Women increasingly present to hospital in early labour, but admission before active labour contributes to overuse of interventions, poorer clinical and psychological outcomes, and higher healthcare costs.
Innovative models of early labour care have so far not improved birth outcomes.
To examine if reconfiguring the early labour service in a large Australian maternity service improved (1) the birth outcomes of women who presented in early labour and (2) alleviated bed blockages by decreasing length of stay in the Pregnancy Assessment and Observation Unit.
Pre-post intervention design, using routinely collected clinical data before and after the implementation of the reconfigured early labour service.
There were 527 women in pre-intervention cohort and 747 in the post-intervention cohort. The two groups were similar in age, body mass index, marital status, education level and gestation at birth. Post intervention, epidural use did not change significantly, but rates of amniotomy (35.7% vs. 49.9%, p = <0.001), meconium-stained liquor (20.1% vs 26.1%, p = 0.04), and neonatal nursery admission (2.7% vs. 5.8% p = 0.01) increased. The proportion of women staying in the Assessment unit more than two hours decreased, but not significantly.
Changing the location and model of early labour care did not influence epidural use, nor improve women’s birth outcomes. For women in early labour, admission to any location within the hospital may be as problematic as admission to birth suite specifically.
Abbreviation:PAOU (Pregnancy Assessment and Outpatient Unit)
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- “Active labor” duration and dilation rates among low-risk, nulliparous women with spontaneous labor onset: a systematic review.J Midwifery Womens Health. 2010; 55: 308-318
- An early labor assessment program: a randomised, controlled trial.Birth. 1998; 25: 5-10
- Proactive support of labor: the challenge of normal childbirth.Cambridge University Press, 2009
- Contemporary patterns of spontaneous labor with normal neonatal outcomes.Obstet Gynecol. 2010; 116: 1281-1287
- Queensland maternity and neonatal clinical guideline: normal birth.Queensland Health, Brisbane2018
- How social context impacts on women’s fears of childbirth: a Western Australian example.Soc Sci Med. 2006; 63: 64-75
- Being in a safe and thus secure place, the core of early labour: a secondary analysis in a Swedish context.Int J Qual Stud Health Well-being. 2016; 11: 30230
- Women’s childbirth preferences and practices in the United States.Soc Sci Med. 2012; 75: 709-716
- Labouring To Better Effect: Studies of Services for Women in Early Labour. The OPAL Study (OPtions for Assessment in early Labour). Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO).2007 (Accessed 15 May 2019. Available at: http://www.netscc.ac.uk/hsdr/files/project/SDO_FR_08-1304-064_V01.pdf)
- The relationship between cervical dilatation at initial presentation in labour and subsequent intervention.BJOG. 2001; 108: 1120-1124
- Labour assessment programs to delay admission to labour wards.Cochrane Database Syst Rev. 2001; 3
- Outcomes of nulliparous women with spontaneous labor onset admitted to hospitals in preactive versus active labor.J Midwifery Womens Health. 2014; 59: 28-34
- Influence of timing of admission in labour and management of labour on method of birth: results from a randomised controlled trial of caseload midwifery (COSMOS trial).Midwifery. 2013; 29: 1297-1302
- Women’s perception of the onset of labour and epidural analgesia: a prospective study.Midwifery. 2013; 29: 284-293
- Roundtable discussion: early labor: what’s the problem?.Birth. 2009; 36: 332-339
- Improving Care at the Primary/Secondary Interface: A Trial of Community-Based Support in Early Labour. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO).2008 (Accessed May 15, 2009. Available at: http://www.netscc.ac.uk/netscc/hsdr/files/project/SDO_FR_08-1304-040_V01.pdf)
- Early labor assessment and support at home versus telephone triage: a randomized controlled trial.Obstet Gynecol. 2006; 108: 1463-1469
- Effect on birth outcomes of a formalised approach to care in hospital labour assessment units: international, randomised controlled trial.BMJ. 2008; 337: a1021
- Effects of algorithm for diagnosis of active labour: cluster randomised trial.BMJ. 2008; 337 (a2396-a)
- Australia’s mothers and babies 2013: in brief.(Perinatal statistics series no. 31. Cat no. PER 72) AIHW, Canberra2015
- Epidural versus non-epidural or no analgesia in labour.Cochrane Database Syst Rev. 2011; (Art. No.: CD000331)https://doi.org/10.1002/14651858.CD000331.pub3
- Older maternal age and intervention in labor: a population-based study comparing older and younger first-time mothers in Victoria, Australia.Birth. 2011; 38: 24-29
- Initial preference for labor without neuraxial analgesia and actual use: results from a national survey in France.Anesth Analg. 2015; 121: 759-766
- Documenting risk: a comparison of policy and information pamphlets for using epidural or water in labour.Women Birth. 2015; 28: 221-227
- MMH-MMPH monthly summary.Mater Misericordiae Health Services, 2013
- MMH-MMPH monthly summary.Mater Misericordiae Health Services, 2012
- From ideal to real: the interfeace between birth territory and the maternity service organization.in: Fahy K. Foureur M. Hastie C. Birth territory and midwifery guardianship. Elsevier, Oxford2008: 149-167
- Women’s preferences for aspects of labor management: results from a discrete choice experiment.Birth. 2011; 38: 36-46
- Nonpharmacologic relief of pain during labor: systematic reviews of five methods.Am J Obstet Gynecol. 2002; 186: 131-159
- Undisturbed birth: nature’s blueprint for ease and ecstasy.J Prenat Perinat Psychol Health. 2003; 17: 261-288
- Alternative versus conventional institutional settings for birth.Cochrane Database Syst Rev. 2012; 9
- Association between anxiety and pain in the latent phase of labour upon admission to the maternity hospital: a prospective, descriptive study.J Health Psychol. 2015; 20: 446-455
- Healthcare redesign: meaning, origins and application.BMJ Qual Saf. 2003; 12: 53-58
- Caseload midwifery care versus standard maternity care for women of any risk: [email protected], a randomised controlled trial.Lancet. 2013; 382: 1723-1732
Published online: May 18, 2019
Accepted: May 7, 2019
Received in revised form: May 7, 2019
Received: September 20, 2018
© 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.