There is no standard definition of labour onset. Without such a definition, there is no benchmark against which to evaluate length and patterns of labour, including dystocia (prolonged, non-progressive labour), the leading indication for primary CS. As well there are major discrepancies in standards for diagnosis of dystocia in Canada, the US, and the UK. Our research cluster will explore clinical algorithms to define labour onset and indicators of developing dystocia that can may serve as “early warning systems” to create opportunities for early intervention. Accurate methods of predicting CS among healthy women are non-existent. Mobilization, managing the physical and psychosocial environment, and use of nonpharmacologic pain management techniques are commonly used among midwives to promote physiologic birth but have not been rigorously evaluated. We will identify opportunities to evaluate cost-effective, low technology methods to increase rates of healthy normal birth.