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Early labour assessment and support at home: a randomized controlled trial
Patricia A Janssen1, Carolyn E Iker, Elaine A Carty
1Department of Health Care and Epidemiology and School of Nursing, University of British Columbia, Vancouver, BC, Canada.
Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
|September 13, 2003
Summary
Early labor assessment at home, compared to telephone triage, reduced hospital admissions during the latent labor phase and decreased analgesic use. Home-based care also led to fewer newborn nursery admissions, indicating improved neonatal outcomes.
Area of Science:
- Obstetrics and Gynecology
- Maternal and Child Health
- Nursing Research
Background:
- Standard hospital practice involved telephone triage for early labor assessment.
- This study explored alternative early labor support models.
- Evaluating childbirth outcomes based on labor assessment location is crucial for optimizing maternal and neonatal care.
Purpose of the Study:
- To compare childbirth outcomes between women receiving early labor assessment and support via home visits versus telephone triage.
- To determine the safety and acceptability of home-based early labor care.
- To assess the impact of early labor support on medical interventions and neonatal outcomes.
Main Methods:
- Prospective randomized controlled trial involving women in early labor seeking telephone advice.
- Participants were randomized to receive either a home visit from an obstetrical nurse or continued telephone triage.
- Childbirth outcomes, including labor progression, analgesia use, and neonatal admission rates, were compared between groups.
Main Results:
- Women receiving home care were significantly less likely to arrive at the hospital in the latent stage of labor (OR, 0.37; 95% CI, 0.19-0.72).
- The home care group showed significantly reduced use of narcotics (OR, 0.55; 95% CI, 0.32-0.96) and fewer neonatal admissions to a level II observation nursery (OR, 0.13; 95% CI, 0.03-0.60).
- A higher proportion of women in the home care group would recommend this type of care (P = 0.001).
Conclusions:
- Early labor assessment and support at home are associated with admission in the active phase of labor and reduced analgesia use.
- Home-based early labor care may lead to fewer neonatal admissions to observation nurseries, potentially due to reduced maternal analgesic exposure.
- Hospital-based obstetrical nurse-led early labor care at home is safe, acceptable, and offers potential benefits including reduced interventions and improved neonatal vigor.