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BMJ. 2008 Aug 28;337:a1021. doi: 10.1136/bmj.a1021.

Effect on birth outcomes of a formalised approach to care in hospital labour assessment units: international, randomised controlled trial.

Abstract

OBJECTIVE:

To determine if a complex nursing and midwifery intervention in hospital labour assessment units would increase the likelihood of spontaneous vaginal birth and improve other maternal and neonatal outcomes.

DESIGN:

Multicentre, randomised controlled trial with prognostic stratification by hospital.

SETTING:

20 North American and UK hospitals.

PARTICIPANTS:

5002 nulliparous women experiencing contractions but not in active labour; 2501 were allocated to structured care and 2501 to usual care.

INTERVENTIONS:

Usual nursing or midwifery care or a minimum of one hour of care by a nurse or midwife trained in structured care, consisting of a formalised approach to assessment of and interventions for maternal emotional state, pain, and fetal position.

MAIN OUTCOME MEASURES:

Primary outcome was spontaneous vaginal birth. Other outcomes included intrapartum interventions, women's views of their care, and indicators of maternal and fetal health during hospital stay and 6-8 weeks after discharge.

RESULTS:

Outcome data were obtained for 4996 women. The rate of spontaneous vaginal birth was 64.0% (n=1597) in the structured care group and 61.3% (n=1533) in the usual care group (odds ratio 1.12, 95% confidence interval 0.96 to 1.27). Fewer women allocated to structured care (n=403, 19.5%) rated staff helpfulness as less than very helpful than those allocated to usual care (n=544, 26.4%); odds ratio 0.67, 98.75% confidence interval 0.50 to 0.85. Fewer women allocated to structured care (n=233, 11.3%) were disappointed with the amount of attention received from staff than those allocated to usual care (n=407, 19.7%); odds ratio 0.51, 98.75% confidence interval 0.32 to 0.70. None of the other results met prespecified levels of statistical significance.

CONCLUSION:

A structured approach to care in hospital labour assessment units increased satisfaction with care and was suggestive of a modest increase in the likelihood of spontaneous vaginal birth. Further study to strengthen the intervention is warranted.

TRIAL REGISTRATION:

Current Controlled Trials ISRCTN16315180.

PMID:
18755762
[PubMed - indexed for MEDLINE]
PMCID:
PMC2526182
Free PMC Article
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