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Randomized Controlled Trial
. 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

Ellen D Hodnett  1 , Robyn Stremler, Andrew R Willan, Julie A Weston, Nancy K Lowe, Kathleen R Simpson, William D Fraser, Amiram Gafni; SELAN (Structured Early Labour Assessment and Care by Nurses) Trial Group
Collaborators, Affiliations
Randomized Controlled Trial

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

Ellen D Hodnett et al. BMJ. .

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.

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Conflict of interest statement

Competing interests: None declared.

Figures

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Flow diagram for trial
See this image and copyright information in PMC

Comment in

References

    1. O’Driscoll K, Meagher D, Boylan P. Active management of labour: the Dublin experience. London: Mosby, 1993.
    1. Oxorn H. Oxorn-Foote human labor and birth. 5th ed. Norwalk, CT: Appleton and Lange, 1986.
    1. Friedman EA, Neff RK. Labor and delivery: impact on offspring. Littleton, MA: PSG, 1987.
    1. Chelmow D, Kilpatrick SJ, Laros RK. Maternal and neonatal outcomes after prolonged latent phase. Obstet Gynecol 1993;81:486-91. - PubMed
    1. Wuitchik M, Bakal D, Lipshitz J. The clinical significance of pain and cognitive activity in latent labor. Obstet Gynecol 1989;73:35-42. - PubMed

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