Background
Pregnant women experience early labour as the first phase of labour with different physical and emotional symptoms. Early admission to hospital has been found to be associated with increased intervention and caesarean section rates. However, primiparous women often contact the hospital before labour progresses because they might have difficulties coping with labour pain at home. Previous studies investigating early labour care have not resulted in increased spontaneous birth rates and have not provided evidence regarding the appropriate care during early labour. An evidence-based instrument assessing the physical and emotional state within the early labour process and the wellbeing of woman and thereby, their need for support, is required to inform the decision “Admitted versus not admitted to hospital”. The study aims therefore to develop and validate a tool for the structured advice for primiparous women during early labour.

Methodological approach
The study will last three years and contains the following steps:
• Generation of an item pool with 70-100 items based on a literature research (symptoms of onset of labour, anxiety, self-efficacy) and focus group discussions with women (experiences) as well as determination of formats of measurements.
• Assessment of content and face validity by an expert panel and item reduction to 30-40 items.
• Multicentre data collection in six sites in the Zurich region as well as Central and Northwest Switzerland, with the application of the preliminary instrument and the validation items with a target sample size of approximately n=400 women, and
• Exploratory factor analysis for item reduction, designing the final version of the instrument with 15-20 items and assessing quality criteria of the instrument, satisfaction with the use of the instrument and perinatal outcomes.

Relevance of the project
The development and validation of a tool to assess the physical and emotional state and wellbeing and thereby, the need of support will provide an instrument to advise primiparous women during early labour. It can be applied by midwives and doctors for the initial telephone or face to face contact. The use of the instrument is of great interest because it has the potential to shorten hospital stays, increase spontaneous birth rates and decrease intervention rates and thereby, lower costs. Additionally, this study will make an important contribution to the scientific discussion for optimising early labour care and provide a basis for further research.