Supporting women in early labor is important for safe maternity care

by Vanora Hundley, Helen Cheyne, The Conversation

edited by Lisa Lock, reviewed by Andrew Zinin

Lisa Lock

Scientific Editor

Meet our editorial team
Behind our editorial process

Andrew Zinin

Chief Editor

Meet our editorial team
Behind our editorial process Editors' notes

This article has been reviewed according to Science X's editorial process and policies. Editors have highlighted the following attributes while ensuring the content's credibility:

fact-checked

trusted source

written by researcher(s)

proofread

The GIST Add as preferred source

The Nottingham University Hospitals NHS Trust report has identified serious failings in care at one of England's largest maternity services, with lessons for maternity units nationally. Among its findings was a repeated problem at the very start of labor: Women and families struggled to access timely assessment and felt dismissed during telephone triage.

In several cases, women were discouraged from attending the hospital when they believed labor had started, only to arrive later in established or advanced labor. In some cases, poor care during this period had serious consequences.

Across hospital-based maternity services, attention and resources tend to focus on women in more advanced labor and those requiring induction of labor or cesarean section. This can mean services miss the chance to identify problems, offer reassurance and build trust at the very start of labor.

Listening to women and providing supportive care at the start of labor sets a woman up for a positive birth experience. Instead, research consistently shows that women report feeling unsupported and discouraged from coming to the hospital in early labor.

Right at the start of labor, there is often a mismatch between the needs and expectations of women and the expectations and priorities of maternity services. Many women have long been told that the hospital is the safest place to give birth. It is therefore unsurprising that they expect to be welcomed to the maternity unit where they are booked to give birth when labor starts.

The drivers of decision-making on the maternity services side are more complex. They include beliefs about early labor care, national guidance, unsuitable environments and workforce pressures.

Early labor

There is a widespread belief in many maternity systems that while women should give birth in the hospital, they should not be admitted until they are in established labor.

This can result in midwives gatekeeping: discouraging or refusing admission in early labor. Women report receiving inconsistent advice, feeling unwelcome and dismissed, and having to negotiate permission for admission.

This belief is influenced by international, national and local guidance. NICE guidance states that if a woman seeks advice or attends a midwifery-led unit or obstetric unit with painful contractions but is not in established labor, she should be encouraged "to remain at or return home," unless doing so could mean she gives birth without a midwife present or becomes distressed.

The same guidance also says early labor assessment should include listening to the woman's story, asking about her wishes, expectations and concerns, asking about the baby's movements, offering support and agreeing on a plan of care. The problem arises when "return home" becomes the default response, rather than the outcome of careful assessment and discussion.

A practical problem is that many maternity units are not designed or staffed to provide sustained early labor care. Historically, women in early labor were more likely to have access to antenatal ward beds or early labor areas, where they could receive midwifery support outside the labor ward.

As maternity care has shifted toward shorter stays, outpatient monitoring and day-case assessment, many services now have fewer options for supporting women before established labor.

The number of maternity beds in England fell by around 52% between 1987–88 and 2019–20, mainly because women spend less time in the hospital before and after birth. Antenatal beds were removed or repurposed to streamline maternity processes, but this also reduced care options.

The result is that many maternity units now lack a suitable environment to care for women in early labor. When there is nowhere appropriate for women to be supported, they are more likely to be encouraged to go home.

Workforce pressures

At the same time, workload and the complexity of women's care needs have increased. There has been a rise in cesarean birth rates in England, with NHS maternity statistics showing that 45% of deliveries in NHS hospitals in England in 2024–25 were by cesarean section.

Induction of labor has also become more common. These changes increase care requirements for women and babies, particularly on labor wards. Staffing models have often struggled to keep pace with workload and the need for safe, personalized care.

Organizational demands exert significant pressure on midwives to keep women out of the hospital and to make decisions based on bed availability and staffing rather than on the care needs of mother and baby.

Midwives have described not admitting women in early labor because of staff and bed shortages. Some have even described hiding women on labor wards because they knew they needed care, while trying to avoid disapproval from senior staff.

The result is a service that can fail to support women at a time when they and their birth partners feel most vulnerable. It is time for a rethink.

Early labor care must be organized around women's needs and safety, rather than institutional pressures alone. That means properly staffed assessment, clear return plans, dedicated early labor spaces where possible, and workforce models that include time for assessment, reassurance and support.

Research from Denmark, Sweden and Switzerland suggests that early labor care works best when it is accessible, individualized and organized around women's needs rather than simply her stage of labor. In the Danish study, women had access to a dedicated early labor unit, and staff received training to emphasize the importance of early labor care. The wider findings highlighted the value of clear plans, emotional support, continuity and flexible care. This change was brought about in one of Denmark's busiest units (6,500 births) and is a lesson in how UK maternity units could work with women to improve care.

The Nottingham report shows what can happen when women's concerns are minimized at the very start of labor. Getting that first contact right will not solve every problem in maternity care, but it is a practical place to begin.

Women need to know that if they call because they are worried, in pain or unsure, someone will listen properly. Early labor may be the beginning of birth, but it should never be the point at which care is weakest.

Key medical concepts

Cesarean DeliveryLabor, Induced

Clinical categories

Obstetrics & gynecologyPregnancyWomen's health Provided by The Conversation Who's behind this story?

Lisa Lock

BA art history, MA material culture. Former museum editor, paramedic, and transplant coordinator. Editing for Science X since 2021. Full profile →

Andrew Zinin

Master's in physics with research experience. Long-time science news enthusiast. Plays key role in Science X's editorial success. Full profile →

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Citation: Supporting women in early labor is important for safe maternity care (2026, June 29) retrieved 29 June 2026 from https://medicalxpress.com/news/2026-06-women-early-labor-important-safe.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.