Perception of nurses from the maternal-child health services about signs of the beginning of childbirth work




Maternal-Child health services; User embracement; Labor onset; Labor, Obstetric.


Objectives: To identify the signs of labor onset, according to the professionals of the Cegonha network. Methodology: This is a cross-sectional study, with a primary data approach, carried out in units of the Rede Cegonha, from August 2017 to July 2019. The sample consisted of 84 nurses. Data collection was performed using variables of interest to the study. A descriptive statistic was performed, for all statistics the significance level of 5% was adopted. This research was approved under CAAE registration: 87854418.3.0000.5187. Results: regarding the signs of the beginning of labor, the following were mentioned: exit of the mucous plug, contractions that constantly increase its strength and pain that starts in the lumbar region and migrates to the pubis (47.94%, n = 35). Also cited were: uterine contractions with a different pattern from the current recommendations and vaginal losses (52.63%, n = 40); contractions, vaginal losses and dilation (10.52%, n = 8); contractions only (15.76%, n = 12). Conclusions: There is not only one sign or symptom that is definitive for the identification of the beginning of labor, but one must take into account the subjectivity and the multifactorial nature that involves care, recognizing each sign and symptom. It is necessary to improve the preparation for childbirth in order to collaborate for a better assistance.


ACOG (2011). The American College of Obstetricians and Gynecologists. How to tell when labor begins.

ACOG (2017). The American College of Obstetricians and Gynecologists. Approaches to Limit Intervention During Labor and Birth. Washigton: ACOG, nº687, 9 p.

Baptista S R., et al. (2015). Assistência pré-natal: ações essenciais desenvolvidas pelos enfermeiros. Murcia: Enfermeira global,; (40): 112-127.

Bétran, A. P., Ye, J., Moller, A. B., Zhang, J., Gülmezoglu, A. M., & Torloni, M. R. (2016). The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS ONE 11(2): e0148343.

Bor, P., et al. (2016). Continuation versus discontinuation of oxytocin infusion during the active phase of labour: a randomised controlled trial. BJOG; 23:129–135.

Cheyne, H., Dowding, D. W., & Hundley, V. (2006). Making the diagnosis of labour: midwives’ diagnostic judgement and management decisions. Medford: Journal of Advanced Nursing, 53 (6): 625–635.

Dias, M. A. B., et al. (2016). Factors associated with cesarean delivery during labor in primiparous women assisted in the Brazilian Public Health System: data from a National Survey. Reproductive Health, 13, s. 3, (114): 175-185.

Eri,. T. S., et al. (2015). A balancing actin an unknown territory: A meta synthesis of first-time mothers' experiences in early labour. Amsterdam: Midwifery; 31 (3): e58-67.

Friedman, E. (1978). Labour: Clinical Evaluation and Management: Appleton Century Crofts, (2ª ed.,) 450 p.

Green, J. M., &Spybi, H. (2009). Early labor: What’s the problem? Medford: Birth, 34 (9): 332-339.

Gross, M., Burian, R. A., Fromke, K., Hecker, H., et al. (2009). Onset of labor: women’s experiences and midwives’ assessments in relation to first stage duration. Deutsche: Arch Gynecol Obstet, 280: 899–905.

Hanada, N. (2015). Psychosocial and educational interventions in latent phase or early labour for improving birth outcomes (Protocol). Cochrane Database of Systematic Reviews; 2 (CD011516).

Hanley, G. E., et al. (2016). Diagnosing onset of labor: a systematic review of definitions in the research literature. London: BMC Pregnancy and Childbirth, 16 (71): 11p.

Harper, L. M., et al. (2014). Defining an abnormal first stage of labor based on maternal and neonatal outcomes. Philadelphia: Am J Obstet Gynecol, 210 (6): 536.e1–536.e7.

Henderson, J., & Redshaw, M. (2017). Sociodemographic differences in women’s experience of early labour care: a mixed methods study.: BMJ Open, 7 (e016351): 12p.

Hoh, J. K., et al. (2012). Estimating time to full uterine cervical dilation using genetic algorithm. Taiwan: Kaohsiung Journal of Medical Sciences, 28:423-428.

How, H. Y., Khoury, J. C., & Sibai, B. H. (2009). Cervical Dilatation on Presentation for Preterm Labor and Subsequent Preterm Birth. New York: Am J Perinatol, 2009; 26:1–6.

Isma, N., et al. (2010). The effect of low molecular weight heparin (dalteparin) on duration and initiation of labour. Netherlands: J Thromb Thrombolysis, 30 (2):149–153.

Kobayashi, S., et al. (2017). Assessment and support during early labour for improving birth outcomes. Cochrane Database of Systematic Reviews; 4(CD011516): 62 p.

Lauzon, L., & Hodnett, E. D. (2009). Labour assessment programs to delay admission to labour wards. Ontario: Cochrane Database of Systematic Reviews, 2009; 3 (CD000936).

Lauzon, L., & Hodnett, E. D. (2013). Antenatal education for self-diagnosis of the onset of active labour at term. Ontario: Cochrane Database of Systematic Reviews, 4 (CD000935).

Lee, S. E., et al. (2008) Amniotic fluid prostaglandin concentrations increase before the onset of spontaneous labor at term. United Kingdom: The Journal of Maternal-Fetal and Neonatal Medicine, 21 (2): 89–94.

Mahalingam, G., & Venkateasan, M (2014). Mother’s knowledge of warning signs of pregnancy, labour and puerperium.: Int J Med Sci Public Health; 3: 720-722.

Marowitz, A. (2014). Caring for Women in Early Labor: Can We Delay Admission and Meet Women’s Needs? : Journal of Midwifery &Women’s Health; 59 (6): 645-650.

Meirowitz, N., et al. (2014). Implementing an Obstetric Triage Acuity Tool in a High-Volume Obstetric Unit. Washington: Obstetrics & gynecology.

Milfont, P. M. S., et. al.(2011). Exploratory study on the implementation of guidelines for a safe delivery and satisfaction of women. Niterói, RJ: Online Brazilian Journal of Nursing; 10 (3): 9p.

Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Ações Programáticas Estratégicas (2013). Avaliação da atenção ao pré-natal, ao parto e aos menores de um ano na Amazônia Legal e no Nordeste, Brasil, 2010. Brasília: Ministério da Saúde; 1: 32-43.

Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Ações Programáticas Estratégicas (2013). Atenção ao pré-natal de baixo risco. Brasília: Ministério da Saúde; (1ª ed.) rev.: 46-49; 146-148.

Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de ações programáticas e estratégicas (2014). Caderneta da Gestante [Internet]. Brasília: Ministério da Saúde. 31 p.

Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Ações Programáticas Estratégicas (2016). Protocolos da Atenção Básica: Saúde das Mulheres: Ministério da Saúde; 230 p.

Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de ações programáticas e estratégicas (2012). Caderneta da Gestante [Internet]: Ministério da Saúde; 31 p.

Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Ações Programáticas Estratégicas (2017). Manual de Acolhimento e Classificação de Risco em Obstetrícia. Brasília: Ministério da Saúde; p.: 6-10; 14-17; 23; 28; 29 p.

Morse, N. L., et al. (2011). Mortalidade materna no Brasil: o que mostra a produção científica nos últimos 30 anos? Rio de Janeiro: Cad. Saúde Pública. 27 (4): 623-638.

Neal, J. L., et al. (2016). Pilot Study of Physiologic Partograph Use Among Low-Risk, Nulliparous Women With Spontaneous Labor Onset. Medford: J Midwifery Womens Health; 61:235–241.

Oliveira, K. K. D., et al. (2012). Conception of Nulliparous on Labor Obstetric and Delivery.Rio de Janeiro:R. pesq.: cuid. fundam. online, 4(3): 2627-35.

Østborg, T. B., Ronundstad, P.R., & Eggebø, T. M. (2017). Duration of the active phase of labor in spontaneous and induced labors. Copenhagen: Acta Obstet Gynecol Scand; 96(1): 120-127.

Paisley, K. S., Wallace, R., & Durant, P. G. (2011). The Development of an Obstetric Triage Acuity Toolv. Bankock: MCN; 35 (15): 290-296.

Pates, J. A., Mcintire, D. D., & Leveno, K. J. (2007). Uterine Contractions Preceding Labor.New York: Obstetrics & Gynecology; 110 (3): 566-569.

Polit, C. T., & Beck, C. T. (2011) Fundamentos de pesquisa em enfermagem: Avaliação de evidências para a prática da enfermagem: Editora Artmed, (7): 263-287.

Shub, A., et al. (2012). Do primigravidae and their carers have a realistic expectation of uncomplicated labour and delivery? A survey of primigravidae in late pregnancy, obstetric staff and medical students. Australian and New Zealand Journal of Obstetrics and Gynaecology; 52: 73–77.

Trae, K., et al. (2007). Follistatin serum concentrations during full-term labour in women – significant differences between spontaneous and induced labour. Cambridge: Reproduction; 134: 705–711.

Victora, C. G., et al. (2011). Saúde de mães e crianças no Brasil: progressos e desafios. The Lancet; 32-46.

Ye, Y. (2015). Effects of Patient-Controlled Epidural Analgesia on Uterine Electromyography During Spontaneous Onset of Labor in Term Nulliparous Women. Thousand Oaks: Reproductive Sciences; 22 (11): 1350-1357.

Zhao, Y., Zhang, J., Zamora, J., et al. (2017). Increases in caesarean delivery rates and change of perinatal outcomes in low- and middle-income countries: a hospital-level analysis of two WHO surveys. Paediatr Perinat Epidemiol; 31: 251–62.



How to Cite

COSTA, I. F. A. F. da .; SOUSA, F. S. de .; FERREIRA, A. G. N. .; OLIVEIRA, F. A. de .; SOUZA, A. R. S. .; GUEDES, T. G. .; FRANÇA, I. S. X. de .; BAPTISTA, R. S. . Perception of nurses from the maternal-child health services about signs of the beginning of childbirth work. Research, Society and Development, [S. l.], v. 10, n. 5, p. e14310514058, 2021. DOI: 10.33448/rsd-v10i5.14058. Disponível em: Acesso em: 2 feb. 2023.



Health Sciences