Open AccessChallenges in the Triage Care of Low-Risk Laboring Patients
Author(s) -
Rachel Blankstein Breman,
Julia C. Phillippi,
Ellen L. Tilden,
Julie Paul,
Erik Barr,
Nicole S. Carlson
Publication year - 2021
Publication title -
the journal of perinatal and neonatal nursing/journal of perinatal and neonatal nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.377
H-Index - 43
eISSN - 1550-5073
pISSN - 0893-2190
DOI - 10.1097/jpn.0000000000000552
Subject(s) - medicine , triage , odds ratio , staffing , context (archaeology) , emergency medicine , obstetrics , retrospective cohort study , confidence interval , psychological intervention , nursing , paleontology , biology
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.