Does introducing a dedicated early labour area improve birth outcomes? A pre-post intervention study |
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| Institution: | 1. Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia;2. Mater Mothers’ Hospital, Mater Health Services, South Brisbane, Queensland, Australia;3. School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia;4. School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia;1. Flinders University, College of Nursing and Health Sciences, NSW, Australia;2. Western Sydney University, School of Nursing and Midwifery, NSW, Australia;3. Western Sydney University, School of Medicine, NSW, Australia;1. Department of Obstetrics & Gynaecology, Yulin First Hospital, Second Affiliated Hospital of Yanan University, Shanxi Province, China;2. The Hospital of Obstetrics & Gynaecology, Fudan University, China;3. Department of Obstetrics & Gynaecology, The University of Auckland, New Zealand;4. Wuxi Maternity and Children Hospital, Nanjing Medical University, 48 Huaishu Street, Wuxi, China;1. Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia;2. Gold Coast University Hospital, Griffith University, Gold Coast, Australia;3. SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia;4. Burnet Institute, Melbourne, Victoria, Australia;5. Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia;6. Institute for Social Science Research, The University of Queensland, Brisbane, Australia;7. Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia;8. University of Sydney, Sydney, NSW, Australia;9. Kolling Institute of Medical Research, University of Sydney, NSW, Australia;10. The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia;11. Safer Care Victoria, Department of Health and Human Services, Melbourne, Victoria, Australia;1. Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000, Australia;2. Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia;1. School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, 1 Geelong, Geringhap Street, 3220 Victoria, Australia;2. Centre for Quality and Patient Safety Research - Western Health Partnership, Sunshine Hospital, Furlong Road, St Albans, 3021 Victoria, Australia;3. Departments of Diabetes and Endocrinology, Royal Melbourne and Women''s Hospitals, Melbourne, 3050 Victoria, Australia;4. Monash Centre for Health Research & Implementation, Faculty of Medicine, Nursing and Health Sciences, School of Public Health & Preventive Medicine, Level 1, 43-51 Kanooka Grove, Locked Bag 29, Clayton, 3168 Victoria, Australia;5. Diabetes Education, Mercy Hospital for Women, 163 Studley Road, Heidelberg, 3084 Victoria, Australia;6. Centre for Nursing and Midwifery Research, James Cook University, 1 James Cook Drive, Townsville, 4811 Queensland, Australia;7. Townsville Hospital and Health Service, 100 Angus Drive, Townsville, 4811 Queensland, Australia;8. Diabetes Education Services, Sunshine Hospital, Furlong Road, St Albans, 3021 Victoria, Australia |
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| Abstract: | ProblemWomen 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.BackgroundInnovative models of early labour care have so far not improved birth outcomes.AimTo 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.MethodsPre-post intervention design, using routinely collected clinical data before and after the implementation of the reconfigured early labour service.FindingsThere 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.ConclusionChanging 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. |
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| Keywords: | Early labour Labour assessment Triage Hospital admission Epidural |
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