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Women's labour experiences and quality of care in relation to a prolonged latent phase of labour
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).ORCID iD: 0000-0001-7729-7912
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).ORCID iD: 0000-0003-1382-4386
Karlstad University, Faculty of Health, Science and Technology (starting 2013).ORCID iD: 0000-0002-2667-4025
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).ORCID iD: 0000-0001-7082-6834
2019 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, p. 155-164Article in journal (Other academic) Published
Abstract [en]

im: 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. 

Place, publisher, year, edition, pages
Elsevier, 2019. p. 155-164
Keywords [en]
Prolonged latent phase of labour; Quality of care; Birth experience; Early labour
National Category
Health Sciences Obstetrics, Gynecology and Reproductive Medicine
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:kau:diva-69839DOI: 10.1016/j.midw.2019.07.006ISI: 000478779100021PubMedID: 31369936OAI: oai:DiVA.org:kau-69839DiVA, id: diva2:1257927
Note

I avhandlingen med titeln: Women’s labour experiences and quality of care in relation to prolonged latent phase of labour and early labour contact with the labour ward

Available from: 2018-10-23 Created: 2018-10-23 Last updated: 2019-08-15Bibliographically approved
In thesis
1. Prolonged latent phase of labour: Prevalence, labour outcomes, quality of care, women’s experiences and preferences, and psychometric properties of a questionnaire
Open this publication in new window or tab >>Prolonged latent phase of labour: Prevalence, labour outcomes, quality of care, women’s experiences and preferences, and psychometric properties of a questionnaire
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
birth experience, prolonged latent phase of labour, quality of care, psychometric evaluation
National Category
Health Sciences
Research subject
Nursing Science
Identifiers
urn:nbn:se:kau:diva-69804 (URN)978-91-7063-889-3 (ISBN)978-91-7063-984-5 (ISBN)
Public defence
2018-12-07, Lagerlöfsalen, 1A 305, Karlstads universitet, Karlstad, 13:00 (Swedish)
Opponent
Supervisors
Funder
Landstinget i Värmland
Available from: 2018-11-13 Created: 2018-10-23 Last updated: 2018-11-13Bibliographically approved

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Ängeby, KarinSandin-Bojö, Ann-KristinPersenius Wentzel, MonaWilde-Larsson, Bodil

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