Main themes and examples arising from the qualitative analysis
| Themes | Subthemes | Examples |
| Differentiating between early and active labour | ‘Rules’ about contractions Behaviour of women in active labour Having to pretend/exaggerate about contractions | […] Called hospital 9 hours later, told midwife I had urge to push, still advised to stay home due to contraction frequency. Felt very uncomfortable, husband called 999, waters broke as soon as ambulance came and I began pushing at home. Decided to go to hospital by ambulance, baby born shortly after arrival. [Primip, IMD1, 25–29 years, white] |
| Staff attitudes | Insensitive, rude, abrupt, dismissive, negative response Being made to feel foolish Feeling vindicated—women in active labour not early labour as staff had thought Received inappropriate advice: stay home, have bath, take paracetamol | I was distressed during my labour as one of the midwives was very patronising in telling me that my contractions weren’t as painful as I was experiencing, she sent me home twice. [Primip, IMD5, 30–34 years, BME] |
| Not being allowed… | To come, to stay—sent home, unit busy Be examined/checked Having to beg for VE | I felt quite pushed back from the hospital when I phoned. I was bleeding (my show) and having regular pains but I just got told to stay at home and if I went through they would just send me away. [Primip, IMD5, 20–24 years, BME] |
| Previous labours | Primiparous women needing reassurance, being uncertain Multiparous women having experience, recognising active labour, being dismissed | When I went into labour with my 3rd child I called the labour ward and wanted to come into hospital but they wouldn't let me. I didn't feel like she was listening to me even though I said I labour quickly. |
| Perceived consequences for women | Rushed delivery—insufficient time for preparation and pain relief Not a normal birth—instrumental/operative delivery Upset—distress, delayed attachment to baby | [… ] Felt unhappy as hadn't had chance for pain relief option and baby had become distressed. Felt that I should have been kept in hospital when first went in or made to feel more welcome on phone. Not the way I wanted my labour to be and was worrying for me and my husband. [Primip, IMD1, 25–29 years, white] |
VE, vaginal examination.