Challenges in the Triage Care of Low-Risk Laboring Patients: A Comparison of 2 Models of Practice

Rachel Blankstein Breman, Julia C. Phillippi, Ellen Tilden, Julie Paul, Erik Barr, Nicole Carlson

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)123-131
Number of pages9
JournalJournal of Perinatal and Neonatal Nursing
Volume35
Issue number2
DOIs
StatePublished - Apr 2021
Externally publishedYes

Keywords

  • labor outcomes
  • nurse-midwives
  • obstetrical triage

ASJC Scopus subject areas

  • Pediatrics
  • Critical Care
  • Maternity and Midwifery

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