Women's recognition of the spontaneous onset of labor

Background: Despite extensive research on the onset of labor, almost no data are available on women's perception of labor onset. We undertook a study to assess how women experience spontaneous onset of term labor. Methods: A semistructured questionnaire was given to 235 women admitted in spontaneous labor at term. Women noted when labor had started, whether and when membranes had ruptured, and answered an open question about how labor had announced itself. Two investigators independently subdivided women's experiences on how labor had started into 369 sampling units corresponding to 8 predefined categories. Results: Nearly two-thirds of the sampling units (63.4%) related to recurrent and nonrecurrent pain, and the ratio between the two types was higher for multiparas than for nulliparas. The number of women and sampling units were identical for each of the following categories: watery fluid (n = 47), blood-stained loss (n = 33), gastrointestinal symptoms (n = 10) and altered sleep patterns (n = 11); 22 sampling units relating to emotional upheaval were mentioned by 16 women. Although 33.6 percent of women experienced rupture of membranes before admission, only 21.6 percent associated it with their onset of labor, either alone (11.5%) or in association with other categories (10.1%). Conclusions: Although women experience onset of labor in a variety of ways, for most it is a concrete event. Studies on duration of labor should take women's perception of onset of labor as a starting point rather than rely on surrogate measures.