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Kjerulff KH, Attanasio LB, Vanderlaan J, Sznajder KK. Timing of hospital admission at first childbirth: A prospective cohort study. PLoS One 2023; 18:e0281707. [PMID: 36795737 PMCID: PMC9934383 DOI: 10.1371/journal.pone.0281707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND AND AIMS It is difficult for women in labor to determine when best to present for hospital admission, particularly at first childbirth. While it is often recommended that women labor at home until their contractions have become regular and ≤ 5-minutes apart, little research has investigated the utility of this recommendation. This study investigated the relationship between timing of hospital admission, in terms of whether women's labor contractions had become regular and ≤ 5-minutes apart before admission, and labor progress. METHODS This was a cohort study of 1,656 primiparous women aged 18-35 years with singleton pregnancies who began labor spontaneously at home and delivered at 52 hospitals in Pennsylvania, USA. Women who were admitted before their contractions had become regular and ≤ 5-minutes apart (early admits) were compared to those who were admitted after (later admits). Multivariable logistic regression models were used to assess associations between timing of hospital admission and active labor status on admission (cervical dilation 6-10 cm), oxytocin augmentation, epidural analgesia and cesarean birth. RESULTS Nearly two-thirds of the participants (65.3%) were later admits. These women had labored for a longer time period before admission (median, interquartile range [IQR] 5 hours (3-12 hours)) than the early admits (median, (IQR) 2 hours (1-8 hours), p < 0.001); were more likely to be in active labor on admission (adjusted OR [aOR] 3.78, 95% CI 2.47-5.81); and were less likely to experience labor augmentation with oxytocin (aOR 0.44, 95% CI 0.35-0.55); epidural analgesia (aOR 0.52, 95% CI 0.38-0.72); and cesarean birth (aOR 0.66, 95% CI 0.50-0.88). CONCLUSIONS Among primiparous women, those who labor at home until their contractions have become regular and ≤ 5-minutes apart are more likely to be in active labor on hospital admission and less likely to experience oxytocin augmentation, epidural analgesia and cesarean birth.
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Affiliation(s)
- Kristen H. Kjerulff
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pennsylvania, United States of America
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
- * E-mail:
| | - Laura B. Attanasio
- School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Jennifer Vanderlaan
- School of Nursing, University of Nevada, Las Vegas, Nevada, United States of America
| | - Kristin K. Sznajder
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pennsylvania, United States of America
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Miller YD, Armanasco AA, McCosker L, Thompson R. Variations in outcomes for women admitted to hospital in early versus active labour: an observational study. BMC Pregnancy Childbirth 2020; 20:469. [PMID: 32807137 PMCID: PMC7430117 DOI: 10.1186/s12884-020-03149-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/31/2020] [Indexed: 11/20/2022] Open
Abstract
Background There is no available evidence for the prevalence of early labour admission to hospital or its association with rates of intervention and clinical outcomes in Australia. The objectives of this study were to: estimate the prevalence of early labour admission in one hospital in Australia; compare rates of clinical intervention, length of hospital stay and clinical outcomes for women admitted in early (< 4 cm cervical dilatation) or active (≥4 cm) labour; and determine the impact of recent recommendations to define early labour as < 5 cm on the findings. Methods We conducted a retrospective cohort study using medical record data from a random sample of 1223 women from live singleton births recorded between July 2013 and December 2015. Analyses included women who had spontaneous onset of labour at ≥37 weeks gestation whilst not a hospital inpatient, who had not scheduled a caesarean section before labour onset or delivered prior to hospital admission. Associations between timing of hospital admission in labour and clinical intervention, outcomes and hospital stay were assessed using logistic regression. Results Between 32.4% (< 4 cm) and 52.9% (< 5 cm) of eligible women (N = 697) were admitted to hospital in early labour. After adjustment for potential confounders, women admitted in early labour (< 4 cm) were more likely to have their labour augmented by oxytocin (AOR = 3.57, 95% CI 2.39–5.34), an epidural (AOR = 2.27, 95% CI 1.51–3.41), a caesarean birth (AOR = 3.50, 95% CI 2.10–5.83), more vaginal examinations (AOR = 1.73, 95% CI = 1.53–1.95), and their baby admitted to special care nursery (AOR = 1.54, 95% CI = 1.01–2.35). Defining early labour as < 5 cm cervical dilatation produced additional significant associations with artificial rupture of membranes (AOR = 1.41, 95% CI = 1.02–1.95), assisted vaginal birth (AOR = 1.96, 95% CI = 1.12–3.41) neonatal resuscitation (AOR = 1.73, 95% CI = 1.01–2.99) and longer maternal hospital stay (AOR = 1.21, 95% CI = 1.04–1.40). Conclusions Findings provide preliminary evidence that a notable proportion of labouring women are admitted in early labour and are more likely to experience several medical procedures, neonatal resuscitation and admission to special care nursery, and longer hospital stay.
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Affiliation(s)
- Yvette D Miller
- Queensland University of Technology, Institute of Health & Biomedical Innovation, School of Public Health & Social Work, Kelvin Grove, Brisbane, QLD, 4059, Australia.
| | - Ashleigh A Armanasco
- Queensland University of Technology, Institute of Health & Biomedical Innovation, School of Public Health & Social Work, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Laura McCosker
- Queensland University of Technology, Institute of Health & Biomedical Innovation, School of Public Health & Social Work, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Rachel Thompson
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
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Hundley V, Downe S, Buckley SJ. The initiation of labour at term gestation: Physiology and practice implications. Best Pract Res Clin Obstet Gynaecol 2020; 67:4-18. [DOI: 10.1016/j.bpobgyn.2020.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/10/2020] [Accepted: 02/13/2020] [Indexed: 11/16/2022]
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Rota A, Antolini L, Colciago E, Nespoli A, Borrelli SE, Fumagalli S. Timing of hospital admission in labour: latent versus active phase, mode of birth and intrapartum interventions. A correlational study. Women Birth 2017; 31:313-318. [PMID: 29054342 DOI: 10.1016/j.wombi.2017.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/18/2017] [Accepted: 10/03/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hospitalization of women in latent labour often leads to a cascade of unnecessary intrapartum interventions, to avoid potential disadvantages the recommendation should be to stay at home to improve women's experience and perinatal outcomes. AIM The primary aim of this study was to investigate the association between hospital admission diagnosis (latent vs active phase) and mode of birth. The secondary aim was to explore the relationship between hospital admission diagnosis, intrapartum intervention rates and maternal/neonatal outcomes. METHODS A correlational study was conducted in a large Italian maternity hospital. Data from January 2013 to December 2014 were collected from the hospital electronic records. 1.446 records of low risk women were selected. These were dichotomized into two groups based on admission diagnosis: 'latent phase' or 'active phase' of labour. FINDINGS 52.7% of women were admitted in active labour and 47.3% in the latent phase. Women in the latent phase group were more likely to experience a caesarean section or an instrumental birth, artificial rupture of membranes, oxytocin augmentation and epidural analgesia. Admission in the latent phase was associated with higher intrapartum interventions, which were statistically correlated to the mode of birth. CONCLUSIONS Women admitted in the latent phase were more likely to experience intrapartum interventions, which increase the probability of caesarean section. Maternity services should be organized around women and families needs, providing early labour support, to enable women to feel reassured facilitating their admission in labour to avoid the cascade of intrapartum interventions which increases the risk of caesarean section.
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Affiliation(s)
- A Rota
- San Raffaele Hospital, Maternity Department, Via Olgettina 60, 20132 Milan, Italy
| | - L Antolini
- Department of Health Science, Center of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Via Cadore, 48, 20900 Monza, Milan, Italy
| | - E Colciago
- Department of Health Science, Center of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Via Cadore, 48, 20900 Monza, Milan, Italy
| | - A Nespoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48, 20900 Monza, Italy
| | - S E Borrelli
- Division of Midwifery, School of Health Sciences, The University of Nottingham, Nottingham UK
| | - S Fumagalli
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48, 20900 Monza, Italy.
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Markowitz S, Adams EK, Lewitt MJ, Dunlop AL. Competitive effects of scope of practice restrictions: Public health or public harm? JOURNAL OF HEALTH ECONOMICS 2017; 55:201-218. [PMID: 28778349 DOI: 10.1016/j.jhealeco.2017.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 07/13/2017] [Accepted: 07/19/2017] [Indexed: 06/07/2023]
Abstract
The demand for healthcare professionals is predicted to grow significantly over the next decade. Securing an adequate workforce is of primary importance to ensure the health and wellbeing of the population in an efficient manner. Occupational licensing laws and related restrictions on scope of practice (SOP) are features of the market for healthcare professionals and are also controversial. At issue is a balance between protecting the public health and removing anticompetitive barriers to entry and practice. In this paper, we examine the case of SOP restrictions for certified nurse midwives (CNMs) and evaluate the effects of changes in states' SOP laws on markets for CNMs and on maternal and infant outcomes. We find that SOP laws are neither helpful nor harmful in regards to health outcomes but states that have no SOP-based barriers have lower rates of induced labor and Cesarean section births. We discuss the implications for state policy.
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Carlson NS, Corwin EJ, Lowe NK. Oxytocin Augmentation in Spontaneously Laboring, Nulliparous Women: Multilevel Assessment of Maternal BMI and Oxytocin Dose. Biol Res Nurs 2017; 19:382-392. [PMID: 28347147 PMCID: PMC5726513 DOI: 10.1177/1099800417701831] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Synthetic oxytocin, the primary tool for labor augmentation, is less effective among obese women, leading to more unplanned cesarean deliveries for slow labor progress. It is not known if obese women require higher doses of oxytocin due to maternal, fetal, or labor factors related to maternal obesity. OBJECTIVES This study had two main objectives: (1) examine the influence of maternal body mass index (BMI) on hourly doses of oxytocin from augmentation initiation until vaginal delivery in obese women; and (2) examine the influence of other maternal, fetal, and labor factors on hourly doses of oxytocin in obese women. STUDY DESIGN Longitudinal study of a cohort ( N = 136) of healthy, nulliparous, spontaneously laboring obese women (BMI ≥ 30 kg/m2) who received oxytocin augmentation and achieved vaginal delivery. We performed iterative multilevel analyses to examine the influence of maternal BMI and other factors on hourly oxytocin doses. RESULTS Maternal BMI explained 16.56% (95% confidence interval [CI] = [13.7, 20.04], p < .001) of the variance in hourly oxytocin doses received in a multilevel model controlling for influence of maternal, fetal, and labor characteristics. Maternal age, gestational age, status of amniotic membranes at hospital admission, and admission cervical dilation examination were not significant; however, neonatal birthweight and cervical dilation at oxytocin initiation were significant predictors of hourly oxytocin dose in these women ( p < .001). CONCLUSIONS Even when parturition preparation has progressed adequately for spontaneous labor initiation, there still may be some obesity-related blunting of myometrial contractility and response to oxytocin used for augmentation.
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Affiliation(s)
- Nicole S. Carlson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | - Nancy K. Lowe
- College of Nursing, University of Colorado, Aurora, CO, USA
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Kobayashi S, Hanada N, Matsuzaki M, Takehara K, Ota E, Sasaki H, Nagata C, Mori R. Assessment and support during early labour for improving birth outcomes. Cochrane Database Syst Rev 2017; 4:CD011516. [PMID: 28426160 PMCID: PMC6478316 DOI: 10.1002/14651858.cd011516.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The progress of labour in the early or latent phase is usually slow and may include painful uterine contractions. Women may feel distressed and lose their confidence during this phase. Support and assessment interventions have been assessed in two previous Cochrane Reviews. This review updates and replaces these two reviews, which have become out of date. OBJECTIVES To investigate the effectiveness of assessment and support interventions for women during early labour.In order to measure the effectiveness of the interventions, we compared the duration of labour, the rate of obstetrical interventions, and the rate of other maternal or neonatal outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (31 October 2016) and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials of any assessment or support intervention in the latent phase of labour. We planned to include cluster-randomised trials if they were eligible. We did not include quasi-randomised trials. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We resolved any disagreement by discussion or by involving a third assessor. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS We included five trials with a total of 10,421 pregnant women in this review update. The trials were conducted in the UK, Canada and America. The trials compared interventions in early labour versus usual care. We examined three comparisons: early labour assessment versus immediate admission to hospital; home visits by midwives versus usual care (telephone triage); and one-to-one structured midwifery care versus usual care. These trials were at moderate- risk of bias mainly because blinding women and staff to these interventions is not generally feasible. For important outcomes we assessed evidence using GRADE; we downgraded evidence for study design limitations, imprecision, and where we carried out meta-analysis, for inconsistency.One trial with 209 women compared early labour assessment with direct admission to hospital. Duration of labour from the point of hospital admission was reduced for women in the assessment group (mean difference (MD) -5.20 hours, 95% confidence interval (CI) -7.06 to -3.34; 209 women, low-quality evidence). There were no clear differences between groups for the number of women undergoing caesarean section or instrumental vaginal birth (risk ratio (RR) 0.72, 95% CI 0.30 to 1.72, very low quality evidence; and, RR 0.86, 95% CI 0.58 to 1.26, very low quality evidence, respectively). Serious maternal morbidity was not reported. Women in the early assessment group were slightly less likely to have epidural anaesthesia (RR 0.87, 95% CI 0.78 to 0.98, low-quality evidence), and considerably less likely to have oxytocin for labour augmentation (RR 0.57, 95% CI 0.37 to 0.86) and this group also had increased satisfaction with their care compared with women in the immediate admission group (MD 16.00, 95% CI 7.53 to 24.47). No babies were born before admission to hospital and only one infant had a low Apgar score at five minutes after the birth (very low quality evidence). Admission to neonatal special care was not reported.Three studies examined home assessment and midwifery support versus telephone triage. One trial reported the duration of labour; home visits did not appear to have any clear impact compared with usual care (MD 0.29 hours, 95% CI -0.14 to 0.72; 1 trial, 3474 women, low-quality evidence). There was no clear difference for the rate of caesarean section (RR 1.05, 95% CI 0.95 to 1.17; 3 trials, 5170 women; I² = 0%; moderate-quality evidence) or the rate of instrumental vaginal birth (average RR 0.95, 95% CI 0.79 to 1.15; 2 trials, 4933 women; I² = 69%; low-quality evidence). One trial reported birth before arrival at hospital or unplanned home birth; there was no clear difference between the groups (RR 1.33, 95% CI 0.30 to 5.95; 1 trial, 3474 women). No clear differences were identified for serious maternal morbidity (RR 0.93, 95% CI 0.61 to 1.42; 1 trial, 3474 women; low-quality evidence), or use of epidural (average RR 0.95, 95% CI 0.87 to 1.05; 3 trials, 5168 women; I² = 60%; low-quality evidence). There were no clear differences for neonatal admission to special care (average RR 0.84, 95% CI 0.50 to 1.42; 3 trials, 5170 infants; I² = 71%; very low quality evidence), or for Apgar score less than seven at five minutes after birth (RR 1.19, 95% CI 0.71 to 1.99; 3 trials, 5170 infants; I² = 0%; low-quality evidence).One study, with 5002 women, examined one-to-one structured care in early labour versus usual care. Length of labour was not reported. There were no clear differences between groups for the rate of caesarean section (RR 0.93, 95% CI 0.84 to 1.02; 4996 women, high-quality evidence), or for instrumental vaginal birth (RR 0.94, 95% CI 0.82 to 1.08; 4996 women, high-quality evidence). No clear differences between groups were reported for serious maternal morbidity (RR 1.13, 95% CI 0.84 to 1.52; 4996 women, moderate-quality evidence). Use of epidural was similar in the two groups (RR 1.00, 95% CI 0.99 to 1.01; 4996 women, high-quality evidence). For infant outcomes, there were no clear differences between groups (admission to neonatal intensive care unit: RR 0.98, 95% CI 0.80 to 1.21; 4989 infants, high-quality evidence; Apgar score less than seven at five minutes: RR 1.07, 95% CI 0.64 to 1.79; 4989 infants, moderate-quality evidence). AUTHORS' CONCLUSIONS Assessment and support in early labour does not have a clear impact on rate of caesarean section or instrumental vaginal birth, or whether the baby was born before arrival at hospital or in an unplanned home birth. However, evidence suggested that interventions may have an impact on reducing the use of epidural anaesthesia, labour augmentation and on increasing maternal satisfaction with giving birth. Evidence about the effectiveness of early labour assessment versus immediate admission was very limited and more research is needed in this area.
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Affiliation(s)
- Shinobu Kobayashi
- National Center for Child Health and DevelopmentDepartment of Health Policy10‐1, Okura 2 chomeTokyoTokyoJapan157‐8535
| | - Nobutsugu Hanada
- National Center for Child Health and DevelopmentDepartment of Health Policy10‐1, Okura 2 chomeTokyoTokyoJapan157‐8535
| | - Masayo Matsuzaki
- Osaka University Graduate School of MedicineDepartment of Children and Women's Health1‐7 YamadaokaSuitaOsakaJapan565‐0871
| | - Kenji Takehara
- National Center for Child Health and DevelopmentDepartment of Health Policy10‐1, Okura 2 chomeTokyoTokyoJapan157‐8535
| | - Erika Ota
- St. Luke's International University, Graduate School of Nursing SciencesGlobal Health Nursing10‐1 Akashi‐choChuo‐KuTokyoJapan104‐0044
| | - Hatoko Sasaki
- National Center for Child Health and DevelopmentDepartment of Health Policy10‐1, Okura 2 chomeTokyoTokyoJapan157‐8535
| | - Chie Nagata
- National Center for Child Health and DevelopmentDepartment of Education for Clinical Research2‐10‐1 OkuraSetagaya‐kuTokyoJapan157‐8535
| | - Rintaro Mori
- National Center for Child Health and DevelopmentDepartment of Health Policy10‐1, Okura 2 chomeTokyoTokyoJapan157‐8535
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Kennedy HP, Doig E, Tillman S, Strauss A, Williams B, Pettker C, Illuzzi J. Perspectives on Promoting Hospital Primary Vaginal Birth: A Qualitative Study. Birth 2016; 43:336-345. [PMID: 27500371 DOI: 10.1111/birt.12245] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND One in three women will deliver by cesarean, a procedure that can be life saving, but which also carries short- and long-term risks. There is growing interest in preventing primary cesarean deliveries, while optimizing the health of the mother and infant. The primary aim of this study was to use participatory action strategies and ethnographic interview data collected from diverse stakeholders in birth (caregivers, women, policymakers) about facilitators and barriers to the achievement of primary vaginal birth in first-time mothers in hospital settings. The secondary aim was to use the findings to identify strategies to promote primary vaginal birth and future areas of research. METHODS Individual and small group interviews were conducted with caregivers and policymakers (N = 79) and first-time mothers (N = 24) at a northeastern hospital. All interviews were audio-recorded, transcribed, and analyzed using Atlas.ti. RESULTS Four broad themes were identified: 1) preparation for childbirth, 2) early labor management, 3) caregiver knowledge and practice style, and 4) birth environment (physical, cultural/emotional). The first two were closely linked from caregivers' perspectives. If the woman was not prepared for childbirth, it was perceived she would be more likely to present to the hospital in early labor. Once there, it was hard to prevent admission and interventions. A woman's knowledge and confidence were perceived as powerful mediators for vaginal birth. CONCLUSION Caregivers and first-time mothers identified early labor management and childbirth preparation as important factors to promote primary vaginal birth in hospital settings. Both deserve further inquiry as potential strategies to decrease rising cesarean delivery rates.
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Affiliation(s)
| | - Eleanor Doig
- Yale University School of Nursing during the time of the study
| | | | - Amanda Strauss
- Yale University School of Nursing during the time of the study
| | - Beth Williams
- Yale University School of Nursing during the time of the study
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Merry L, Semenic S, Gyorkos TW, Fraser W, Gagnon AJ. Predictors of Unplanned Cesareans among Low-Risk Migrant Women from Low- and Middle-Income Countries Living in Montreal, Canada. Birth 2016; 43:209-19. [PMID: 27095259 DOI: 10.1111/birt.12234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research has yielded little understanding of factors associated with high cesarean rates among migrant women (i.e., women born abroad). The objective of this study was to identify medical, migration, social, and health service predictors of unplanned cesareans among low-risk migrant women from low- and middle-income countries (LMICs). METHODS We used a case-control research design. The sampling frame included migrant women from LMICs living in Canada less than 8 years, who gave birth at one of three Montreal hospitals between March 2014 and January 2015. Data were collected from medical records and by interview-administration of the Migrant-Friendly Maternity Care Questionnaire. We performed multi-variable logistic regression for low-risk women (i.e., vertex, singleton, term pregnancies) who delivered vaginally (1,615 controls) and by unplanned cesarean indicated by failure to progress, fetal distress, or cephalopelvic disproportion (233 cases). RESULTS Predictors of unplanned cesarean included being from sub-Saharan Africa/Caribbean (OR 2.37 [95% CI 1.02-5.51]) and admission for delivery during early labor (OR 5.43 [95% CI 3.17-9.29]). Among women living in Canada less than 2 years predictors were having a humanitarian migration classification (OR 4.24 [95% CI 1.16-15.46]) and admission for delivery during early labor (OR 7.68 [95% CI 3.12-18.88]). CONCLUSION Migrant women from sub-Saharan Africa/Caribbean and recently arrived migrant women with a humanitarian classification are at greater risk for unplanned cesareans compared with other low-risk migrant women from LMICs after controlling for medical factors. Strategies to prevent cesareans should consider the circumstances of migrant women that may be contributing to the use of unplanned cesareans in this population.
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Affiliation(s)
- Lisa Merry
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Sonia Semenic
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.,Women's Health Mission, McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - Theresa W Gyorkos
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, QC, Canada.,Division of Clinical Epidemiology, McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - William Fraser
- Centre hospitalier universitaire de Sherbrooke (CHUS) Research Centre, Sherbrooke, QC, Canada.,Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Anita J Gagnon
- Ingram School of Nursing, Montreal, QC, Canada.,The Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, QC, Canada
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Cervical Dilation on Admission in Term Spontaneous Labor and Maternal and Newborn Outcomes. Obstet Gynecol 2016; 127:481-488. [PMID: 26855106 DOI: 10.1097/aog.0000000000001294] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine associations between cervical dilation on admission and maternal and newborn outcomes in term spontaneous labor. METHODS This is a retrospective cohort study of 11,368 singleton, term (37-43 6/7 weeks of gestation) spontaneously laboring women delivering in 14 hospitals in Washington State between 2012 and 2014 using chart abstracted data from the Obstetrics Clinical Outcomes Assessment Program. Women with prior cesarean delivery or ruptured membranes on admission were excluded. Pregnancy history, cervical dilation on admission, and outcomes were analyzed. Associations between early (less than 4 cm cervical dilation) and late (4 cm or greater cervical dilation) admission and outcomes were examined using general linear models with a log-link stratifying by parity. Results were reported as adjusted relative risks (RRs) with 95% confidence intervals (CIs). RESULTS Early admission compared with late admission was associated with increased epidural use of 84.8% compared with 71.8% in nulliparous women and 66.3% compared with 53.1% in multiparous women (nulliparous RR 1.18, 95% CI 1.13-1.24; multiparous RR 1.25, 95% CI 1.18-1.32); oxytocin augmentation in 58.5% compared with 36.6% in nulliparous women and 45.9% compared with 20.7% in multiparous women (nulliparous RR 1.56, 95% CI 1.50-1.63; multiparous RR 2.14, 95% CI 1.87-2.44); and cesarean delivery of 21.8% compared with 14.5% in nulliparous women and 3.7% compared with 1.9% in multiparous women (nulliparous RR 1.50, 95% CI 1.32-1.70; multiparous women RR 1.95, 95% CI 1.47-2.57). Early admission was associated with increased neonatal intensive care unit admission for newborns of nulliparous women only (RR 1.38, 95% CI 1.01-1.89). Between 2012 and 2014, late admission increased 14.6% for nulliparous patients and 10.1% for multiparous patients, and the cesarean delivery rate decreased from 10.5% to 7.9% (P<.001) for all. CONCLUSION Early admission (less than 4 cm cervical dilation) is a risk factor for increased medical intervention and cesarean delivery.
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Tilden EL, Emeis CL, Caughey AB, Weinstein SR, Futernick SB, Lee CS. The Influence of Group Versus Individual Prenatal Care on Phase of Labor at Hospital Admission. J Midwifery Womens Health 2016; 61:427-34. [DOI: 10.1111/jmwh.12437] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hanley GE, Munro S, Greyson D, Gross MM, Hundley V, Spiby H, Janssen PA. Diagnosing onset of labor: a systematic review of definitions in the research literature. BMC Pregnancy Childbirth 2016; 16:71. [PMID: 27039302 PMCID: PMC4818892 DOI: 10.1186/s12884-016-0857-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 03/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnosis of labor onset has been described as one of the most important judgments in maternity care. There is compelling evidence that the duration of both latent and active phase labor are clinically important and require consistent approaches to measurement. In order to measure the duration of labor phases systematically, we need standard definitions of their onset. We reviewed the literature to examine definitions of labor onset and the evidentiary basis provided for these definitions. METHODS Five electronic databases were searched using predefined search terms. We included English, French and German language studies published between January 1978 and March 2014 defining the onset of latent labor and/or active labor in a population of healthy women with term births. Studies focusing exclusively on induced labor were excluded. RESULTS We included 62 studies. Four 'types' of labor onset were defined: latent phase, active phase, first stage and unspecified. Labor onset was most commonly defined through the presence of regular painful contractions (71% of studies) and/or some measure of cervical dilatation (68% of studies). However, there was considerable discrepancy about what constituted onset of labor even within 'type' of labor onset. The majority of studies did not provide evidentiary support for their choice of definition of labor onset. CONCLUSIONS There is little consensus regarding definitions of labor onset in the research literature. In order to avoid misdiagnosis of the onset of labor and identify departures from normal labor trajectories, a consistent and measurable definition of labor onset for each phase and stage is essential. In choosing standard definitions, the consequences of their use on rates of maternal and fetal morbidity must also be examined.
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Affiliation(s)
- Gillian E. Hanley
- />Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC Canada
- />Child and Family Research Institute, University of British Columbia, Vancouver, BC Canada
| | - Sarah Munro
- />Interdisciplinary Studies Department, University of British Columbia, Vancouver, BC Canada
- />School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
- />Child and Family Research Institute, University of British Columbia, Vancouver, BC Canada
| | - Devon Greyson
- />Interdisciplinary Studies Department, University of British Columbia, Vancouver, BC Canada
| | - Mechthild M. Gross
- />Midwifery Research and Education Unit, Hannover Medical School, Hanover, Germany
| | - Vanora Hundley
- />Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
| | - Helen Spiby
- />School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Patricia A. Janssen
- />School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
- />Child and Family Research Institute, University of British Columbia, Vancouver, BC Canada
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Cappelletti G, Nespoli A, Fumagalli S, Borrelli SE. First-time mothers’ experiences of early labour in Italian maternity care services. Midwifery 2016; 34:198-204. [DOI: 10.1016/j.midw.2015.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 06/09/2015] [Accepted: 09/03/2015] [Indexed: 11/26/2022]
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14
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Trojner Bregar A, Lucovnik M, Verdenik I, Jager F, Gersak K, Garfield RE. Uterine electromyography during active phase compared with latent phase of labor at term. Acta Obstet Gynecol Scand 2015; 95:197-202. [DOI: 10.1111/aogs.12818] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 10/09/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Andreja Trojner Bregar
- Department of Perinatology; Division of Obstetrics and Gynecology; University Medical Center Ljubljana; Ljubljana Slovenia
| | - Miha Lucovnik
- Department of Perinatology; Division of Obstetrics and Gynecology; University Medical Center Ljubljana; Ljubljana Slovenia
| | - Ivan Verdenik
- Department of Perinatology; Division of Obstetrics and Gynecology; University Medical Center Ljubljana; Ljubljana Slovenia
| | - Franc Jager
- Faculty of Computer and Information Science; University of Ljubljana; Ljubljana Slovenia
| | - Ksenija Gersak
- Department of Perinatology; Division of Obstetrics and Gynecology; University Medical Center Ljubljana; Ljubljana Slovenia
| | - Robert E. Garfield
- Department of Obstetrics and Gynecology; St Joseph's Hospital and Medical Center; Phoenix Arizona USA
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Pazandeh F, Huss R, Hirst J, House A, Baghban AA. An evaluation of the quality of care for women with low risk pregnanacy: The use of evidence-based practice during labour and childbirth in four public hospitals in Tehran. Midwifery 2015; 31:1045-53. [DOI: 10.1016/j.midw.2015.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 06/01/2015] [Accepted: 07/04/2015] [Indexed: 11/16/2022]
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16
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Carlson NS. Current resources for evidence-based practice, March/April 2015. J Midwifery Womens Health 2015; 60:214-9. [PMID: 25782855 DOI: 10.1111/jmwh.12299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Carlson NS. Current Resources for Evidence‐Based Practice, March/April 2015. J Obstet Gynecol Neonatal Nurs 2015; 44:279-87. [DOI: 10.1111/1552-6909.12558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Vogt SE, Silva KSD, Dias MAB. Comparison of childbirth care models in public hospitals, Brazil. Rev Saude Publica 2015; 48:304-13. [PMID: 24897052 PMCID: PMC4206134 DOI: 10.1590/s0034-8910.2014048004633] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 12/16/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To compare collaborative and traditional childbirth care models. METHODS Cross-sectional study with 655 primiparous women in four public health system
hospitals in Belo Horizonte, MG, Southeastern Brazil, in 2011 (333 women for
the collaborative model and 322 for the traditional model, including those
with induced or premature labor). Data were collected using interviews and
medical records. The Chi-square test was used to compare the outcomes and
multivariate logistic regression to determine the association between the
model and the interventions used. RESULTS Paid work and schooling showed significant differences in distribution
between the models. Oxytocin (50.2% collaborative model and 65.5%
traditional model; p < 0.001), amniotomy (54.3% collaborative model and
65.9% traditional model; p = 0.012) and episiotomy (collaborative model
16.1% and traditional model 85.2%; p < 0.001) were less used in the
collaborative model with increased application of non-pharmacological pain
relief (85.0% collaborative model and 78.9% traditional model; p = 0.042).
The association between the collaborative model and the reduction in the use
of oxytocin, artificial rupture of membranes and episiotomy remained after
adjustment for confounding. The care model was not associated with
complications in newborns or mothers neither with the use of spinal or
epidural analgesia. CONCLUSIONS The results suggest that collaborative model may reduce interventions
performed in labor care with similar perinatal outcomes.
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Affiliation(s)
- Sibylle Emilie Vogt
- Departamento de Enfermagem, Universidade Estadual de Montes Claros, Montes Claros, MG, Brasil
| | - Kátia Silveira da Silva
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Marcos Augusto Bastos Dias
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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Marowitz A. Caring for Women in Early Labor: Can We Delay Admission and Meet Women's Needs? J Midwifery Womens Health 2014; 59:645-650. [DOI: 10.1111/jmwh.12252] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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DeCesare JZ, Jackson JR. Centering Pregnancy: practical tips for your practice. Arch Gynecol Obstet 2014; 291:499-507. [PMID: 25315379 DOI: 10.1007/s00404-014-3467-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/09/2014] [Indexed: 11/24/2022]
Abstract
IMPORTANCE With increased access to care, current health delivery systems will need expansion to meet higher demands and needs. PURPOSE To define Centering Pregnancy and practical tips for implementation into both private and academic practices. METHODS/EVIDENCE ACQUISITION Evidence was gathered through literature reviews. RESULTS It was found that Centering Pregnancy offers a patient-centered, evidence-based approach to helping with access issues, as well as improving outcomes. CONCLUSIONS This article describes the benefits of Centering Pregnancy to the practice, the provider, and the patient. RELEVANCE Practical implementation tips will be offered, with suggestions for negating common implementation barriers.
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Affiliation(s)
- Julie Z DeCesare
- OBGYN Residency Program, Florida State University College of Medicine, Pensacola, Florida,
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21
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Janssen PA, Weissinger S. Women's perception of pre-hospital labour duration and obstetrical outcomes; a prospective cohort study. BMC Pregnancy Childbirth 2014; 14:182. [PMID: 24884415 PMCID: PMC4060864 DOI: 10.1186/1471-2393-14-182] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 05/23/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Progress during early labour may impact subsequent labour trajectories. Women admitted to hospital in latent phase (<3 cm cervical dilation) labour have been shown to be at higher risk of obstetrical interventions. METHODS We conducted a secondary analysis of data from a randomized controlled trial of 1247 healthy nulliparous women in spontaneous labour at term with a singleton fetus in cephalic presentation at seven hospitals in Southwestern British Columbia. We computed relative risks and their 95% confidence intervals to examine our primary outcome of cesarean section and secondary outcomes including obstetrical interventions and maternal and newborn outcomes according to women's perception of length of pre-hospital labour. Women were asked on admission to hospital how long they had been experiencing contractions prior to coming to hospital. RESULTS Women indicating that they had been in labour for 24 hours or longer at the time of hospital admission were at elevated risk for cesarean birth, relative risk (RR) 1.40, (95% Confidence Intervals 1.15-1.72), admission with a cervical dilation of 3 cm or less, RR 1.21 (1.07-1.36), more obstetrical interventions including continuous electronic fetal monitoring RR 1.11 (1.03-1.20), augmentation of labour RR 1.33 (1.23-1.44), use of narcotic RR 1.21 (1.06-1.37) and epidural analgesia RR 1.18 (1.09-1.28). Adverse neonatal outcomes did not differ apart from a significant increase in meconium-stained amniotic fluid RR 1.60 (1.09-2.35). CONCLUSIONS A single question asked of women on presentation to hospital was an important predictor of cesarean birth and may have utility in identifying women who would benefit from close observation and more active management of labour.
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Affiliation(s)
- Patricia A Janssen
- University of British Columbia, School of Population and Public Health, Child and Family Research Institute, 2206 East Mall, Vancouver, BC V6T-1Z3, Canada
| | - Sandra Weissinger
- University of British Columbia, Faculty of Medicine, Midwifery Program, Vancouver, Canada
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22
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Carlson NS, Lowe NK. Intrapartum Management Associated with Obesity in Nulliparous Women. J Midwifery Womens Health 2014; 59:43-53. [DOI: 10.1111/jmwh.12073] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Lundgren I, Andrén K, Nissen E, Berg M. Care seeking during the latent phase of labour--frequencies and birth outcomes in two delivery wards in Sweden. SEXUAL & REPRODUCTIVE HEALTHCARE 2013; 4:141-6. [PMID: 24216043 DOI: 10.1016/j.srhc.2013.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 08/28/2013] [Accepted: 09/03/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the frequency of women seeking care during the latent phase of labour at two delivery wards. Also, to investigate interventions during labour and birth outcomes in relation to parity and remaining in hospital or not during the latent phase. METHODS A retrospective, population-based cohort study in two delivery wards in Sweden. The sample was based on electronic childbirth records of all births with spontaneous onset. RESULTS Of 5797 women, 17.6% (n=1023) sought care during the latent phase. Of these, 57.8% (n=591) remained at the hospital, and 50.5% (n=517) had a prolonged latent phase. Nulliparae remaining in hospital had a lower rate of spontaneous vaginal births (p=0.007), more emergency Caesarean sections (CSs) (p<0.001) and more babies with Apgar <7 at 5 min (p=0.045) compared with those returning home. Nulliparae having a prolonged latent phase and remaining in hospital had fewer spontaneous vaginal births (p=0.045), more emergency CSs (p=0.002) and more babies with Apgar <7 at 5 min (p=0.023) compared with those returning home. For multiparous women with a previous vaginal birth, with or without prolonged latent phase, mode of delivery was not influenced by remaining in hospital or not. CONCLUSION These findings indicate a need for different guidelines for nulliparous and multiparous women seeking hospital care during the latent phase, and for special attention to be given to nulliparous with a prolonged latent phase remaining in hospital during the latent phase.
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Affiliation(s)
- Ingela Lundgren
- Head of Department, Institute of Health and Care Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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24
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Carlson NS, Lowe NK. A concept analysis of watchful waiting among providers caring for women in labour. J Adv Nurs 2013; 70:511-22. [DOI: 10.1111/jan.12209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - Nancy K. Lowe
- College of Nursing; University of Colorado Denver; USA
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25
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Nyman V, Bondas T, Downe S, Berg M. Glancing beyond or being confined to routines: labour ward midwives' responses to change as a result of action research. Midwifery 2013; 29:573-8. [PMID: 23566557 DOI: 10.1016/j.midw.2013.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 09/23/2012] [Accepted: 02/21/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE to examine midwives' responses to a changed approach in the initial encounters with women and their partners in the labour ward. DESIGN as part of a local project to improve hospital based childbirth care, Action Research (AR) was undertaken with midwives. To establish their beliefs, practices, and responses to change during the first cycle, 37 out of 57 midwives were interviewed. Data analysis was guided by interpretative description. SETTING a labour ward in western Sweden. FINDINGS two themes emerged: 'Glancing beyond routines' describes how the changed care approach enabled 'valuing the idea' and 'acquiring extended space to create a lingering presence'. The theme 'being confined to inherent routines' expresses 'resistance to the need for change' and a 'feeling of pressure to change'. KEY CONCLUSIONS the AR study design enabled the midwives to reflect on their routines and to transform tacit use-in-action to reflection-in-action. Midwives who persisted in being confined to inherent routines felt pressured by the change process. Others felt that the AR process granted them official licence to create chronological and emotional space in which they could 'be' and not just 'do'. IMPLICATIONS FOR PRACTICE to a greater or lesser extent, midwives in this setting had integrated relatively impersonal system-wide technocratic norms of childbirth into their belief systems and behaviours. The data suggest that a whole-system shift is necessary to enable caring, behaviours based on the formation of positive relationships to become the key driver of the first encounter on the labour ward.
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Affiliation(s)
- Viola Nyman
- NÄL-Hospital, Larketorpsvagen 5, 461 85 Trollhattan, Sweden.
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Abstract
Some intrapartum care practices promote vaginal birth, whereas others may increase the risk for cesarean section. Electronic fetal monitoring and use of the Friedman graph to plot and monitor labor progress are associated with increasing the cesarean section rate. Continuous one-to-one support and midwifery management are associated with lower cesarean section rates. This article reviews the evidence that links specific intrapartum care practices to cesarean section. Strategies that can be implemented in the current social and cultural setting of obstetrics today are recommended.
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Affiliation(s)
- Tekoa L King
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
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27
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Harris SJ, Janssen PA, Saxell L, Carty EA, MacRae GS, Petersen KL. Effect of a collaborative interdisciplinary maternity care program on perinatal outcomes. CMAJ 2012; 184:1885-92. [PMID: 22966055 DOI: 10.1503/cmaj.111753] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The number of physicians providing maternity care in Canada is decreasing, and the rate of cesarean delivery is increasing. We evaluated the effect on perinatal outcomes of an interdisciplinary program designed to promote physiologic birth and encourage active involvement of women and their families in maternity care. METHODS We conducted a retrospective cohort study involving 1238 women who attended the South Community Birth Program in Vancouver, Canada, from April 2004 to October 2010. The program offers comprehensive, collaborative, interdisciplinary care from family physicians, midwives, community health nurses and doulas to a multiethnic, low-income population. A comparison group, matched for neighbourhood of residence, maternal age, parity and gestational age at delivery, comprised 1238 women receiving standard care in community-based family physician, obstetrician and midwife practices. The primary outcome was the proportion of women who underwent cesarean delivery. RESULTS Compared with women receiving standard care, those in the birth program were more likely to be delivered by a midwife (41.9% v. 7.4%, p < 0.001) instead of an obstetrician (35.5% v. 69.6%, p < 0.001). The program participants were less likely than the matched controls to undergo cesarean delivery (relative risk [RR] 0.76, 95% confidence interval [CI] 0.68-0.84) and, among those with a previous cesarean delivery, more likely to plan a vaginal birth (RR 3.22, 95% CI 2.25-4.62). Length of stay in hospital was shorter in the program group for both the mothers (mean ± standard deviation 50.6 ± 47.1 v. 72.7 ± 66.7 h, p < 0.001) and the newborns (47.5 ± 92.6 v. 70.6 ± 126.7 h, p < 0.001). Women in the birth program were more likely than the matched controls to be breastfeeding exclusively at discharge (RR 2.10, 95% CI 1.85-2.39). INTERPRETATION Women attending a collaborative program of interdisciplinary maternity care were less likely to have a cesarean delivery, had shorter hospital stays on average and were more likely to breastfeed exclusively than women receiving standard care.
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Affiliation(s)
- Susan J Harris
- Department of Family Practice, University of British Columbia, Vancouver, BC
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Comparison of Labor and Delivery Care Provided by Certified Nurse-Midwives and Physicians: A Systematic Review, 1990 to 2008. Womens Health Issues 2012; 22:e73-81. [DOI: 10.1016/j.whi.2011.06.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 06/14/2011] [Accepted: 06/15/2011] [Indexed: 02/06/2023]
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Dowding DW, Cheyne HL, Hundley V. Complex interventions in midwifery care: Reflections on the design and evaluation of an algorithm for the diagnosis of labour. Midwifery 2011; 27:654-9. [DOI: 10.1016/j.midw.2009.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 09/28/2009] [Accepted: 11/08/2009] [Indexed: 10/19/2022]
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King TL. Can a vaginal birth after cesarean delivery be a normal labor and birth? Lessons from midwifery applied to trial of labor after a previous cesarean delivery. Clin Perinatol 2011; 38:247-63. [PMID: 21645793 DOI: 10.1016/j.clp.2011.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Women who undergo a trial of labor after a previous cesarean delivery (TOLAC) have special needs prenatally and during the intrapartum period. Counseling about the choice of TOLAC versus an elective repeat cesarean delivery involves complex statistical concepts. Prenatal counseling that is patient centered, individualized, and presented in a way that addresses the health literacy and health numeracy of the recipient encompasses best practices that support patient decision making. Evidence-based practices during labor that support vaginal birth and increase patient satisfaction are of special value for this population.
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Affiliation(s)
- Tekoa L King
- Department of Obstetrics, Gynecology and Reproductive Medicine, University of California San Francisco, CA, USA.
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31
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Abstract
Advanced practice nurses, including midwives, are well positioned to conduct, participate, or both in both basic and translational research to improve the outcomes and processes of perinatal care. This article contains suggestions for future research by perinatal advanced practice nurses, conceptualized around a scale to promote balance in outcomes. More research is needed in a number of areas, examples include collaborative practice, normal birth, and translation of the evidence concerning skin-to-skin practice. Health disparities; maternal, neonatal, and infant morbidity and mortality; formula feeding; and other vulnerabilities need more research to decrease these problematic outcomes. Advanced practice nurses are encouraged to be actively involved in perinatal research, to help confront and reduce health disparities, and to apply evidence in practice, broadly promoting wellness for women and their families.
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Abstract
The latent phase of labor is complex and not completely understood by modern science. Studies often ignore evaluation of this phase of labor because determination of onset is subjective. In this article, the definition and time parameters of latent phase labor are discussed, and generalized distinctions between prelabor and labor are evaluated. Outpatient relief measures for latent phase as well as inpatient medical interventions for prolonged latent phase of labor are reviewed. Recommendations for policy development are included along with a discussion about the need to consider the significance of time limits. For optimal outcomes, clinicians are encouraged to individualize a management plan that is made in collaboration with the laboring woman.
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Affiliation(s)
- Betsy Greulich
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM 87131-0001, USA.
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Lowe NK. A Review of Factors Associated With Dystocia and Cesarean Section in Nulliparous Women. J Midwifery Womens Health 2010; 52:216-28. [PMID: 17467588 DOI: 10.1016/j.jmwh.2007.03.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The primary indication for cesarean section in nulliparous women continues to be clinical diagnoses that fall under the rubric of dystocia. These diagnoses account for approximately two-thirds of all cesareans experienced by otherwise healthy nulliparous women. Contemporary research evidence suggests that this clinical phenomenon is complex and multifactorial. This review explores factors associated with the phenomenon of dystocia in the context of a conceptual model that considers women's physical and psychological characteristics, fetal factors, intrapartum care and interventions, assessments and clinical decision-making of health care providers, the sociopolitical environment, and the social and physical environment of childbirth. Clinical recommendations include emphasis on the maintenance of normal weight and weight gain during pregnancy, delaying the admission of nulliparous women to the hospital until active labor is established, avoiding elective induction for nulliparous women, keeping women well-hydrated and well-fed during labor, providing high-quality supportive care during labor, staying the course with effective treatment when dystocia is encountered, and a renewed emphasis on the psychobehavioral preparation of nulliparous women for the realities of labor.
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Affiliation(s)
- Nancy K Lowe
- Oregon Health & Science University, Portland, OR 97239-2941, USA.
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Lucovnik M, Kuon RJ, Chambliss LR, Maner WL, Shi SQ, Shi L, Balducci J, Garfield RE. Use of uterine electromyography to diagnose term and preterm labor. Acta Obstet Gynecol Scand 2010; 90:150-7. [PMID: 21241260 DOI: 10.1111/j.1600-0412.2010.01031.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Current methodologies to assess the process of labor, such as tocodynamometry or intrauterine pressure catheters, fetal fibronectin, cervical length measurement and digital cervical examination, have several major drawbacks. They only measure the onset of labor indirectly and do not detect cellular changes characteristic of true labor. Consequently, their predictive values for term or preterm delivery are poor. Uterine contractions are a result of the electrical activity within the myometrium. Measurement of uterine electromyography (EMG) has been shown to detect contractions as accurately as the currently used methods. In addition, changes in cell excitability and coupling required for effective contractions that lead to delivery are reflected in changes of several EMG parameters. Use of uterine EMG can help to identify patients in true labor better than any other method presently employed in the clinic.
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Affiliation(s)
- Miha Lucovnik
- Department of Obstetrics and Gynecology, St Joseph's Hospital and Medical Center, Phoenix, AZ 85004, USA
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35
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Nguyen USDT, Rothman KJ, Demissie S, Jackson DJ, Lang JM, Ecker JL. Epidural Analgesia and Risks of Cesarean and Operative Vaginal Deliveries in Nulliparous and Multiparous Women. Matern Child Health J 2009; 14:705-712. [DOI: 10.1007/s10995-009-0515-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gharoro EP, Enabudoso EJ. Labour management: An appraisal of the role of false labour and latent phase on the delivery mode. J OBSTET GYNAECOL 2009; 26:534-7. [PMID: 17000500 DOI: 10.1080/01443610600811094] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Achieving normal vaginal delivery requires an orderly transition from early labour to an established active labour. We analysed retrospectively the outcome of labour and the delivery mode based on the diagnosis of labour from the first examination of 3,130 parturients. A total of 1,847 (59.1%) delivered mothers had the first vaginal examination performed by the senior house officer (SHO). The majority (74.4%) of the mothers presented in established labour (cervical dilatation > or =4 cm), 25.6% in early labour, while 11.3% in latent phase. Patients who presented in established labour had a statistically significant higher spontaneous vertex delivery (SVD) rate (Pearson chi2 = 29.74, p = 0.000). A total of 62 parturients (17.5%) who presented in the latent phase and 204 (29.1%) in early labour had an unfavourable delivery mode; 46 had a caesarean section. There was a significant correlation between delivery mode and prolonged latent phase (Pearson correlation coefficient R = -0.066, p = 0.000). Linear regression analysis showed that the total number of VEs was the most significant predictor of the delivery mode of SVD (Regression beta-coefficient = 0.278, t = 10.37, p = 0.000). Early admissions in labour and a prolonged (abnormal) latent phase are significant predictors of difficult mode of delivery (poor labour outcome). We suggest that the first vaginal examination should be undertaken by the most experienced medical personal present at admission.
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Affiliation(s)
- E P Gharoro
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin City, Nigeria.
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Carlsson IM, Hallberg LRM, Odberg Pettersson K. Swedish women's experiences of seeking care and being admitted during the latent phase of labour: A grounded theory study. Midwifery 2009; 25:172-80. [PMID: 17600602 DOI: 10.1016/j.midw.2007.02.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Revised: 02/03/2007] [Accepted: 02/06/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE to gain a deeper understanding of how women who seek care at an early stage experience the latent phase of labour. DESIGN a qualitative interview study using the grounded theory approach. SETTING the study was conducted at a hospital in the southwestern part of Sweden with a range of 1600-1700 deliveries per year. The interviews took place in the women's homes two to six weeks after birth. PARTICIPANT eighteen Swedish women, aged 22-36, who were admitted to the labour ward while they were still in the latent phase of labour. FINDINGS 'Handing over responsibility' to professional caregivers emerged as the core category or the central theme in the data. The core category and five additional categories formed a conceptual model explaining what it meant to women being admitted in the early stage of labour and their experiences of the latent phase of labour. The categories, which all related to the core category, were labelled: (1) 'longing to complete the pregnancy,' (2) 'having difficulty managing the uncertainty,' (3) 'having difficulty enduring the slow progress,' (4) 'suffering from pain to no avail' and (5) 'oscillating between powerfulness and powerlessness.' CONCLUSIONS AND IMPLICATIONS FOR PRACTICE findings indicate that women being admitted to the labour ward in the latent phase of labour experienced a need for handing over responsibility for the labour, the well-being of the unborn baby, and for themselves. Midwives have an important role in assisting women with coping during the latent phase of labour, and in giving the women opportunity to hand over responsibility. This care should include validation of experienced pain and confirmation of the normality of the slow process, information and support.
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Affiliation(s)
- Ing-Marie Carlsson
- School of Social and Health Sciences, Halmstad University, PO Box 823, SE-301 18 Halmstad, Sweden.
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Cheyne H, Hundley V, Dowding D, Bland JM, McNamee P, Greer I, Styles M, Barnett CA, Scotland G, Niven C. Effects of algorithm for diagnosis of active labour: cluster randomised trial. BMJ 2008; 337:a2396. [PMID: 19064606 PMCID: PMC2601030 DOI: 10.1136/bmj.a2396] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the effectiveness of an algorithm for diagnosis of active labour in primiparous women with standard care in terms of maternal and neonatal outcomes. DESIGN Cluster randomised trial. SETTING Maternity units in Scotland with at least 800 annual births. PARTICIPANTS 4503 women giving birth for the first time, in 14 maternity units. Seven experimental clusters collected data from a baseline sample of 1029 women and a post-implementation sample of 896 women. The seven control clusters had a baseline sample of 1291 women and a post-implementation sample of 1287 women. INTERVENTION Use of an algorithm by midwives to assist their diagnosis of active labour, compared with standard care. Main outcomes Primary outcome: use of oxytocin for augmentation of labour. SECONDARY OUTCOMES medical interventions in labour, admission management, and birth outcome. RESULTS No significant difference was found between groups in percentage use of oxytocin for augmentation of labour (experimental minus control, difference=0.3, 95% confidence interval -9.2 to 9.8; P=0.9) or in the use of medical interventions in labour. Women in the algorithm group were more likely to be discharged from the labour suite after their first labour assessment (difference=-19.2, -29.9 to -8.6; P=0.002) and to have more pre-labour admissions (0.29, 0.04 to 0.55; P=0.03). CONCLUSIONS Use of an algorithm to assist midwives with the diagnosis of active labour in primiparous women did not result in a reduction in oxytocin use or in medical intervention in spontaneous labour. Significantly more women in the experimental group were discharged home after their first labour ward assessment. TRIAL REGISTRATION Current Controlled Trials ISRCTN00522952.
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Affiliation(s)
- Helen Cheyne
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling FK9 4LA.
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Abstract
BACKGROUND High cesarean birth rates are an international concern. The role of patterns of nursing care responsibility in preventing or contributing to cesarean births has been understudied. Our study sought to identify and describe indicators of continuity of nursing care responsibility during labor and to explore whether any association between these indicators and risk of cesarean birth could be identified empirically using an existing data set. METHODS We obtained a representative sample of low-risk women giving birth in an intrapartum unit at a university hospital in Quebec, Canada, with approximately 3,700 births per year. To be considered for inclusion, women needed to have been primiparous, carrying singletons in vertex position, and at 37 weeks' gestation or more. All women giving birth over a 13-month period were assessed for eligibility using the hospital's birth log. Data were extracted from the medical records of every second eligible birth, including information related to patterns of nursing care responsibility, maternal and infant characteristics, obstetric procedures, non-health-related risk factors, and type of birth. RESULTS Data on all variables of interest were available for 467 women. These women were cared for by 1-17 nurses, care responsibility changed hands for them from 1 to 28 times, and the mean length of labor for which the same nurse was responsible for a woman ranged from 10 to 1,045 minutes. After controlling for length of labor, maternal age, maternal height, infant weight, gestational age, induction, type of rupture, and epidural analgesia, the odds ratio for cesarean birth due to number of nurses was 1.17 (95% CI 1.04, 1.32); 1 or more nurses switch per 2 hours (i.e., number of times care responsibilities changed hands), 1.04 (95% CI 0.62, 1.74); and 33 percent or more of the labor attended by the same nurse, 0.74 (95% CI 0.42, 1.30). CONCLUSIONS An association was observed between number of nurses caring for a laboring woman and risk of cesarean delivery. Estimates of the association of other patterns of nursing care responsibility on cesarean birth were not sufficiently precise to draw conclusions.
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Affiliation(s)
- Anita J Gagnon
- McGill University School of Nursing and Department of Obstetrics and Gynecology, Montreal, Quebec, Canada
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Beebe KR, Humphreys J. Expectations, perceptions, and management of labor in nulliparas prior to hospitalization. J Midwifery Womens Health 2006; 51:347-353. [PMID: 16945782 DOI: 10.1016/j.jmwh.2006.02.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This ethnographic qualitative study was designed to explore the phenomenon of prehospitalization labor from the perspective of nulliparous women. Twenty-three women were interviewed in the early postpartum period using a semistructured interview guide. The participants recounted their experiences with labor onset recognition and management before being admitted to the hospital for birthing. Qualitative analyses included verbatim transcription of audiotaped interviews, line-by-line coding, and categorization of data into codes and categories. Interpretive analyses were validated with a collaborative research team and the participants themselves. The central theme that emerged from this study was confronting the relative incongruence between expectations and actual experiences. Supporting categories included: expectations about the labor experience, identifying labor onset, managing the physical and emotional responses to labor, supportive resources, and decision making about hospital admission. Early labor experiences in nulliparas offer insight into the contributions of both expectations and environment to adaptation in labor. Midwives and perinatal nurses are in a unique position to design interventions that support and reinforce laboring women's activities outside of the hospital setting.
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Affiliation(s)
- Kathleen R Beebe
- Kathleen R. Beebe, RNC, PhD, is Assistant Professor of Nursing at Dominican University of California in San Rafael, a former Post-Doctoral Fellow in the Center for Symptom Management at the University of California, San Francisco, and a Staff Nurse in the Labor and Delivery Unit at Santa Rosa Memorial Hospital, Santa Rosa, CA.Janice Humphreys, RN, PhD, CS, PNP, is Associate Professor of Nursing and Vice-Chair for Faculty Practice in the Department of Family Health Care Nursing at the University of California, San Francisco
| | - Janice Humphreys
- Kathleen R. Beebe, RNC, PhD, is Assistant Professor of Nursing at Dominican University of California in San Rafael, a former Post-Doctoral Fellow in the Center for Symptom Management at the University of California, San Francisco, and a Staff Nurse in the Labor and Delivery Unit at Santa Rosa Memorial Hospital, Santa Rosa, CA.Janice Humphreys, RN, PhD, CS, PNP, is Associate Professor of Nursing and Vice-Chair for Faculty Practice in the Department of Family Health Care Nursing at the University of California, San Francisco
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Rahnama P, Ziaei S, Faghihzadeh S. Impact of early admission in labor on method of delivery. Int J Gynaecol Obstet 2006; 92:217-20. [PMID: 16434043 DOI: 10.1016/j.ijgo.2005.12.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 12/12/2005] [Accepted: 12/17/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The effect of the timing of admission in labor unit on the method of delivery was evaluated in a cohort study. METHOD Four hundred and sixty six low-risk nulliparous women who were admitted in the labor unit in latent phase (group 1) were compared with 329 parturient women who were admitted in the active phase (group 2) to determine rate of and reasons for cesarean section, cervical dilation at the time of cesarean, and the rate of labor augmentation. RESULT The number of cesarean deliveries in group 1 was greater than that in the group 2 (301 vs 80, p<0.0001 ). The main reason for cesarean section in group 1 was dystocia, and in 2, fetal distress. The rate of cesarean section in the women who were augmented was greater in group 1 than in group 2 (54% vs 23%, p<0.0001). CONCLUSION Later admission in labor increases the rate of spontaneous vaginal delivery in low risk nulliparous women.
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Affiliation(s)
- P Rahnama
- Tarbiat Modarres University and Shahed University, Tehran, Iran
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Albers L. Commentary on “Impact of Collaborative Management and Early Admission in Labor on Method of Delivery”. J Obstet Gynecol Neonatal Nurs 2003. [DOI: 10.1111/j.1552-6909.2003.tb00139.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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