Balancing safety and comfort in childbirth: a grounded theory of labor progress assessment among frontline obstetric healthcare providers

During labor, both invasive and noninvasive assessments are performed to track progress. Invasive methods are more commonly employed in clinical settings but uncomfortable for women, whereas noninvasive assessments are less frequently used but more comfortable. This study aimed to understand the evolving processes of labor progress assessment conducted by frontline obstetricians, registered nurses, and practicing midwives during the labor process. This study adopted a qualitative design based on Straussian grounded theory. Participants included obstetricians, registered nurses, and midwives from northern, central, and southern Taiwan. A total of 33 participants (21 healthcare workers and 12 midwives) were recruited through theoretical sampling until data saturation was reached. Individual semi-structured interviews were conducted, audio-recorded, transcribed verbatim, and analyzed using constant comparative analysis. Analysis revealed that labor progress assessment by frontline healthcare providers comprised six interrelated categories: “React,” “Rapport,” “Record,” “Readjust,” “Rudimentary,” and “Rebuild”, integrated by a core category, “Balancing Safety and Comfort to Achieve Holistic Health in Childbirth.” These categories illustrate how healthcare workers and midwives continuously adjust assessment strategies in response to women’s physiological and behavioral cues, clinical documentation requirements, and situational demands during labor. Labor progress assessment practices are shaped by professional education, training philosophies, clinical experience, and underlying perspectives on childbirth held by both midwives and obstetric healthcare workers. The proposed model provides a conceptual framework that may support reflection on current assessment practices, contribute to reducing reliance on routine invasive examinations, and facilitate dialogue between midwives and obstetric professionals regarding the integration of non-invasive assessment approaches in clinical care. Not applicable.