital admission for childbirth. The most frequent symptoms reported at labor onset were contractions, pain, ruptured membranes, cramping, and feelings of nervousness and excitement. Women reported that as labor progressed to the active phase, their pain increased, length and strength of contractions increased, and labor symptoms became more difficult to tolerate. Women's descriptions of symptoms of labor onset can aid the development of criteria to help women identify active labor and support decisions about timing of hospital admission for childbirth.
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Spiby H, Borrelli S, Hughes AJ. Women's expectations and experiences of rupture of membranes and views of the potential use of reagent pads for detecting amniotic fluid. J Adv Nurs 2017. [PMID: 28637100 DOI: 10.1111/jan.13365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To explore first-time mothers' expectations and experiences regarding rupture of membranes at term and their views on the potential use of reagent pads that detect amniotic fluid. BACKGROUND There is little information available on women's experiences of spontaneous rupture of membranes, or interest in using methods to confirm rupture of membranes (e.g. reagent pads). DESIGN Descriptive qualitative study, using focus groups and telephone interviews with women during pregnancy and after the birth of their first baby. Thematic analysis was undertaken to analyse women's responses. METHODS Ethics committee approval was obtained. Twenty-five women participated in the study of whom 13 contributed both during pregnancy and postpartum between October 2015-March 2016. FINDINGS Three overarching themes were identified from the data from women's expectations and experiences: uncertainty in how, when and where membranes may rupture; information which was felt to be limited and confirmation of rupture of membranes. The potential use of reagent pads met with varied responses. CONCLUSION Women were interested in having facts and figures regarding rupture of membranes, such as characteristics of liquor; volume and probability of membranes rupturing spontaneously at term. Use of a pad as a means of confirmation was viewed as helpful, although the potential for increasing anxiety was raised.
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Affiliation(s)
- Helen Spiby
- School of Health Sciences, Division of Midwifery, University of Nottingham, Nottingham, UK
| | - Sara Borrelli
- School of Health Sciences, Division of Midwifery, University of Nottingham, Nottingham, UK
| | - Anita J Hughes
- School of Health Sciences, Division of Midwifery, University of Nottingham, Nottingham, UK
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Kobayashi S, Hanada N, Matsuzaki M, Takehara K, Ota E, Sasaki H, Nagata C, Mori R. Assessment and support during early labour for improving birth outcomes. Cochrane Database Syst Rev 2017; 4:CD011516. [PMID: 28426160 PMCID: PMC6478316 DOI: 10.1002/14651858.cd011516.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The progress of labour in the early or latent phase is usually slow and may include painful uterine contractions. Women may feel distressed and lose their confidence during this phase. Support and assessment interventions have been assessed in two previous Cochrane Reviews. This review updates and replaces these two reviews, which have become out of date. OBJECTIVES To investigate the effectiveness of assessment and support interventions for women during early labour.In order to measure the effectiveness of the interventions, we compared the duration of labour, the rate of obstetrical interventions, and the rate of other maternal or neonatal outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (31 October 2016) and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials of any assessment or support intervention in the latent phase of labour. We planned to include cluster-randomised trials if they were eligible. We did not include quasi-randomised trials. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We resolved any disagreement by discussion or by involving a third assessor. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS We included five trials with a total of 10,421 pregnant women in this review update. The trials were conducted in the UK, Canada and America. The trials compared interventions in early labour versus usual care. We examined three comparisons: early labour assessment versus immediate admission to hospital; home visits by midwives versus usual care (telephone triage); and one-to-one structured midwifery care versus usual care. These trials were at moderate- risk of bias mainly because blinding women and staff to these interventions is not generally feasible. For important outcomes we assessed evidence using GRADE; we downgraded evidence for study design limitations, imprecision, and where we carried out meta-analysis, for inconsistency.One trial with 209 women compared early labour assessment with direct admission to hospital. Duration of labour from the point of hospital admission was reduced for women in the assessment group (mean difference (MD) -5.20 hours, 95% confidence interval (CI) -7.06 to -3.34; 209 women, low-quality evidence). There were no clear differences between groups for the number of women undergoing caesarean section or instrumental vaginal birth (risk ratio (RR) 0.72, 95% CI 0.30 to 1.72, very low quality evidence; and, RR 0.86, 95% CI 0.58 to 1.26, very low quality evidence, respectively). Serious maternal morbidity was not reported. Women in the early assessment group were slightly less likely to have epidural anaesthesia (RR 0.87, 95% CI 0.78 to 0.98, low-quality evidence), and considerably less likely to have oxytocin for labour augmentation (RR 0.57, 95% CI 0.37 to 0.86) and this group also had increased satisfaction with their care compared with women in the immediate admission group (MD 16.00, 95% CI 7.53 to 24.47). No babies were born before admission to hospital and only one infant had a low Apgar score at five minutes after the birth (very low quality evidence). Admission to neonatal special care was not reported.Three studies examined home assessment and midwifery support versus telephone triage. One trial reported the duration of labour; home visits did not appear to have any clear impact compared with usual care (MD 0.29 hours, 95% CI -0.14 to 0.72; 1 trial, 3474 women, low-quality evidence). There was no clear difference for the rate of caesarean section (RR 1.05, 95% CI 0.95 to 1.17; 3 trials, 5170 women; I² = 0%; moderate-quality evidence) or the rate of instrumental vaginal birth (average RR 0.95, 95% CI 0.79 to 1.15; 2 trials, 4933 women; I² = 69%; low-quality evidence). One trial reported birth before arrival at hospital or unplanned home birth; there was no clear difference between the groups (RR 1.33, 95% CI 0.30 to 5.95; 1 trial, 3474 women). No clear differences were identified for serious maternal morbidity (RR 0.93, 95% CI 0.61 to 1.42; 1 trial, 3474 women; low-quality evidence), or use of epidural (average RR 0.95, 95% CI 0.87 to 1.05; 3 trials, 5168 women; I² = 60%; low-quality evidence). There were no clear differences for neonatal admission to special care (average RR 0.84, 95% CI 0.50 to 1.42; 3 trials, 5170 infants; I² = 71%; very low quality evidence), or for Apgar score less than seven at five minutes after birth (RR 1.19, 95% CI 0.71 to 1.99; 3 trials, 5170 infants; I² = 0%; low-quality evidence).One study, with 5002 women, examined one-to-one structured care in early labour versus usual care. Length of labour was not reported. There were no clear differences between groups for the rate of caesarean section (RR 0.93, 95% CI 0.84 to 1.02; 4996 women, high-quality evidence), or for instrumental vaginal birth (RR 0.94, 95% CI 0.82 to 1.08; 4996 women, high-quality evidence). No clear differences between groups were reported for serious maternal morbidity (RR 1.13, 95% CI 0.84 to 1.52; 4996 women, moderate-quality evidence). Use of epidural was similar in the two groups (RR 1.00, 95% CI 0.99 to 1.01; 4996 women, high-quality evidence). For infant outcomes, there were no clear differences between groups (admission to neonatal intensive care unit: RR 0.98, 95% CI 0.80 to 1.21; 4989 infants, high-quality evidence; Apgar score less than seven at five minutes: RR 1.07, 95% CI 0.64 to 1.79; 4989 infants, moderate-quality evidence). AUTHORS' CONCLUSIONS Assessment and support in early labour does not have a clear impact on rate of caesarean section or instrumental vaginal birth, or whether the baby was born before arrival at hospital or in an unplanned home birth. However, evidence suggested that interventions may have an impact on reducing the use of epidural anaesthesia, labour augmentation and on increasing maternal satisfaction with giving birth. Evidence about the effectiveness of early labour assessment versus immediate admission was very limited and more research is needed in this area.
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Affiliation(s)
- Shinobu Kobayashi
- National Center for Child Health and DevelopmentDepartment of Health Policy10‐1, Okura 2 chomeTokyoTokyoJapan157‐8535
| | - Nobutsugu Hanada
- National Center for Child Health and DevelopmentDepartment of Health Policy10‐1, Okura 2 chomeTokyoTokyoJapan157‐8535
| | - Masayo Matsuzaki
- Osaka University Graduate School of MedicineDepartment of Children and Women's Health1‐7 YamadaokaSuitaOsakaJapan565‐0871
| | - Kenji Takehara
- National Center for Child Health and DevelopmentDepartment of Health Policy10‐1, Okura 2 chomeTokyoTokyoJapan157‐8535
| | - Erika Ota
- St. Luke's International University, Graduate School of Nursing SciencesGlobal Health Nursing10‐1 Akashi‐choChuo‐KuTokyoJapan104‐0044
| | - Hatoko Sasaki
- National Center for Child Health and DevelopmentDepartment of Health Policy10‐1, Okura 2 chomeTokyoTokyoJapan157‐8535
| | - Chie Nagata
- National Center for Child Health and DevelopmentDepartment of Education for Clinical Research2‐10‐1 OkuraSetagaya‐kuTokyoJapan157‐8535
| | - Rintaro Mori
- National Center for Child Health and DevelopmentDepartment of Health Policy10‐1, Okura 2 chomeTokyoTokyoJapan157‐8535
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Hanley GE, Munro S, Greyson D, Gross MM, Hundley V, Spiby H, Janssen PA. Diagnosing onset of labor: a systematic review of definitions in the research literature. BMC Pregnancy Childbirth 2016; 16:71. [PMID: 27039302 PMCID: PMC4818892 DOI: 10.1186/s12884-016-0857-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 03/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnosis of labor onset has been described as one of the most important judgments in maternity care. There is compelling evidence that the duration of both latent and active phase labor are clinically important and require consistent approaches to measurement. In order to measure the duration of labor phases systematically, we need standard definitions of their onset. We reviewed the literature to examine definitions of labor onset and the evidentiary basis provided for these definitions. METHODS Five electronic databases were searched using predefined search terms. We included English, French and German language studies published between January 1978 and March 2014 defining the onset of latent labor and/or active labor in a population of healthy women with term births. Studies focusing exclusively on induced labor were excluded. RESULTS We included 62 studies. Four 'types' of labor onset were defined: latent phase, active phase, first stage and unspecified. Labor onset was most commonly defined through the presence of regular painful contractions (71% of studies) and/or some measure of cervical dilatation (68% of studies). However, there was considerable discrepancy about what constituted onset of labor even within 'type' of labor onset. The majority of studies did not provide evidentiary support for their choice of definition of labor onset. CONCLUSIONS There is little consensus regarding definitions of labor onset in the research literature. In order to avoid misdiagnosis of the onset of labor and identify departures from normal labor trajectories, a consistent and measurable definition of labor onset for each phase and stage is essential. In choosing standard definitions, the consequences of their use on rates of maternal and fetal morbidity must also be examined.
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Affiliation(s)
- Gillian E. Hanley
- />Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC Canada
- />Child and Family Research Institute, University of British Columbia, Vancouver, BC Canada
| | - Sarah Munro
- />Interdisciplinary Studies Department, University of British Columbia, Vancouver, BC Canada
- />School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
- />Child and Family Research Institute, University of British Columbia, Vancouver, BC Canada
| | - Devon Greyson
- />Interdisciplinary Studies Department, University of British Columbia, Vancouver, BC Canada
| | - Mechthild M. Gross
- />Midwifery Research and Education Unit, Hannover Medical School, Hanover, Germany
| | - Vanora Hundley
- />Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
| | - Helen Spiby
- />School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Patricia A. Janssen
- />School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
- />Child and Family Research Institute, University of British Columbia, Vancouver, BC Canada
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18
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Eri TS, Bondas T, Gross MM, Janssen P, Green JM. A balancing act in an unknown territory: A metasynthesis of first-time mothers׳ experiences in early labour. Midwifery 2015; 31:e58-67. [DOI: 10.1016/j.midw.2014.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 11/03/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
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Marowitz A. Caring for Women in Early Labor: Can We Delay Admission and Meet Women's Needs? J Midwifery Womens Health 2014; 59:645-650. [DOI: 10.1111/jmwh.12252] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Spiby H, Walsh D, Green J, Crompton A, Bugg G. Midwives' beliefs and concerns about telephone conversations with women in early labour. Midwifery 2014; 30:1036-42. [DOI: 10.1016/j.midw.2013.10.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/23/2013] [Accepted: 10/31/2013] [Indexed: 11/30/2022]
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Bräne E, Olsson A, Andolf E. A randomized controlled trial on early induction compared to expectant management of nulliparous women with prolonged latent phases. Acta Obstet Gynecol Scand 2014; 93:1042-9. [PMID: 24974855 DOI: 10.1111/aogs.12447] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 06/16/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare early induction and expectant management regarding delivery outcomes and the experience of delivery in nulliparous women with prolonged latent phases. DESIGN Randomized controlled trial. SETTING One delivery unit in a Swedish hospital. POPULATION Nulliparous women at term experiencing continuous contractions impeding rest (women's report) and exceeding 18 h, a cervical dilation of less than 4 cm, intact membranes and with a singleton fetus in cephalic presentation. METHODS The women were randomly allocated to either early induction (n = 65) or expectant management (n = 64). All participants received medication for therapeutic rest. The early induction group was induced five hours after medication, and the expectant group awaited spontaneous onset of labor. The Wijma Delivery Experience Questionnaire (W-DEQ version B) was filled in after delivery. MAIN OUTCOME MEASURES The primary outcome was mode of delivery. Secondary outcomes included birth experience, duration of labor, postpartum hemorrhage, and neonatal outcomes. RESULTS The cesarean section rate was 15 of 65 (23.1%) in the early induction group and 24 of 64 (37.5%) in the expectant group (p = 0.076, OR 2.00, 95% CI 0.93-4.31). No significant differences were shown regarding delivery, neonatal outcomes or birth experience. CONCLUSIONS No significant differences were shown between the two groups in the rate of cesarean sections or the experience of delivery. According to the actual results, the power to detect a difference was only 45%. The cesarean section rate was high in both groups, regardless of intervention.
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Affiliation(s)
- Elena Bräne
- Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden
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22
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Dixon L, Skinner J, Foureur M. Women's perspectives of the stages and phases of labour. Midwifery 2012; 29:10-7. [PMID: 22906490 DOI: 10.1016/j.midw.2012.07.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 06/25/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND within childbirth there is a common and widely known explanation of labour and birth which describes and defines the birth process as stages and phases. The aim of this research was to determine whether the discourse of labour as stages and phases resonated with women who had experienced spontaneous labour and birth. METHOD a critical feminist standpoint methodology was used to explore the perspectives of 18 New Zealand women through in-depth, one to one, interviews. FINDINGS the participants did not talk about their labour as occurring in stages or phases and often considered this description to be an abstract concept. The current descriptions of labour onset and progression did not appear to resonate with these women or provide sufficient clarity for them to understand how far they had progressed in their labour. For women who had previously laboured there was the ability to make comparisons with their previous experiences and therefore experiential knowledge was privileged over other forms of knowledge. Despite this the discourse of measurement of cervical dilatation was dominant and considered as an authoritative means of determining labour and labour progress. CONCLUSION AND IMPLICATION FOR PRACTICE women considered labour to be a continuous process. If women are to be able to make sense of their experience of labour, the maternity sector needs to explore and determine descriptions of labour which resonate more fully with the woman's experience of labour and birth.
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Affiliation(s)
- Lesley Dixon
- Practice Advice and Research Development, The New Zealand College of Midwives, PO Box 21 106, Christchurch 8143, New Zealand.
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23
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Eri TS, Blystad A, Gjengedal E, Blaaka G. ‘Stay home for as long as possible’: Midwives' priorities and strategies in communicating with first-time mothers in early labour. Midwifery 2011; 27:e286-92. [DOI: 10.1016/j.midw.2011.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 01/10/2011] [Accepted: 01/27/2011] [Indexed: 10/18/2022]
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Scotland GS, McNamee P, Cheyne H, Hundley V, Barnett C. Women's preferences for aspects of labor management: results from a discrete choice experiment. Birth 2011; 38:36-46. [PMID: 21332773 DOI: 10.1111/j.1523-536x.2010.00447.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The latent phase of labor can vary greatly in duration, and many women are uncertain about when to contact the maternity unit. The aim of this study was to elicit and value women's preferences for some aspects of labor management. METHODS A questionnaire was sent to 1,251 women who had recently given birth to their first child at one of 14 maternity units in Scotland. Discrete choice questions were used to measure women's preferences for five attributes of care: number of visits (assessments) before admission to the labor ward, time spent on the labor ward before delivery, mobility during labor, pain relief required, and mode of delivery. Responses were analyzed for the sample as a whole and for subgroups defined by recent experiences of labor. RESULTS A total of 730 (58.4%) questionnaires were returned and analyzed. Women expressed a preference for fewer visits before admission, shorter times on the labor ward before delivery, mobility during labor, normal vaginal deliveries, and moderate forms of pain relief (Entonox and opiates). Subgroup analysis suggests that women's preferences for pain relief are influenced by their recent labor experience. The elicited preference values provide a means for estimating the tradeoffs women are willing to make between attributes of labor management. CONCLUSIONS Women appear to dislike being turned away from the labor ward before admission for delivery. Extra visits before admission only appear to be a price worth paying if they result in reductions in the duration of time spent on the labor ward, reductions in the chance of being immobilized in hospital during labor, or a lower chance of requiring an instrumental or operative delivery.
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Affiliation(s)
- Graham S Scotland
- Health Economics Research Unit, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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Abstract
The latent phase of labor is complex and not completely understood by modern science. Studies often ignore evaluation of this phase of labor because determination of onset is subjective. In this article, the definition and time parameters of latent phase labor are discussed, and generalized distinctions between prelabor and labor are evaluated. Outpatient relief measures for latent phase as well as inpatient medical interventions for prolonged latent phase of labor are reviewed. Recommendations for policy development are included along with a discussion about the need to consider the significance of time limits. For optimal outcomes, clinicians are encouraged to individualize a management plan that is made in collaboration with the laboring woman.
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Affiliation(s)
- Betsy Greulich
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM 87131-0001, USA.
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26
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Eri TS, Blystad A, Gjengedal E, Blaaka G. Negotiating credibility: first-time mothers’ experiences of contact with the labour ward before hospitalisation. Midwifery 2010; 26:e25-30. [DOI: 10.1016/j.midw.2008.11.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 11/19/2008] [Accepted: 11/23/2008] [Indexed: 10/21/2022]
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Eri TS, Blystad A, Gjengedal E, Blaaka G. ‘The waiting mode’: First-time mothers’ experiences of waiting for labour onset. SEXUAL & REPRODUCTIVE HEALTHCARE 2010; 1:169-73. [DOI: 10.1016/j.srhc.2010.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 05/01/2010] [Accepted: 07/27/2010] [Indexed: 11/25/2022]
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Gross MM, Petersen A, Hille U, Hillemanns P. Association between women's self-diagnosis of labor and labor duration after admission. J Perinat Med 2010; 38:33-8. [PMID: 19954412 DOI: 10.1515/jpm.2010.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To examine the association between women's perception of onset and the duration of labor after hospital admission. METHODS Women whose labor started spontaneously at term, delivering at the Hannover Medical School Hospital, Germany, between 2001 and 2004 were asked when and how labor had started. Answers were analyzed using structured content analysis. Women's symptoms were grouped in eight predefined categories; inter-rater agreement was assessed (kappa=0.93). Associations between women's symptoms and labor duration after admission were also analyzed. RESULTS Duration of labor after admission was longer in nulliparas (n=347) than in multiparas (n=304, P<0.001). Nulliparas experienced shorter labor in association with recurrent pain, advanced cervical dilatation at admission and spontaneous rupture of membranes. Oxytocin augmentation and epidural analgesia were associated with a longer duration. In multiparas, advanced cervical dilatation at admission, spontaneously ruptured membranes, blood-tinged mucus or emotional upheaval perceived by women were associated with a shorter interval from admission until birth. CONCLUSIONS How women diagnose their onset of labor relates to some extent with labor duration after admission. Recognized symptoms and their association with labor duration differed between nulliparas and multiparas.
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Affiliation(s)
- Mechthild M Gross
- Department of Obstetrics, Gynecology and Reproductive Medicine, Midwifery Research Unit, Hannover Medical School, Germany.
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29
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Janssen P, Nolan ML, Spiby H, Green J, Gross MM, Cheyne H, Hundley V, Rijnders M, de Jonge A, Buitendijk S. Roundtable discussion: Early labor: what's the problem? Birth 2009; 36:332-9. [PMID: 20002426 DOI: 10.1111/j.1523-536x.2009.00361.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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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Affiliation(s)
- Patricia Janssen
- University of British Columbia, Department of Health Care and Epidemiology, Vancouver, BC, Canada
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Gharoro EP, Enabudoso EJ. Labour management: An appraisal of the role of false labour and latent phase on the delivery mode. J OBSTET GYNAECOL 2009; 26:534-7. [PMID: 17000500 DOI: 10.1080/01443610600811094] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Achieving normal vaginal delivery requires an orderly transition from early labour to an established active labour. We analysed retrospectively the outcome of labour and the delivery mode based on the diagnosis of labour from the first examination of 3,130 parturients. A total of 1,847 (59.1%) delivered mothers had the first vaginal examination performed by the senior house officer (SHO). The majority (74.4%) of the mothers presented in established labour (cervical dilatation > or =4 cm), 25.6% in early labour, while 11.3% in latent phase. Patients who presented in established labour had a statistically significant higher spontaneous vertex delivery (SVD) rate (Pearson chi2 = 29.74, p = 0.000). A total of 62 parturients (17.5%) who presented in the latent phase and 204 (29.1%) in early labour had an unfavourable delivery mode; 46 had a caesarean section. There was a significant correlation between delivery mode and prolonged latent phase (Pearson correlation coefficient R = -0.066, p = 0.000). Linear regression analysis showed that the total number of VEs was the most significant predictor of the delivery mode of SVD (Regression beta-coefficient = 0.278, t = 10.37, p = 0.000). Early admissions in labour and a prolonged (abnormal) latent phase are significant predictors of difficult mode of delivery (poor labour outcome). We suggest that the first vaginal examination should be undertaken by the most experienced medical personal present at admission.
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Affiliation(s)
- E P Gharoro
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin City, Nigeria.
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Walsh TC. Exploring the effect of hospital admission on contraction patterns and labour outcomes using women's perceptions of events. Midwifery 2009; 25:242-52. [PMID: 17624645 DOI: 10.1016/j.midw.2007.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Revised: 03/21/2007] [Accepted: 03/31/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE this study investigated the phenomenon of spontaneous labour contractions becoming less frequent on admission to hospital, which is observed anecdotally but is not evident in the literature. Anxiety in response to hospitalisation has been proposed to be responsible by initiating the biochemical response termed 'fight or flight'. DESIGN A non-experimental prospective design and a combination of quantitative and qualitative analysis. Data were collected using self-report labour diaries, postnatal questionnaires and hospital records of labour. Univariate analysis using t-test and chi(2)-test was performed to examine relationships between variables, and content analysis was undertaken on qualitative data regarding reactions to hospitalisation. SETTING hospital and community maternity services provided by a National Health Service hospital in Southern England in 1997. PARTICIPANTS about 87 women at least 37-week gestation, uncomplicated singleton pregnancy anticipating spontaneous labour with a live fetus. MEASUREMENTS AND FINDINGS labour diaries were analysed from 26 births. In three home births and 11 hospital births, labour contractions became more frequent, but in the remaining 12 labours, contractions decreased after admission to hospital. Women whose contractions slowed were not more anxious, but they rarely had cervical dilatation over 5cm and usually assumed a recumbent position in hospital. Artificial rupture of membranes was performed more frequently in these women, they used more pain relief and had a higher incidence of complicated childbirth; however, these differences were not statistically significant. KEY CONCLUSIONS labour contractions can increase or decrease in frequency following admission to hospital, and the change of frequency may be associated with stage of cervical dilatation and posture rather than anxiety. IMPLICATIONS FOR PRACTICE routine intervention to speed up labour on the basis of admission observations is called into question, and women should be made aware that slowing of contractions can occur as a normal part of changing the labour environment. Further research is needed to determine the physiological parameters of spontaneous labour and the role of posture in labour progress is needed.
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Affiliation(s)
- Teresa C Walsh
- School of Nursing and Midwifery, University of Queensland, Ipswich Campus, Qld 4305, Australia.
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Onset of labour: women's experiences and midwives' assessments in relation to first stage duration. Arch Gynecol Obstet 2009; 280:899-905. [PMID: 19283397 DOI: 10.1007/s00404-009-0990-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 02/03/2009] [Indexed: 10/21/2022]
Abstract
AIM The study aimed to assess the time of labour onset and its symptoms as perceived by women in labour and midwives, and the relationship between these and first stage duration. METHODS A longitudinal cohort study of women with a singleton pregnancy in cephalic presentation was performed in 41 maternity units. The sample comprised 1,170 women, 611 nulliparae (np) and 559 multiparae (mp), who answered two standardized questions on the onset of labour and selected the applicable symptoms of labour onset from a list of eight. A multivariate Cox regression model was computed covering further perinatal factors. RESULTS The median durations of the first stage of labour as assessed by the women themselves were 11 (np) and 6.5 h (mp), and as assessed by the midwives 7 (np) and 4 h (mp). Median time intervals between the start of labour onset symptoms as perceived by the women concerned and the midwives' diagnoses varied greatly: the shortest related to watery fluid loss (np = 1.5 h, mp = 0.0 h), the longest to alterations in sleep patterns (np = 11.5 h, mp = 4.5 h). Irregular pain, watery fluid loss and the time between self-diagnosed and professionally diagnosed onset of labour were just as closely associated with the duration of the first stage of labour as perinatal factors. Significant perinatal factors were induction with oxytocin, herbal remedies and PROM. CONCLUSIONS 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.
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Barnett C, Hundley V, Cheyne H, Kane F. ‘Not in labour’: impact of sending women home in the latent phase. ACTA ACUST UNITED AC 2008. [DOI: 10.12968/bjom.2008.16.3.28692] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - H Cheyne
- Nursing Midwifery and Allied Health Professionals Research Unit
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- Nursing Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling
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Gross MM, Hecker H, Matterne A, Guenter HH, Keirse MJNC. Does the way that women experience the onset of labour influence the duration of labour? BJOG 2006; 113:289-94. [PMID: 16487200 DOI: 10.1111/j.1471-0528.2006.00817.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess whether the way in which women experience the onset of their labour influences the duration of their labour. DESIGN Longitudinal study on a convenient sample of women in spontaneous labour with a singleton pregnancy in cephalic presentation at term. SETTING University hospital in Germany. POPULATION/SAMPLE Six hundred and fifty-one women (347 primiparae and 304 parae). METHODS Women recorded how and when labour had started. Responses were subjected to structured content analysis. Two investigators independently subdivided women's reported signs and symptoms into eight predefined categories. These data were related to maternal characteristics and to the course and outcome of labour as documented in the perinatal record. MAIN OUTCOME MEASURES Women's perception of how labour had started, interval between onset of labour and rupture of the membranes and duration of first stage labour and overall duration of labour. RESULTS Only 60% of women reported contractions as a sign of the onset of their labour. These women had a longer interval between the onset of labour and rupture of the membranes but a similar duration of labour when compared with women who did not report contractions as a sign of the onset of labour. Self-reported loss of amniotic fluid was the only sign that showed a consistent relationship with the duration of labour. Other patterns of labour onset had no effect on the duration of labour. CONCLUSION Irrespective of whether they have given birth before, women experience their onset of labour in a variety of ways. A large proportion of these experiences bear no resemblance to the classical diagnosis of labour and most are unrelated to the duration of labour.
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Affiliation(s)
- Mechthild M Gross
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Germany
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Abstract
BACKGROUND No accurate method, clinical or otherwise, currently exists to determine the onset of labor precisely. The objective of this study was to investigate what influences the duration of first stage labor in women with spontaneous labor and childbirth in a nonclinical setting. METHODS From a population-based cohort of 1,448 planned home and birth center births, we selected 932 births for absence of pathology, absence of intervention, and completeness of data. Duration of first stage labor was analyzed with regression analysis for duration data or time-to-event analysis, using a specialized Transition Data Analysis software. The effects of fixed (age, parity, education, antenatal classes, infant birthweight, first cervical assessment) and time-varying factors (start of midwifery care, spontaneous rupture of membranes) in labor were estimated with piecewise-constant exponential hazard models. RESULTS Of the characteristics immutable at the onset of labor, only parity had a strong effect on the duration of first stage labor. Cervical dilatation at first assessment and time-varying factors, such as the timing of spontaneous rupture of membranes and midwifery care, each had a strong influence on labor duration; however, the sequence in which they occurred exerted an even stronger influence. First stage labors were much shorter if the membranes ruptured before rather than after the start of care. CONCLUSION With the exception of parity, events occurring during labor and their timing have a greater influence on the duration of first stage spontaneous labor than elements which are immutable at the onset of labor. Trials of interventions to influence the duration of labor need to consider not only whether the intervention was applied or not, but also when it was applied, if cause-effect relationships are to become properly understood.
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Affiliation(s)
- Mechthild M Gross
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
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