Abstract
Problem
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.
Background
Innovative models of early labour care have so far not improved birth outcomes.
Aim
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.
Methods
Pre-post intervention design, using routinely collected clinical data before and after
the implementation of the reconfigured early labour service.
Findings
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.
Conclusion
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)Keywords
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Article info
Publication history
Published online: May 18, 2019
Accepted:
May 7,
2019
Received in revised form:
May 7,
2019
Received:
September 20,
2018
Identification
Copyright
© 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
