Objective: To investigate primiparous women's preferences for care during a prolonged latent phase of labour.

Methods: A qualitative study based on focus groups and individual interviews and analysed with inductive content analysis.

Results: Sixteen primiparous women with a prolonged latent phase of labour >18 hours were interviewed in five focus groups (n = 11) or individually (n = 5). One main category emerged “Beyond normality – a need of individual adapted guidance in order to understand and manage an extended latent phase of labour” which covers the women's preferences during the prolonged latent phase. Five categories were generated from the data: “A welcoming manner and not being rejected”, “Individually adapted care”, “Important information which prepares for reality and coping”, “Participation and need for feedback” and “Staying nearby the labour ward or being admitted for midwifery support”. Women with a prolonged latent phase of labour sought to use their own resources, but their needs for professional support increased as time passed. A welcoming attitude from an available midwife during the latent phase created a feeling of security, and personally adapted care was perceived positively.

Conclusions: Women with a prolonged latent phase of labour preferred woman-centred care. Midwives play an important role in supporting these women. Women's need for midwifery-support increases as the time spent in latent phase increases.

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.

Aim: To describe primiparous and multiparous women's labour experiences and their perception of quality of intrapartum care, in relation to background characteristics and length of latent phase of labour prior to admittance to labour ward.

Design: A cross-sectional study.

Setting: A middle-sized hospital in a rural county in western part of Sweden.

Participants: Primiparous and multiparous women, both low-risk and risk, with a spontaneous onset of labour after gestational week 37+0 were included. In total, n =1193 women were invited, and n = 757 responded the questionnaire, n = 342 primiparous and n = 415 multiparous women.

Methods: The Intrapartal-specific Quality from Patient Perspective (QPP-I), with responses on perceived reality and subjective importance, was used for data collection. QPP-I covers ten factors of quality of care. Background characteristics, length of latent phase of labour, global items about labour experience and items regarding feelings during labour and birth were included. Data were analysed with descriptive and analytic statistics.

Findings: All factors in QPP-I were rated higher for subjective importance than perceived reality, except for information about selfcare, for both primi- and multiparous women. Labour experience, perceived reality of quality of care, and feelings were related to length of the latent phase of labour. Primiparous women with a prolonged latent phase (>18 h) had significantly lower scores regarding six out of ten QPP-I factors (PR); Information procedures, Information self-care, Commitment (midwives), Commitment (enrolled nurses), Midwives present, and Partner/ significant others. They scored lower on Experience birth as normal and Safe during labour and birth. The felt less proud and felt more ignored by professionals. Multiparous women with a prolonged latent phase of labour scored significantly lower on one QPP-I factor, Commitment (midwives). They also scored lower on Control over the situation and felt less safe during labour and birth.

Key Conclusion: Women's perception of quality of intrapartum care, the birth experience and feelings are related to length of the latent phase of labour. Women perceive quality of intrapartum care as being lower than its subjective importance.

Implications for Practice: A prolonged latent phase of labour can be regarded as a risk factor for a more negative birthing experience. 

Objective: (a) to psychometrically test the Early Labour Experience Questionnaire (ELEQ) among both primi- and multiparous women giving birth in a Swedish setting, and (b) to describe and compare their experiences during early labour in relation to background characteristics.

Design: a cross-sectional study.

Setting: a county in Sweden.

Participants: primi- and multiparous women with a spontaneous onset of labour after gestational week 37 + 0. In total, n = 1193 women were invited, and n = 754 responded the questionnaire, with a final total of n = 344 primi and n = 410 multiparous women.

Methods: the ELEQ was translated with cross-cultural adaptation. The validity was determined using exploratory factor analysis with principal axis factoring analyses. Reliability was estimated from the internal consistency using Cronbach's alpha. The relationship between the questionnaire and the demographic characteristics of the participating women were analysed using ANOVA and t-test.

Findings: an explorative factor analysis showed a three-factor solution for primiparas women (SWE-ELEQ-PP) consist of 23 items and a stable factor structure that explained 49.2% of the total variance with sufficient reliability coefficients (0.81–0.86). A four-factor solution for multiparous women (SWE-ELEQ-MP) consist of 22 items, with 52.62% of the total variance explained and with adequate internal consistency reliability coefficients (0.77–0.86) for three factors and relatively low stability (0.62) for the fourth factor with two items. Primiparous women scored significantly higher on items about feeling confused, and significantly lower on some items measuring emotional wellbeing and perceptions of midwifery care compared to multiparous women. Primiparous women with longer early labour (>18 h), scored significantly lower on the perceptions of midwifery care. Primi- and multiparous women who were dissatisfied with their telephone conversation or with not being admitted during early labour, scored significantly lower on emotional wellbeing, higher regarding emotional distress, and significantly lower about perceptions of midwifery care.

Key conclusions: the SWE-ELEQ-PP and SWE-ELEQ-MP are considered valid questionnaires for use in a Swedish setting. Differences exist between parity and the factor structure and experiences in early labour vary. Women less content with early labour management decisions rated perceived midwifery care lower regardless of parity.

Implication for practice: the questionnaire can be used to evaluate early labour care in a Swedish setting. The result suggests that differences according to parity exist and should be addressed when managing early labour care and a more individualised approach requires considerations.