Assessment and support during early labour for improving birth outcomes
- PMID: 28426160
- PMCID: PMC6478316
- DOI: 10.1002/14651858.CD011516.pub2
Assessment and support during early labour for improving birth outcomes
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 This review updates and replaces these two reviews, which have become out of date.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.
Conflict of interest statement
Nobutsugu Hanada: none known. Masayo Matsuzaki: none known. Erika Ota: none known. Rintaro Mori: none known. Shinobu Kobayashi: none known. Kenji Takehara: none known. Hatoko Sasaki: none known. Chie Nagata: Chie Nagata's institution receives government funding from the Clinical Research Program for Child Health and Development, AMED, Japan to provide support for the Cochrane Pregnancy and Childbirth Satellite.
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- doi: 10.1002/14651858.CD011516
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References
References to studies included in this review
Cheyne 2008 {published data only}
-
- Cheyne H. A cluster randomised trial to investigate the use of a decision aid for the diagnosis of active labour in term pregnancy. National Research Register (www.nrr.nhs.uk) (accessed 6 July 2006) 2006.
Hodnett 2008 {published data only}
ISRCTN11168521 {published data only}
-
- ISRCTN11168521. Improving care at the primary/secondary interface: a trial of community‐based support in early labour. isrctn.com/ISRCTN11168521 Date first received 5 November 2004.
Janssen 2003 {published data only}
-
- Janssen PA, Iker CE, Carty EA. Early labour assessment and support at home: a randomized controlled trial. Journal of Obstetrics and Gynaecology Canada: JOGC 2003;25(9):734‐41. - PubMed
Janssen 2006 {published data only}
-
- Janssen PA, Desmarais SL. Women's experience with early labour management at home vs. in hospital: a randomised controlled trial. Midwifery 2013;29(3):190‐4. - PubMed
-
- Janssen PA, Still DK, Klein MC, Singer J, Carty EA, Liston RM, et al. Early labor assessment and support at home versus telephone triage: a randomized controlled trial. Obstetrics & Gynecology 2006;108(6):1463‐9. - PubMed
McNiven 1996 {published data only}
-
- McNiven P. Feasibility Study for a Multi‐centre Randomized Trial of the Effect of an Early Labour Assessment Program on the Rate of Cesarean Delivery. [thesis]. Toronto: University of Toronto, 1996.
-
- McNiven PS, Williams JI, Hodnett E, Kaufman K, Hannah ME. An early labor assessment program: a randomized, controlled trial. Birth 1998;25(1):5‐10. - PubMed
References to studies excluded from this review
Bonovich 1990 {published data only}
-
- Bonovich L. Recognizing the onset of labor. Journal of Obstetric, Gynecologic & Neonatal Nursing 1990;19:2:141‐5. - PubMed
Dowding 2011 {published data only}
-
- 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. - PubMed
Fenwick 2015 {published data only}
IRCT138903063078N4 {published data only}
-
- IRCT138903063078N4. The effects of consultation with mother in third trimester of pregnancy on pregnancy outcomes. en.search.irct.ir/view/3199 Date first received: 27 May 2010.
Janssen 2013 {published data only}
-
- Janssen PA, Desmarais SL. Development and psychometric properties of the Early Labour Experience Questionnaire (ELEQ). Midwifery 2013;29(3):181‐9. - PubMed
Jesse 2015 {published data only}
-
- Jesse DE, Gaynes BN, Feldhousen E, Newton ER, Bunch S, Hollon SD. Performance of a culturally tailored cognitive behavioral intervention (CBI) integrated in a public health setting to reduce risk of antepartum depression: a randomized clinical trial. Journal of Midwifery & Women's Health 2015;60(5):578‐92. - PMC - PubMed
Karp 2013 {published data only}
Khooshide 2015 {published data only}
Lumluk 2011 {published data only}
-
- Lumluk T, Kovavisarach E. Effect of antenatal education for better self‐correct diagnosis of true labor: a randomized control study. Journal of the Medical Association of Thailand 2011;94(7):772‐4. - PubMed
Magriples 2015 {published data only}
Memon 2015 {published data only}
Toohill 2014 {published data only}
Werner 2016 {published data only}
Zocco 2007 {published data only}
-
- Zocco J, Williams MJ, Longobucco DB, Bernstein B. A systems analysis of obstetric triage. Journal of Perinatal & Neonatal Nursing 2007;21(4):315‐22. - PubMed
Additional references
Alehagen 2005
-
- Alehagen S, Wijma B, Lundberg U, Wijma K. Fear, pain and stress hormones during childbirth. Journal of Psychosomatic Obstetrics & Gynecology 2005;26(3):153‐65. [PUBMED: 16295513] - PubMed
Austin 1999
-
- Austin DA, Calderon L. Triaging patients in the latent phase of labor. Journal of Nurse‐Midwifery 1999;44(6):585‐91. [PUBMED: 10634015] - PubMed
Bailit 2005
-
- Bailit JL, Dierker L, Blanchard MH, Mercer BM. Outcomes of women presenting in active versus latent phase of spontaneous labor. Obstetrics & Gynecology 2005;105(1):77‐9. [PUBMED: 15625145] - PubMed
Barnett 2008
-
- Barnett C, Hundley V, Cheyne H, Kane F. ‘Not in labour’: impact of sending women home in the latent phase. British Journal of Midwifery 2008;16:144‐53.
Baxter 2007
-
- Baxter J. Care during the latent phase of labour: supporting normal birth. British Journal of Midwifery 2007;15(12):765.
Carlsson 2009
-
- Carlsson IM, Hallberg LR, 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(2):172‐80. [PUBMED: 17600602] - PubMed
Chamberlain 2013
Cheyne 2007
-
- Cheyne H, Terry R, Niven C, Dowding D, Hundley V, McNamme P. 'Should I come in now?' : a study of women's early labour experiences. British Journal of Midwifery 2007;15(10):604‐9.
Dennis 2007a
Dennis 2007b
Dennis 2013
Fekete 2007
-
- Fekete EM, Antoni MH, Schneiderman N. Psychosocial and behavioral interventions for chronic medical conditions. Current Opinion in Psychiatry 2007;20(2):152‐7. [PUBMED: 17278914] - PubMed
Flamm 1998
-
- Flamm BL, Berwick DM, Kabcenell A. Reducing cesarean section rates safely: lessons from a "breakthrough series" collaborative. Birth 1998;25(2):117‐24. [PUBMED: 9668746] - PubMed
Friedman 1972
Gross 2003
-
- Gross MM, Haunschild T, Stoexen T, Methner V, Guenter HH. Women's recognition of the spontaneous onset of labor. Birth 2003;30(4):267‐71. [PUBMED: 14992158] - PubMed
Gross 2006
-
- Gross MM, Hecker H, Matterne A, Guenter HH, Keirse MJ. Does the way that women experience the onset of labour influence the duration of labour?. BJOG: an international journal of obstetrics and gynaecology 2006;113(3):289‐94. [PUBMED: 16487200] - PubMed
Hemminki 1986
-
- Hemminki E, Simukka R. The timing of hospital admission and progress of labour. European Journal of Obstetrics & Gynecology and Reproductive Biology 1986;22(1‐2):85‐94. [PUBMED: 3721051] - PubMed
Higgins 2011
-
- Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Hodnett 1996
-
- Hodnett E. Nursing support of the laboring woman. Journal of Obstetric, Gynecologic & Neonatal Nursing 1996;25(3):257‐64. [PUBMED: 8683362] - PubMed
Holmes 2001
-
- Holmes P, Oppenheimer LW, Wen SW. The relationship between cervical dilatation at initial presentation in labour and subsequent intervention. BJOG: an international journal of obstetrics and gynaecology 2001;108(11):1120‐4. [PUBMED: 11762649] - PubMed
Jackson 2003
-
- Jackson DJ, Lang JM, Ecker J, Swartz WH, Heeren T. Impact of collaborative management and early admission in labor on method of delivery. Journal of Obstetric, Gynecologic & Neonatal Nursing 2003;32(2):147‐57; discussion 158‐60. [PUBMED: 12685666] - PubMed
Klein 2004
-
- Klein MC, Kelly A, Kaczorowski J, Grzybowski S. The effect of family physician timing of maternal admission on procedures in labour and maternal and infant morbidity. Journal of Obstetrics and Gynaecology Canada: JOGC 2004;26(7):641‐5. [PUBMED: 15248933] - PubMed
Lawrence 2013
Lederman 1979
-
- Lederman RP, Lederman E, Work BA Jr, McCann DS. Relationship of psychological factors in pregnancy to progress in labor. Nursing Research 1979;28(2):94‐7. [PUBMED: 254068] - PubMed
Loughney 2006
-
- Loughney A, Collis R, Dastgir S. Birth before arrival at delivery suite: associations and consequences. British Journal of Midwifery 2006;14(4):204‐8.
Lui 2008
NICE 2007
-
- National Collaborating Centre for Women's and Children's Health. Normal labour: first stage. Intrapartum care, Care of Healthy Women and their Babies During Childbirth. London: RCOG Press at the Royal College of Obstetricians and Gynaecologists, 2007:138‐55. - PubMed
Petersen 2013
-
- Petersen A, Penz SM, Gross MM. Women's perception of the onset of labour and epidural analgesia: a prospective study. Midwifery 2013;29(4):284‐93. [PUBMED: 23079870] - PubMed
Rahnama 2006
-
- Rahnama P, Ziaei S, Faghihzadeh S. Impact of early admission in labor on method of delivery. International Journal of Gynecology & Obstetrics 2006;92(3):217‐20. [PUBMED: 16434043] - PubMed
RevMan 2014 [Computer program]
-
- The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Simkin 2011
-
- Simkin P, Ancheta R. The Labor Progress Handbook. Third Edition. Oxford: Wiley‐Blackwell, 2011.
Tierney 2005
-
- Tierney JF, Stewart LA. Investigating patient exclusion bias in meta‐analysis. International Journal of Epidemiology 2005;34(1):79‐87. [PUBMED: 15561753] - PubMed
Vos 2006
-
- Vos PJ, Visser AP, Garssen B, Duivenvoorden HJ, Haes HC. Effects of delayed psychosocial interventions versus early psychosocial interventions for women with early stage breast cancer. Patient Education & Counselling 2006;60(2):212‐9. [PUBMED: 16442463] - PubMed
Wuitchik 1989
-
- Wuitchik M, Bakal D, Lipshitz J. The clinical significance of pain and cognitive activity in latent labor. Obstetrics & Gynecology 1989;73(1):35‐42. [PUBMED: 2909041] - PubMed
References to other published versions of this review
Hanada 2015
Lauzon 1998
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