A study of labour
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The partograph, developed over 50 years ago and based on research conducted by Friedman (1954, 1955 & 1956), has been promoted by the World Health Organisation as the “gold” standard for assessing progress in labour. The basic premise of the partograph is that regular vaginal examinations throughout labour that calculate the extent and rate of cervical dilation will be the most reliable indicator of labour progress. A review of the medical and midwifery literature suggested that the progress of labour can also be assessed by observing women’s behavioural responses to labour. This study set out to describe and test the reliability and consistency of these behavioural cues. These cues were derived from published literature and used to construct a “Labour Assessment Tool” (LAT). The LAT was tested and modified using an expert reference group and results of a pilot test. Inter-rater reliability was established during the pilot study and verified with other experienced midwives as data collectors. The LAT recorded partograph observations as well as labour behaviours. The study was undertaken in two Australian hospitals between 1999 and 2002. Women were given information on the study during regular antenatal visits to the hospitals from 30 weeks gestation and invited to participate during one of their antenatal visits between 37 weeks and 42 weeks of pregnancy. There were 21 women of the 225 women approached who declined to participate. The LAT observations were recorded on 203 participants however only 179 participants (94 nulliparous and 85 multiparous women) who generated 47,768 individual observations were suitable for analysis. There were 59 participants (31 nulliparous and 28 multiparous women) who were induced into labour or had their labours augmented. Women excluded from the study included those with complications of pregnancy and labour. Women were also withdrawn from the study at the time an epidural was commenced but their data to that point were retained for analysis. The data were examined from three perspectives. The first was from a ‘phases of labour’ perspective based on the work of Friedman (1954; 1955). Data obtained at the time the women had an internal cervical assessment were allocated to early labour, active labour, transition or full dilation, based on the results of the cervical measurements. The second perspective examined all the descriptors over the course of labour from admission to hospital or the beginning of an induction of labour, to second stage of labour. Frequencies were again generated for each behaviour from admission to hospital until full dilation. They were compared to the mean dilation generated for both parity groups based on the 279 cervical examinations that were performed on the participants. The third perspective examined behavioural patterns observed within each woman’s labour unrelated to the time to full dilation or Friedman’s phases of labour model. Results indicate that specific behavioural descriptors associated with progress were observed before cervical dilation increased. Descriptors indicating cervical dilation was occurring, or had occurred, and descriptors indicating impending second stage as well as second stage itself, were identified. Differences were observed between the labours of multiparous and nulliparous women and induced labours and non induced labours.
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