An Early Labor Assessment Program: A Randomized, Controlled Trial


  • Patricia S. McNiven RM, PhD,

    1. Patricia McNiven is a faculty member with the McMaster University Midwifery Education Programme and has a part-time midwifery practice in Hamilton,
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  • Jack I. Williams PhD,

    1. Jack Williams is a Professor at the University of Toronto and the Deputy Director-Research, Institute for Clinical Evaluative Sciences, Toronto,
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  • Ellen Hodnett RN, PhD,

    1. Ellen Hodnett is a Professor at the University of Toronto and Heather Reisman Chair in Perinatal Nursing Research, Toronto,
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  • Karyn Kaufman RM, DrPH,

    1. Karyn Kaufman is Professor and Chair of the McMaster Midwifery Education Programme, Hamilton,
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  • Mary E. Hannah MSc, MDCM, FRCSC

    1. Mary Hannah is the Director of the University of Toronto Maternal, Infant and Reproductive Health Research Unit, Toronto, Ontario, Canada
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  • This study was supported by a grant from The Perinatal Nursing Research Unit, University of Toronto, Toronto, Ontario, Canada.

Patricia McNiven, McMaster University Midwifery Education Programme, St. Joseph's Hospital, Fontbonne Building, F622, 50 Charleton Ave. East, Hamilton, Ont L8N 4A6, Canada.



Approximately 31 percent of cesarean deliveries in the United States and Canada are performed for dystocia. The aim of this study was to determine the effectiveness of early labor assessment to reduce cesarean birth rates for low-risk nulliparous women.


Two hundred and nine low-risk nulliparous women were randomly allocated to either the early labor assessment group or the direct admission to hospital group. Women in the early labor assessment group were evaluated and, if found to be in false or latent labor, were encouraged to go home or walk before admission to the labor unit. Those in the direct admission group were admitted to the labor unit without an assessment. Data were collected and analyzed about method of delivery, duration of labor, intrapartum interventions, and neonatal well-being. Women completed an evaluation of their experience in the early postpartum period.


Significant decreases occurred in duration of labor, use of epidural analgesia for pain, and use of oxytocin to augment labor in the early labor assessment group. These women evaluated their labor and birth experience more positively than women in the direct admission group. No significant differences were found in the frequency of cesarean section or instrumental vaginal delivery for the two groups.


Early labor assessment has the potential to reduce the number of women receiving oxytocin for augmentation, the rate of epidural analgesia for pain relief, and the duration of the active and second stages of labor, and to improve women's evaluations of their labor and birth experiences. (BIRTH 25:1, March 1998)