Early Labour Assessment Research Articles

Admission Process of Low Risk Women in Labour: Development of an Evidence-based Protocol

Abstract Introduction: To protect normal birth, admission of pregnant women in labour units is one of the most important decisions. This study developed a protocol for admission of women during labour in order to improve the accuracy of the diagnosis of onset of labour. Methods: First the admission processes of 25 pregnant women were observed in the study hospital. Then the multi-disciplinary team searched and reviewed the Iranian database using related key words. Evidence-based medicine resources and other databases were searched using related key words for the most important symptoms in relation to the onset of active labour as well as early labour assessment programs. Results: The results of observation of the admission process in the study hospital and review of the literature indicated that low-risk pregnant women in labour were admitted using different criteria. The evidence-based protocol for admission of women in labour was developed using these criteria to provide a guide, which lists the necessary measures in dealing with women in various situations during the onset of labour. Presence of regular uterine contractions, cervical dilatation ≥ 4 cm and effacement should be considered as signs of starting labour, which may be accompanied by spontaneous rupture of membranes or bloody show. Conclusions: Protocols are appropriate clinical tools for the design and standardization of clinical processes based on the available evidence. This protocol could be used in a multi-center clinical trial to assess its effectiveness.

Assessment and support during early labour for improving birth outcomes.

Assessment and support during early labour for improving birth outcomes.

Women's experience with early labour management at home vs. in hospital: A randomised controlled trial

Objectiveto compare experiences with early labour assessment and support at home vs. by telephone. Designa randomised controlled trial of nurse home visits vs. telephone support for assessment and support of women in early labour. Settinghospitals serving obstetrical populations in metropolitan and suburban Vancouver, British Columbia, Canada. Participantshealthy nulliparous women in labour at term with uncomplicated pregnancies participating in the third and fourth year of the trial. Interventionwomen were randomised to receive early labour assessment and support at home (n=241) and or to receive assessment and support by telephone (n=182). Measurementthe Early Labour Experience Questionnaire (ELEQ), a 26-item self-administered questionnaire that measures women's experience with early labour care across three domains: emotional well-being, emotional distress and perceptions of nursing care. Findingswomen who received home visits rated their early labour experience more positively overall compared to women who received telephone support (103.14±12.45 vs. 99.67±13.11, p<.01)including perceptions of nursing care that they received (38.64±2.90 vs. 36.82±4.09, p<.001). However, women's affective experiences did not differ. Key conclusionsearly labour nursing care provided at home is associated with a more positive experience of early labour compared to telephone support.

Setting up a triage telephone line for women in early labour

This article aims to provide an overview of a collaborative service improvement project that was undertaken by midwives at the Royal Berkshire NHS Foundation Trust to improve services for women in early labour. The labour triage line was set up to increase the consistency of information and advice provided to women in early labour and to enable women to feel confident in using coping strategies to help them remain at home during early labour. It was hoped that this would reduce the number of women attending the labour ward for early labour assessment and increase both Women's and midwives' satisfaction with the service provided. A review of early labour services was initially undertaken to inform the project. This revealed that most women in early labour telephoned and were assessed on the labour ward with only a small proportion receiving advice about coping strategies. A survey of postnatal women found that the provision of calm, friendly advice over the telephone was reassuring, with more than half of the women surveyed stating that their experience of early labour could be improved through good telephone advice from a midwife. Following this, the telephone labour triage line was implemented and evaluated following a 6-month pilot. Feedback from women suggested a high degree of satisfaction with the service and a significant improvement in midwives discussing coping strategies with women in early labour. Other findings included an increase in the use of the midwifery-led unit and normal birth rate for low-risk first-time mothers. The triage line has now been extended to 24 hours and will move to the new midwifery-led unit that is being built this year where the outcomes will continue to be monitored.

Early Labor Assessment and Support at Home Versus Telephone Triage: A Randomized Controlled Trial

Obstetrical triage is thought by some to lessen the need for cesarean delivery. Trials have confirmed lower rates of operative delivery, epidural analgesia, and oxytocin augmentation following triage at hospital. The present study compared cesarean delivery rates in healthy nulliparous women in labor at term who were randomly assigned to either telephone triage (n = 731) or to "hands on" triage during a home visit by a nurse (n = 728). Women triaged via telephone were advised to come in if amniotic fluid was colored, vaginal bleeding was present, fetal movements decreased, they could no longer cope with contractions, or contractions lasted longer than 1 minute or occurred more often than every 5 minutes. A nurse carried out home triage when women sought advice about when to come to the hospital. In addition to the same questions, the nurse took vital signs, palpated the abdomen, auscultated the fetal heart rate, assessed contractions, and examined the cervix. The relative risk (RR) of cesarean delivery for home-triaged women, compared with those given only telephone support, was 1.12, with a 95% confidence interval (CI) of 0.94-1.32; this was not a significant difference. Indications for cesarean delivery were similar in the two groups. Significantly fewer home-triaged women were admitted with cervical dilatation of 3 cm or less (RR, 0.85; 95% CI, 0.76-0.94). Significantly more women having a nurse visit their home did not need to go to the hospital for assessment (RR, 1.54; 95% CI, 1.23-1.92). No significant group differences were found in the use of either narcotic analgesia or epidural analgesia, or in augmentation of labor. Women assigned to home support were significantly less likely to be judged as not coping with their labor when reaching the hospital (RR, 0.74; 95% CI, 0.62-0.90). Among women who entered labor spontaneously, those given home support spent an average of 50 minutes less in hospital. Infants in the two groups had comparable 1- and 5-minute Apgar scores and similar rates of neonatal resuscitation. These healthy nulliparous women in early labor did not require cesarean delivery substantially less often when visited at home by a nurse as opposed to telephone triage. A home visit does, however, help women to cope with labor and reduces the number of hospital visits during latent-phase labor.

Early Labor Assessment and Support at Home Versus Telephone Triage

To compare rates of cesarean delivery among women who were triaged by obstetric nurses, either by telephone or by means of home visits. Healthy, nulliparous women in labor at term with uncomplicated pregnancies residing in the City of Vancouver, British Columbia, and suburbs between November 2001 and October 2004 were randomized when they sought advice about when to come to hospital. Women randomized to telephone triage (n=731) were provided with advice by telephone. Women randomized to a home visit (n=728) were triaged after a "hands-on" assessment in their homes. The relative risk (RR) for cesarean delivery among home-triaged women compared with those receiving only telephone support was 1.12 (95% confidence interval [CI] 0.94-1.32). The study was designed to have 80% power to detect a RR less than 0.78 or greater than 1.27 for cesarean delivery. Significantly fewer women in the home visit group were admitted to hospital with cervical dilatation at 3 cm or less (RR 0.85, 95% CI 0.76-0.94). Significantly more women in the home visit group managed their labor without a visit to hospital for assessment (RR 1.54, 95% CI 1.23-1.92). There were no statistically significant differences in use of narcotic analgesia, epidural analgesia, and augmentation of labor. Adverse neonatal outcomes were rare and did not differ between study groups. Early labor assessment and support at home versus support by telephone reduces the number of visits to hospital in latent phase labor but does not impact cesarean delivery rates among healthy nulliparous women. ISRCTN, www.controlled-trials.com/isrctn, MCT-44153 I.

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

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.

Triaging patients in the latent phase of labor

Many pregnant women who present to a hospital triage area, office, or clinic setting, or seek advice from a midwife by telephone, require early labor assessment. This article reviews parameters for normal and abnormal latent phase labor and discusses triage assessment and management strategies for the patient in latent phase labor.

Early labour assessment improved several intrapartum outcomes

McNiven PS, Williams JI, Hodnett E , et al. An early labor assessment program: a randomized, controlled trial. Birth1998 Mar; 25 : 5 –10 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Question Can early...

An Early Labor Assessment Program

McNiven, Patricia S.; Williams, Jack I.; Hodnett, Ellen; Kaufman, Karyn; Hannah, Mary E. Author Information

An Early Labor Assessment Program: A Randomized, Controlled Trial

Patterson, Ellen Tate DSN, RNEditor(s): PATTERSON, ELLEN TATE DSN, RN; BAKEWELL-SACHS, SUSAN PhD, CPNP, RN, CS Author Information