CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Prolonged latent phase of labour: Prevalence, labour outcomes, quality of care, women’s experiences and preferences, and psychometric properties of a questionnaire
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).ORCID iD: 0000-0001-7729-7912
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to investigate the prevalence and labour outcome of a prolonged latent phase of labour, quality of care, women’s experiences and preferences during labour, and to psychometrically test a questionnaire.

Methods: Qualitative and quantitative methods. Sixteen primiparous women’s preferences for care during a prolonged latent phase of labour were studied with focus-group and individual interviews and analysed with content analysis (I). From a one-year cohort of 2660 women, 1554 women with a spontaneous onset of labour were invited to participate and 1389 women accepted invitation (II-IV). Data from 1343 women’s birth records were analysed with descriptive and analytic statistics (II). 758 women, (RR 64%), 343 primiparous and 415 multiparous, responded to the Intrapartal-specific Quality from Patients Perspective Questionnaire, QPP-I (III), the Early Labour Experience Questionnaire, ELEQ (IV) and additionally birth-related items. Data were analysed with descriptive, analytic, and psychometric statistics.

Main findings: According to women’s self-reports, 23% of women with a spontaneous onset of labour had a prolonged latent phase (>18 hours), which was associated with more obstetrical interventions and instrumental births (II). These women preferred individualised care (I), rated the quality of their intrapartum care lower, were less content with the birth experience, and had more negative feelings during labour and birth than women with a shorter latent phase (III). The ELEQ was translated and adapted to Swedish and resulted in two questionnaires, one for primiparous women, SWE-ELEQ-PP, and one for multiparous women, SWE-ELEQ-MP. Both are valid and reliable and can be used to evaluate early labour care in Sweden (IV).

Conclusions: A prolonged latent phase of labour can be regarded as a risk factor. It can result in more obstetrical interventions, more instrumental births, a lower perceived quality of care, and a more negative birth experience regardless of parity. Differences in parity must be considered when evaluating early labour care during the latent phase of labour, with special focus to primiparous women.

Abstract [en]

Women’s preferences are not always adequately met during the latent phase of labour. Further exploration is needed to investigate the experiences, preferences, and labour outcome of women with a prolonged latent phase. The overall aim of this thesis was to investigate the prevalence and labour outcomes of a prolonged latent phase, quality of care, women’s experiences and preferences during labour, and to psychometrically test a questionnaire. The prevalence of a prolonged latent phase of labour was 23% of women with a spontaneous onset of labour and was associated with more obstetrical interventions and instrumental births. These women preferred individualised care, rated the quality of their intrapartum care lower, were less content with the birth experience, and had more negative feelings during labour and birth than women with a shorter latent phase. A questionnaire about experiences during early labour was adapted and can be used to evaluate early labour care in Sweden for both primiparous and multiparous women. A prolonged latent phase of labour can be regarded as a risk factor, and differences in parity must be considered when evaluating early labour care. Special focus should be on primiparous women, and a women-centred perspective is required for management during the latent phase of labour, regardless of parity.

Place, publisher, year, edition, pages
Karlstads universitet, 2018. , p. 76
Series
Karlstad University Studies, ISSN 1403-8099 ; 2018:49
Keywords [en]
birth experience, prolonged latent phase of labour, quality of care, psychometric evaluation
National Category
Health Sciences
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:kau:diva-69804ISBN: 978-91-7063-889-3 (print)ISBN: 978-91-7063-984-5 (electronic)OAI: oai:DiVA.org:kau-69804DiVA, id: diva2:1257992
Public defence
2018-12-07, Lagerlöfsalen, 1A 305, Karlstads universitet, Karlstad, 13:00 (Swedish)
Opponent
Supervisors
Funder
Landstinget i VärmlandAvailable from: 2018-11-13 Created: 2018-10-23 Last updated: 2018-11-13Bibliographically approved
List of papers
1. Primiparous women's preferences for care during a prolonged latent phase of labour
Open this publication in new window or tab >>Primiparous women's preferences for care during a prolonged latent phase of labour
2015 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, no 3, p. 145-150Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
prolonged latent phase, primpara, preference, content analysis
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-35740 (URN)10.1016/j.srhc.2015.02.003 (DOI)000361580000006 ()26842637 (PubMedID)
Available from: 2015-04-01 Created: 2015-04-01 Last updated: 2018-10-23Bibliographically approved
2. Prevalence of Prolonged Latent Phase and Labor Outcome: Review of Birth Records in a Swedish Population
Open this publication in new window or tab >>Prevalence of Prolonged Latent Phase and Labor Outcome: Review of Birth Records in a Swedish Population
2018 (English)In: Journal of midwifery & women's health, ISSN 1526-9523, E-ISSN 1542-2011, Vol. 63, no 1, p. 33-44, article id JMWH12704Article in journal (Refereed) Published
Abstract [en]

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.

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).

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.

Place, publisher, year, edition, pages
Hoboken: John Wiley & Sons, 2018
Keywords
intrapartum care, labor, first stage, obstetric complications, quantitative research
National Category
Nursing Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology Clinical Science Obstetrics, Gynecology and Reproductive Medicine
Research subject
Nursing Science; Public Health Science
Identifiers
urn:nbn:se:kau:diva-64681 (URN)10.1111/jmwh.12704 (DOI)000424649100005 ()29419927 (PubMedID)
Available from: 2017-10-13 Created: 2017-10-13 Last updated: 2018-10-23Bibliographically approved
3. Manuskript: Women’s labour experiences and quality of care in relation to prolonged latent phase of labour and early labour contact with the labour ward
Open this publication in new window or tab >>Manuskript: Women’s labour experiences and quality of care in relation to prolonged latent phase of labour and early labour contact with the labour ward
(English)Manuscript (preprint) (Other academic)
National Category
Health Sciences
Identifiers
urn:nbn:se:kau:diva-69839 (URN)
Available from: 2018-10-23 Created: 2018-10-23 Last updated: 2018-10-23
4. Early labour experience questionnaire: Psychometric testing and women's experiences in a Swedish setting
Open this publication in new window or tab >>Early labour experience questionnaire: Psychometric testing and women's experiences in a Swedish setting
2018 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 64, p. 77-84Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Churchill Livingstone, 2018
Keywords
Early Labour, Early Labour Experience, Factor analysis, Psychometric test, Questionnaire
National Category
Nursing
Identifiers
urn:nbn:se:kau:diva-69018 (URN)10.1016/j.midw.2018.06.008 (DOI)29966880 (PubMedID)2-s2.0-85049358036 (Scopus ID)
Available from: 2018-09-05 Created: 2018-09-05 Last updated: 2018-10-23Bibliographically approved

Open Access in DiVA

fulltext(981 kB)36 downloads
File information
File name FULLTEXT02.pdfFile size 981 kBChecksum SHA-512
fa83eb1e20938d630cc8f978ec34f4ba2b8aff96f7acdb54fadcbe473872c35641e692ce032f5fbfe34752a4184dce6ce58a260b21524fd0392dad0b9471d97b
Type fulltextMimetype application/pdf

Authority records BETA

Ängeby, Karin

Search in DiVA

By author/editor
Ängeby, Karin
By organisation
Department of Health Sciences (from 2013)
Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 36 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 454 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf