Prolonged latent phase of labour : Prevalence, labour outcomes, quality of care, women’s experiences and preferences, and psychometric properties of a questionnaire

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.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