Challenges in the Triage Care of Low-Risk Laboring Patients: A Comparison of 2 Models of Practice. Issue 2 (April 2021)

• Record Type: Journal Article
• Authors: Breman, Rachel Blankstein; Phillippi, Julia C.; Tilden, Ellen; Paul, Julie; Barr, Erik; Carlson, Nicole
• Is Part Of: Journal of perinatal & neonatal nursing. Volume 35:Issue 2(2021)
• Publication Date: 2021-04
• Subjects: labor outcomes -- nurse-midwives -- obstetrical triage; Maternity nursing -- Periodicals; Neonatal nursing -- Periodicals; Maternal health services -- Periodicals; Newborn infants -- Medical care -- Periodicals; 610.7362
• DOI: 10.1097/JPN.0000000000000552
• Languages: English
• ISSNs: 0893-2190

Abstract

Abstract : Triage and the timing of admission of low-risk pregnant women can affect the use of augmentation, epidural, and cesarean. The purpose of this analysis was to explore these outcomes in a community hospital by the type of provider staffing triage. This was a retrospective cohort study of low-risk nulliparous women with a term, vertex fetus laboring in a community hospital. Bivariate and multivariable statistics evaluated associations between triage provider type and labor and birth outcomes. Patients in this sample ( N = 335) were predominantly White (89.5%), with private insurance (77.0%), and married (71.0%) with no significant differences in these characteristics by triage provider type. Patients admitted by midwives had lower odds of oxytocin augmentation (adjusted odds ratio [aOR] = 0.50, 95% confidence interval [CI] = 0.29-0.87), epidural (aOR = 0.29, 95% CI = 0.12-0.69), and cesarean birth (aOR = 0.308, 95% CI = 0.14-0.67), compared with those triaged by physicians after controlling for patient characteristics and triage timing. This study provides additional context to midwives as labor triage providers for healthy, low-risk pregnant individuals; however, challenges persisted with measurement. More research is needed on the specific components of care during labor that support low-risk patients to avoid medical interventions and poor outcomes.