Impact of Collaborative Management and Early Admission in Labor on Method of Delivery
Article first published online: 9 MAR 2006
Journal of Obstetric, Gynecologic, & Neonatal Nursing
Volume 32, Issue 2, pages 147–157, March 2003
How to Cite
Jackson, D. J., Lang, J. M., Ecker, J., Swartz, W. H. and Heeren, T. (2003), Impact of Collaborative Management and Early Admission in Labor on Method of Delivery. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 32: 147–157. doi: 10.1177/0884217503252045
- Issue published online: 9 MAR 2006
- Article first published online: 9 MAR 2006
- Accepted: October 2002
- Assisted delivery;
- Certified nurse midwives;
- Cesarean section;
- Labor management;
- Latent phase
Objective: This study compared the effects of early admission in labor and perinatal care provider on delivery method. Higher spontaneous vaginal delivery rates for certified nurse midwives as compared with physicians have been reported in observational studies and randomized clinical trials. Certified nurse midwives, with their more expectant approach to labor management, would be expected to admit women later in labor than obstetricians.
Methods: Prospective cohort study of 2,196 low-risk pregnancies, with singleton, vertex infants admitted in spontaneous labor. Independent and joint effects of perinatal care provider and cervical dilation at admission on delivery method were evaluated. Confounding was addressed using restriction and multiple regression.
Results: Fewer (23.4%) women in collaborative care were admitted in early labor (< 4 cm cervical dilation) than women managed by obstetricians (95% CI =−27.6 to −19.2). Obstetrician care had 9% to 30% fewer spontaneous vaginal deliveries. Women admitted early in labor also had 6% to 34% fewer spontaneous vaginal deliveries. Evaluation of joint effects suggested that interaction between obstetrician provider and earlier admission increased the risk of operative delivery.
Conclusion: Later admission in labor (at 4 cm or greater cervical dilation) and management of perinatal care by certified nurse midwives in collaboration with obstetricians increased the rate of spontaneous vaginal delivery in low-risk women.