Promoting admission in active labor for childbirth: Triage dynamics and early labor lounge use

Abstract

Background: Cesarean birth is the most common surgery amongst women of reproductive age and nearly one third of term pregnant women will birth via cesarean. All professional organizations involved in intrapartum care are advocating for reducing the rate. Overwhelming evidence supports admission in active labor as an effective strategy to promote vaginal birth. Yet, how this evidence translates into decision-making during triage is unknown. Use of an early labor lounge (ELL) as an alternative to hospital admission is one care innovation that has not been evaluated. Purpose: The study aims were to: 1) examine the dynamics of triage from the clinician perspective, and 2) explore the facilitators and barriers to use of an ELL by clinicians. Patient use of the ELL and satisfaction was also explored. Methods: A mixed methods approach was used. Semi-structured interviews of clinical staff were conducted using a qualitative descriptive approach to explore the triage and admission process. A framework analysis utilized the domains of the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to ELL use. Surveys examined the satisfaction of women after childbirth; for women using the ELL, their experience was also assessed. Results: Interviews revealed the decision-making triad among the pregnant woman, the provider, and the triage nurse that influences admission. The category that emerged is "Admission of Low-Risk Pregnant Women Depends on Many Factors." Four themes revealed were: 1) woman's expectation about birth, 2) woman's coping with labor, 3) variation in care management, and, 4) maternal and fetal safety. Several barriers and facilitators to ELL use were identified. A higher proportion of ELL users received their prenatal care from a midwife, were informed about the ELL during their prenatal visits, and experienced vaginal deliveries. Conclusion: Obstetrical triage is a complex process with multiple factors to be considered when deciding to admit a woman in labor. The decision making process and the use of an ELL must be further examined in a variety of settings to get a better understanding of context, birth outcomes and satisfaction with birth.