title: First stage of labour management practices: A survey of Australian obstetric providers.
abstract: OBJECTIVE
  To report on the opinions and reported practices of Australian obstetricians and general practice (GP) obstetricians, in the definition and management of spontaneous first stage of labour, in low-risk nulliparous women.
  
  
  METHODS
  Cross-sectional survey sent electronically to all Australian Specialist obstetricians (FRANZCOG) and Diplomates. Respondents answered questions regarding care of nulliparous women in spontaneous labour at term across three domains: (i) practitioners' characteristics; (ii) current practice; (iii) opinion regarding joint statement by ACOG/SMFM (Society of Maternal Fetal Medicine) 'Safe prevention of primary caesarean section'.
  
  
  RESULTS
  The dataset included responses from 664 participants, representing 29% of Specialists and 11% of Diplomates. Responses varied in the criteria used to define normal labour, and the diagnosis and management of prolonged labour. Clinicians with more post-qualification experience considered the minimal acceptable progress to be faster than those with fewer years of experience (P = 0.02). Clinicians working in higher acuity hospitals were more likely to augment labour for longer prior to recommending a caesarean section for active phase arrest, compared to those in lower acuity hospitals (P = 0.025). The majority of respondents (58.2%) already based their practice on the ACOG/SMFM 'Safe prevention of primary caesarean section' statement, or would now consider changing their practice.
  
  
  CONCLUSIONS
  There is a lack of consensus among Australian obstetricians and GP obstetricians regarding definition of normal progress in first stage of labour and how to manage abnormal progress; however, many are open to new recommendations for practice.
authors.affiliation: Obstetrics and Gynaecology, Gold Coast University Hospital, Southport, Queensland, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: White
authors.affiliation: Midwifery Research Unit/Mater Research Institute, Brisbane, Queensland, Australia.
authors.forename: Nigel
authors.initials: N
authors.lastname: Lee
authors.affiliation: Obstetrics and Gynaecology, Mater Mothers Hospital, Brisbane, Queensland, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Beckmann
mesh_terms: D002585:Cesarean Section; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004420:Dystocia / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D005260:Female; D006761:Hospitals / Q000145:classification; D006801:Humans; D007747:Labor Stage, First; D009774:Obstetrics; D010120:Oxytocics / Q000627:therapeutic use; D010121:Oxytocin / Q000627:therapeutic use; D010298:Parity; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011795:Surveys and Questionnaires
chemical_list: D010120:Oxytocics; D010121:Oxytocin
keywords: consensus; dystocia; labour obstetric; labour stage; practice guidelines as topic