The extent to which viewing a 'virtual' limb, the mirror image of an intact limb, modifies the experience of a phantom limb, was investigated in 80 lower limb amputees before, during and after repeated attempts to simultaneously move both intact and phantom legs. Subjects were randomly assigned to one of two conditions, a control condition in which they only viewed the movements of their intact limb and a mirror condition in which they additionally viewed the movements of a 'virtual' limb. Although the mirror condition elicited a significantly greater number of phantom limb movements than the control condition, it did not attenuate phantom limb pain and sensations any more than the control condition. The potential of a 'virtual' limb as a treatment for phantom limb pain was discussed in terms of its ability to halt and/or reverse the cortical re-organisation of motor and somatosensory cortex following acquired limb loss.

Memories of labor pain can evoke intense negative reactions in a few women, but are more likely to give rise to positive consequences related to coping, self-efficacy, and self-esteem.

Research has indicated that the way individuals cope with pain may influence pain, and physical and psychological adjustment. The present study assessed the relationship between coping strategy use and adjustment in amputees with phantom limb pain (PLP). Coping strategies were measured using the Coping Strategies Questionnaire (CSQ) and their relationship with adjustment was examined using both composite scores and individual strategy scores. The results indicated that the relationship between coping and adjustment was primarily explained by the use of strategies within the 'Helplessness' factor of the CSQ. A clearer picture of coping strategy use was gained from examining individual strategies rather than the composite measures. Catastrophizing explained the largest proportion of variance in pain report (26%), while increasing behavioral activity and hoping or praying strategies explained a smaller proportion of the variance (3% and 1%, respectively). Catastrophizing also explained a large proportion of the variance in physical and psychosocial dysfunction (11% and 22%), while hoping or praying strategies accounted for only a small proportion of the variance in physical dysfunction (3%), and re-interpreting pain sensations accounted for a small proportion of the variance in psychosocial dysfunction (3%). The findings in this study have important clinical implications in that coping strategy use was associated with increased, rather than decreased, levels of pain and disability. However, since the reported use of coping strategies in the present study was low, further research, perhaps utilizing other measures of coping, is required to clarify these findings.

In spite of the advice from midwives to stay at home for as long as possible after the perceived onset of labour, many women still present at hospital in the very early stages of labour. In this qualitative study, 21 women discussed their early labour experiences, and factors which influenced their decisions regarding when to go to hospital. The data were transcribed and analysed using latent content analysis. We found a combination of uncertainty, pain and anxiety influenced women's early labour decisions. While many felt they were coping well with their labour on admission, women often wanted to be in hospital ‘just in case’ and lacked the confidence to cope with labour at home. We suggest that the relationship between anxiety and timing of admission should be investigated further and that the value of midwifery support and reassurance in the latent and early stages of labour should not be underestimated.

Objective To compare the effectiveness of an algorithm for diagnosis of active labour in primiparous women with standard care in terms of maternal and neonatal outcomes.Design Cluster randomised trial.Setting Maternity units in Scotland with at least 800 annual births.Participants 4503 women giving birth for the first time, in 14 maternity units. Seven experimental clusters collected data from a baseline sample of 1029 women and a post-implementation sample of 896 women. The seven control clusters had a baseline sample of 1291 women and a post-implementation sample of 1287 women.Intervention Use of an algorithm by midwives to assist their diagnosis of active labour, compared with standard care.Main outcomes Primary outcome: use of oxytocin for augmentation of labour. Secondary outcomes: medical interventions in labour, admission management, and birth outcome.Results No significant difference was found between groups in percentage use of oxytocin for augmentation of labour (experimental minus control, difference=0.3, 95% confidence interval −9.2 to 9.8; P=0.9) or in the use of medical interventions in labour. Women in the algorithm group were more likely to be discharged from the labour suite after their first labour assessment (difference=−19.2, −29.9 to −8.6; P=0.002) and to have more pre-labour admissions (0.29, 0.04 to 0.55; P=0.03).Conclusions Use of an algorithm to assist midwives with the diagnosis of active labour in primiparous women did not result in a reduction in oxytocin use or in medical intervention in spontaneous labour. Significantly more women in the experimental group were discharged home after their first labour ward assessment.Trial registration Current Controlled Trials ISRCTN00522952.