Can an educational web intervention, co-created by service users, affect nulliparous women's experiences of early labour? (A randomised control trial). The Let’s Talk Early Labour (L-TEL) Trial.

Abstract

Background: Women without complications have lower obstetric intervention if they remain at home whilst in early labour. Many women report dissatisfaction in doing this, describing a disparity between their expectations and the reality of this phase. A dichotomy exists between what is clinically of benefit to women (remaining at home) and what women require emotionally, which is support and reassurance. Previous research has been driven by the needs of the maternity service, focusing on the transition between early and active labour, commonly testing interventions that aim to improve clinical outcomes and the timing of admission. To date, no studies have evaluated interventions specifically developed to improve women’s early labour experiences. Intervention: Using self-efficacy theory as an underpinning framework, a web-based intervention was co-created with women who had previously used maternity services. It provides early labour advice, alongside videoed, real experiences of women who have previously had babies. Methodology: The primary aim of this study was to evaluate the impact of this intervention on women’s self-reported experiences of early labour. The intervention was trialled in a pragmatic, randomised control study at an NHS Trust in England between October 2018 and June 2020. A total of 140 low-risk, nulliparous, pregnant women were randomised to the intervention group (n=69) or the control group (n=71). The intervention group received the web-based intervention antenatally to use at their own convenience and the control group received usual care. Data was collected at 7-28 days postnatally using an online version of the pre-validated, self-report Early Labour Experience Questionnaire (ELEQ). Secondary, clinical outcomes were collected from the existing hospital system, as well as information about the acceptability and usability of the intervention. Findings: There were no statistically significant differences in the ELEQ scores between trial arms. The intervention group scored more positively in two of the three ELEQ subscale domains (emotional wellbeing and emotional distress) and less positively in the perceptions of midwifery subscale domain. Participants in the intervention group were less likely to require augmentation during labour. Discussion: The L-TEL Trial demonstrates that women evaluate different aspects of their early labour experience continuum independently where an improved emotional experience does not necessarily equate to an overall improved experience of this phase. Equipping women to have better emotional experiences at home may negatively impact on their perceptions of midwifery care when it is sought. It is recommended that a larger trial evaluating the intervention is undertaken, which will collect more qualitative data to provide a richer understanding of the relationship between the L-TEL intervention, emotional early labour experiences and the perceptions of midwifery care. A larger trial, with the power to detect differences in augmentation rates is also recommended. Impact: The L-TEL Trial is the first study to develop an intervention specifically to improve women’s experiences of early labour. The co-creation process provided a woman-centred approach, when preceding early labour research has been predominantly service-centred. The trial was well timed, responding to a number of research recommendations about online, digital information, early labour expectation management and support interventions for this specific phase. In this, the L-TEL Trial has made a unique and valuable contribution to this research field.