Early Labour Assessment and Support at Home: A Randomized Controlled Trial

Abstract

Objective: To compare childbirth outcomes of women prospectively randomized to receive early labour assessment and support either through a home visit or by telephone triage.Methods: Women in early labour, upon seeking prior telephone advice on whether or not they were ready to be admitted to BC Women’s Hospital (as was standard hospital practice), were voluntarily randomized to receive either a home visit by an obstetrical nurse or telephone triage.Results: One hundred seventeen women were randomized to receive home care and 120 to receive telephone triage. Significantly fewer women in the home care group arrived at hospital in the latent stage of labour, compared to women in the telephone triage group (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.19–0.72). Significantly fewer women in the home care group received narcotics (OR, 0.55; 95% CI,0.32–0.96). Differences observed in use of epidural analgesia (OR, 0.64; 95% CI, 0.36–1.16) were not statistically significant. Newborns in the home care group were significantly less likely to be admitted to a level II observation nursery (OR,0.13;95% CI, 0.03–0.60). More women in the home care group would recommend this type of care to a friend (P = 0.001).Conclusion: Our findings suggest an association of early labour assessment at home with both admission to hospital in the active phase of labour and reduction in use of analgesia during labour. Early labour support at home was associated with reduced rates of admission of neonates to a level II observation nursery, possibly secondary to reduced exposure to analgesics. Early labour care at home by hospital-based obstetrical nurses is safe and acceptable to women, and may offer advantages in terms of reduced interventions and more vigorous neonates.