and mind to withstand the rigours of this physiological process. In this way the rates of operative birth are maintained or increased and bring with them the well- recognized maternal morbidity and worse. References Cheyne H, Dunlop A, Shields N & Mathers AM (2003) A rando- mised controlled trial of admission electronic fetal monitoring in normal labour. Midwifery 19, 221–229. Howell CJ (1999) Epidural versus non-epidural analgesia for pain relief in labour. The Cochrane Database of Systematic Reviews Issue 1 Copyright Ó 2005, The Cochrane Collaboration, John Wiley & Sons Ltd, NY. Nystedt A, Ho ¨ gberg U & Lundman B (2005) The negative birth experience of prolonged labour: a case-referent study. Journal of Clinical Nursing 14, 579–586. Thomson AM, Hillier VF (1994) A re-evaluation of the effect of pethidine on the length of labour. Journal of Advanced Nursing 19, 448–456. RESPONSE doi: 10.1111/j.1365-2702.2005.01444.x In response to Mander’s (2006) commentary on our paper (Nystedt et al. 2005) we do agree that a biomedical approach to childbirth could overdo by its efficiency, rationality and risk minimization. The inherent possibility of iatrogenic conse- quences of medical technology is well recognized for skilled birth attendance. However, neither a life world perspective nor a nurse care perspective should exclude the biomedical one. We do agree that the condition of prolonged labour is not easily well-defined. On the one hand the definition towards normal progress could be difficult, while on the other hand still the condition is one cause of maternal and child morbidity in high-income countries and as obstructed labour is one cause of maternal and child mortality in low-income countries. We are sorry that the study design in the paper could be interpreted as simplistic and reductionist. Our paper (Nystedt et al. 2005) is one part of a project exploring women’s experiences of prolonged labour compri- sing both quantitative and qualitative research methods. The selection criteria for this study were to have most well- defined cases, hence not only following the criteria of prolonged labour set by WHO and the International Clas- sification for diseases (World Health Organization 1994), but also adding having an assisted delivery, ventouse or caesar- ean delivery, due to the prolonged labour. Thus, with our selection criteria only 84 mothers out of 3140 births in the three hospitals during the study period fulfilled those criteria, i.e. 2.7% of all parturients. The delivery experience of those few mothers was then compared to mothers having a normal course of delivery. Our interpretation of the results is that those women with prolonged labour more often are having a worse birth experience than referents have. By this, we do not disregard that the length of labour could be irrelevant for the birth experience, only that those mothers who have a prolonged labour requiring a medical intervention will have a more difficult or complex birthing process. Astrid Nystedt, MSc, RNM, Doctoral Student, Department of Nursing, and Department of Clinical Science, Obstetrics and Gynaecology, Umea ˚ University Hospital, Umea ˚, Sweden Berit Lundman, PhD, RN, Associate Professor, Department of Nursing, Umea ˚ University Hospital, Umea ˚, Sweden Ulf Ho ¨ gberg, PhD, MD, Professor, Obstetrics and Gynaecology, Department of Clinical Science, and Department of Public Health and Clinical Medicine, Epidemiology, Umea ˚ University Umea ˚, Sweden References Mander R (2006) Commentary on Nystedt A, Ho ¨ gberg U & Lundman B (2005) The negative birth experience of prolonged labour: a case–referent study. Journal of Clinical Nursing 14, 579–586. Journal of Clinical Nursing 15, 1206–1207. Nystedt A, Ho ¨ gberg U & Lundman B (2005) The negative birth experience of prolonged labour: a case-referent study. Journal of Clinical Nursing 14, 579–586. World Health Organization (1994) International Statistical Classifi- cation of Diseases and Related Health Problems: ICD-10. World Health Organization, Geneva. Correspondence: Astrid Nystedt, Department of Nursing, Umea ˚ University, S-901 87 Umea ˚ Sweden. Telephone: þ046 612 610 50; fax: þ46 90 786 91 69; e-mail: astrid.nystedt@nurs.umu.se Ó 2006 Blackwell Publishing Ltd, Journal of Clinical Nursing, 15, 1206–1209 1207