TY - JOUR
T1 - Challenges in the Triage Care of Low-Risk Laboring Patients
T2 - A Comparison of 2 Models of Practice
AU - Breman, Rachel Blankstein
AU - Phillippi, Julia C.
AU - Tilden, Ellen
AU - Paul, Julie
AU - Barr, Erik
AU - Carlson, Nicole
N1 - Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/4
Y1 - 2021/4
N2 - 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.
AB - 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.
KW - labor outcomes
KW - nurse-midwives
KW - obstetrical triage
UR - http://www.scopus.com/inward/record.url?scp=85105760499&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85105760499&partnerID=8YFLogxK
U2 - 10.1097/JPN.0000000000000552
DO - 10.1097/JPN.0000000000000552
M3 - Article
C2 - 33900241
AN - SCOPUS:85105760499
SN - 0893-2190
VL - 35
SP - 123
EP - 131
JO - Journal of Perinatal and Neonatal Nursing
JF - Journal of Perinatal and Neonatal Nursing
IS - 2
ER -