Outcomes of Nulliparous Women With Spontaneous Labor Onset Admitted to Hospitals in Preactive Versus Active Labor

Abstract

Introduction The timing of when a woman is admitted to the hospital for labor care following spontaneous contraction onset may be among the most important decisions that labor attendants make as it can influence care patterns and birth outcomes. The aims of this study were to estimate the percentage of low-risk, nulliparous women at term who are admitted to labor units prior to active labor and to evaluate the effects of the timing of admission (i.e., pre-active versus active labor) on labor interventions and mode of birth. Methods Obstetrics data from low-risk, nulliparous women with spontaneous labor onset at term gestation (N = 216) were merged from two prospective studies conducted at three large, Midwestern hospitals. Baseline characteristics, labor interventions, and outcomes were compared between groups using Fisher’s exact and Mann-Whitney U tests, as appropriate. Likelihoods for oxytocin augmentation, amniotomy, and cesarean delivery were assessed by logistic regression. Results Of the sample of 216 low-risk nulliparous women, 114 (52.8%) were admitted in pre-active labor and 102 (47.2%) were admitted in active labor. Women admitted in pre-active labor were more likely to undergo oxytocin augmentation (84.2% and 45.1%, respectively; odds ratio (OR) 6.5, 95% confidence interval (CI) 3.43–12.27) but not amniotomy (55.3% and 61.8%, respectively; OR 0.8, 95% CI 0.44–1.32) when compared to women admitted in active labor. The likelihood of cesarean delivery was higher for women admitted before active labor onset (15.8% and 6.9%, respectively; OR 2.6, 95% CI 1.02–6.37). Discussion Many low-risk nulliparous women with regular, spontaneous uterine contractions are admitted to labor units before active labor onset, which increases their likelihood of receiving oxytocin and being delivered via cesarean section. An evidence-based, standardized approach for labor admission decision-making is recommended to decrease inadvertent admissions of women in pre-active labor. When active labor cannot be diagnosed with relative certainty, observation before admission to the birthing unit is warranted.

Place, provider and timing: Factors influencing the overuse of cesarean in low-risk primigravid women

“…Our findings support previous research that has shown that early admission in labor is associated with increased risk of CB [21] . We propose that causal association is rooted in the increased likelihood that women who are admitted earlier in labor are more likely to require more interventions to manage the labor process.…”

“…While the previously mentioned studies have shown that individual clinical interventions may lead to increased utilization of CB, interventions are rarely used in isolation during labor and a growing body of knowledge suggests that obstetrical interventions create a 'cascade' or cumulative effect associated with higher rates of surgical birth [11,[19][20][21][22] . In addition, moderate variation in CB rates across health systems have been reported for nulliparious women at term with singleton vertex presentations.…”

A balancing act in an unknown territory: A metasynthesis of first-time mothers׳ experiences in early labour

“…Women's sense of security when admitted to the hospital stands in contrast to research showing that admittance in early labour increases the likelihood of receiving oxytocin and giving birth via caesarean section (Bailit et al, 2005, Neal et al, 2014. It is thus questionable if a hospital ward is the optimal place for first-time women in early labour.…”

The Influence of Group Versus Individual Prenatal Care on Phase of Labor at Hospital Admission

“…Given evidence that many women seek hospital admission prior to more conservatively (Ͻ 4 cm) defined latent labor, 8,9,11,33,45 and challenges encountered with modifying early labor services, 46 delaying admission until further along the labor trajectory may prove a difficult goal to reach. Our findings propose that group prenatal care be explored as one safe, feasible, and cost-equivalent vehicle with potential to reach this goal while also seeking women's positive childbearing experiences and satisfaction.…”