title: A balancing act in an unknown territory: a metasynthesis of first-time mothers' experiences in early labour.
abstract: OBJECTIVE
  to integrate findings of individual studies in order to broaden the understanding of first-time mothers' experiences of early labour.
  
  
  METHODS
  the methodology was metasynthesis which is based on the interpretive meta-ethnography described by Noblit and Hare (1988). Metasynthesis is research on research which synthesises the findings of previous qualitative studies, and the focus is on interpretation and the creation of new knowledge.
  
  
  METHODS
  all included studies originated from high resource countries (USA 2, UK 4, and Scandinavia 5) and all were carried out in a context of hospital based maternity care.
  
  
  METHODS
  a total of 231 women participated in the studies.
  
  
  RESULTS
  11 articles were included. The main results are presented with the metaphor a balancing act in an unknown territory. The 'unknown territory' has a double meaning: as the personal experience of going into labour for the first time and as encountering the maternity care system. On both levels women have to make significant decisions: whether labour really has started and subsequently when to go to the hospital. A key challenge is to balance the arrival on the labour ward at the 'right' time, not too early and not too late. Arriving at the 'right' time leads to a positive path, while arriving 'too soon' might lead to a cascade of negative experiences. The results are further presented with five central themes: 'Finding out if labour has started is absorbing'; 'Dealing with labour at home'; 'Trying to arrive at the labour ward at the right time'; 'There is always a risk of being sent home'; 'Encountering health professionals arouses strong emotions'.
  
  
  CONCLUSIONS
  the metasynthesis broadens the understanding of first-time mothers' experiences of early labour, and suggests that women's needs when planning a hospital birth are not being adequately met at this stage in the labour process. Three areas of future research are suggested: how to support and strengthen women during pregnancy in order to cope with early labour; women's experiences of early labour when planning a birth in contexts other than hospital; and to continue to investigate new ways of giving care during early labour.
authors.affiliation: Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, P.O. Box 4 St. Olavs Plass, 0130 Oslo, Norway. Electronic address: tine.eri@hioa.no.
authors.forename: Tine S
authors.initials: TS
authors.lastname: Eri
authors.affiliation: University of Nordland, Faculty of Professional Studies, 8049 Bodö, Norway.
authors.forename: Terese
authors.initials: T
authors.lastname: Bondas
authors.affiliation: Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology & Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
authors.forename: Mechthild M
authors.initials: MM
authors.lastname: Gross
authors.affiliation: University of British Columbia School of Population and Public Health and Child and Family Research Institute, 2206 East Mall, Vancouver, BC, Canada V6T-1Z3.
authors.forename: Patricia
authors.initials: P
authors.lastname: Janssen
authors.affiliation: University of York, Department of Health Sciences, York YO10 5DD, England, UK.
authors.forename: Josephine M
authors.initials: JM
authors.lastname: Green
mesh_terms: D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007747:Labor Stage, First / Q000523:psychology*; D008016:Life Change Events; D008880:Midwifery / Q000379:methods*; D009035:Mothers / Q000523:psychology*; D009723:Nurse-Patient Relations; D010298:Parity; D011247:Pregnancy; D036301:Qualitative Research
keywords: Early labour; First-time mothers; Metasynthesis; Midwives; Women׳s experiences