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Roundtable Discussion: Early Labor: What's the Problem?

Authors

  • Patricia Janssen MPH, BSN, PhD,

    Corresponding author
    1. Patricia Janssen, MPH, BSN, PhD, is Assistant Professor at the University of British Columbia, Department of Health Care and Epidemiology, Canada.
      Patricia Janssen, The University of British Columbia, Department of Health Care and Epidemiology, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3.
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  • Mary L. Nolan BA (Hons), MA, PhD,

    Corresponding author
    1. Mary L. Nolan, BA (Hons), MA, PhD, is Professor of Perinatal Education in the Department of Allied Health Science at the University of Worcester, United Kingdom, and an antenatal teacher and tutor with the National Childbirth Trust.
      Professor Mary Nolan, Institute of Health and Society, University of Worcester, Henwick Grove, Worcester WR2 6AJ, United Kingdom.
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  • Helen Spiby RM, MPhil,

    Corresponding author
    1. Helen Spiby, RM, MPhil, is Senior Lecturer (Evidence-based Practice in Midwifery) at the Mother and Infant Research Unit, University of York, United Kingdom.
      Helen Spiby, Mother and Infant Research Unit, Department of Health Sciences, Area 4, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, United Kingdom.
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  • Josephine Green BA, PhD,

    1. Josephine Green, BA, PhD, is Professor of Psychosocial Reproductive Health and Deputy Director of the Mother and Infant Research Unit, University of York, United Kingdom.
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  • Mechthild M. Gross RM, RN, PhD,

    Corresponding author
    1. Mechthild M. Gross, RM, RN, PhD, is Senior Research Fellow and Head of Midwifery Unit at the Department of Obstetrics, Gynaecology & Reproductive Medicine at the Hannover Medical School, Germany.
      Dr. Mechthild M. Gross, Department of Obstetrics, Gynaecology & Reproductive Medicine, Medical School Hannover, Carl-Neuberg-Str. 1, D - 30625 Hannover, Germany.
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  • Helen Cheyne RM, PhD,

    Corresponding author
    1. Helen Cheyne, RM, PhD, is Reader and Research Programme Director at the Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, United Kingdom.
      Dr. Helen Cheyne, NMAHP Research Unit, University of Stirling, Stirling FK9 4LA, Scotland.
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  • Vanora Hundley RM, PhD,

    1. Vanora Hundley, RM, PhD, is Honorary Senior Lecturer at the Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, United Kingdom.
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  • Marlies Rijnders RM,

    Corresponding author
    1. Marlies Rijnders, RM, is a research midwife at TNO Quality of Life, Leiden, The Netherlands.
      Marlies Rijnders, TNO Quality of Life, P.O. Box 2215, 2301 CE Leiden, The Netherlands.
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  • Ank De Jonge RM, MSc, PhD,

    1. Ank de Jonge, RM, MSc, PhD, is a midwife researcher at EMGO Institute for Health and Care, VU University Medical Center, The Netherlands.
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  • Simone Buitendijk MD, MPH, PhD

    1. Simone Buitendijk, MD, MPH, PhD, is a perinatal epidemiologist at TNO Quality of Life and Professor of Midwifery Studies at the Academic Medical Center of the University of Amsterdam (AMC), The Netherlands.
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Patricia Janssen, The University of British Columbia, Department of Health Care and Epidemiology, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3.

Professor Mary Nolan, Institute of Health and Society, University of Worcester, Henwick Grove, Worcester WR2 6AJ, United Kingdom.

Helen Spiby, Mother and Infant Research Unit, Department of Health Sciences, Area 4, Seebohm Rowntree Building, University of York, Heslington, York YO10 5DD, United Kingdom.

Dr. Mechthild M. Gross, Department of Obstetrics, Gynaecology & Reproductive Medicine, Medical School Hannover, Carl-Neuberg-Str. 1, D - 30625 Hannover, Germany.

Dr. Helen Cheyne, NMAHP Research Unit, University of Stirling, Stirling FK9 4LA, Scotland.

Marlies Rijnders, TNO Quality of Life, P.O. Box 2215, 2301 CE Leiden, The Netherlands.

PREFACE:

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.

The Roundtable Discussion project and the Preface were prepared by Josephine M. Green and Helen Spiby.

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