Background Intrapartum foetal heart rate (FHR) monitoring helps assess foetal wellbeing. It relies on observers’ subjective assessments, with variation in interpretations leading to variations in intrapartum care. Objectives To summarize and evaluate inter- and intra-rater reliability research on human interpretation of intrapartum FHR monitoring. Search Strategy We searched for the terms ‘foetal heart rate monitoring’, ‘interpretation agreement’ and related concepts on Embase, Medline, Maternity & Infant Care Database and CINAHL. Last search was 31st January 2022. Selection Criteria We included studies that assess inter- and intra-rater reliability of health professionals’ intrapartum FHR monitoring and excluded studies including other assessment of foetal wellbeing. Data collection and analysis We extracted data in reviewer pairs using QAREL (quality appraisal tool for studies of diagnostic reliability) forms. We performed a random effect meta-analysis to present pooled estimates with 95% confidence intervals. Narrative synthesis reported results not appropriate for meta-analysis. Main results Forty-nine articles concerning continuous FHR monitoring were included, all with considerable heterogeneity in quality and measures. The pooled κ coefficient was 0.45 (95% CI 0.33-0.56) for FIGO (International Federation of Gynecology and Obstetrics) classifications. Conclusions There are few high-quality studies that evaluate inter- and intra-observer variations in intrapartum FHR monitoring. We found great variation in reliability measures and noted methodological concerns in the studies. Funding C. H. Engelhart received a PhD scholarship from the Norwegian Research Centre for Women’s Health at Oslo University Hospital. Keywords Inter-rater reliability and agreement, intra-rater reliability and agreement, foetal heart rate monitoring, systematic review, meta-analysis.

Objective To explore and describe what women who have given birth in Norway emphasise as important aspects of care during childbirth. Design The study is based on data from the Babies Born Better survey, version 2, a mixed-method online survey. Setting The maternity care system in Norway. Study population Women who gave birth in Norway between 2013 and 2018. Method Descriptive statistics were used to describe sample characteristics and to compare data from the B3 survey with national data from the MBRN, using SPSS® software (version 20). The open-ended questions were analysed with an inductive thematic analysis, using NVIVO 12® software. Main outcome measures Themes developed from two open-ended questions. Results The final sample included 8,401 women. There were no important differences between the sample population and the national population with respect to maternal age, marital status, parity, mode of birth and place of birth, except for the proportion of planned homebirths. Four themes and one overarching theme were identified; Compassionate and Respectful Care, A Family Focus, Continuity and Consistency, and Sense of Security, and the overarching theme Coherence in Childbearing. Conclusions Socio-cultural and psychological aspects of care are significant for women in childbirth, alongside physical and clinical factors. Caring for the woman implies caring for her partner and having a baby is about ‘becoming a family or expanding the family’. Childbirth is a continuous experience in women’s lives and continuity and consistency are important for women to maintain and promote a coherent experience.