Challenges in the Triage Care of Low-Risk Laboring Patients: A Comparison of 2 Models of Practice.
Rachel Blankstein Breman, Julia C Phillippi, Ellen Tilden and 3 others
PMID 33900241WHAT IT FOUND
Low-risk nulliparous patients admitted to labor by midwives had fewer interventions and more vaginal births than those admitted by physicians, though all also received nursing care.
Key findings
01Patients admitted by midwives received less oxytocin augmentation (39.8% vs 55.1%) and fewer epidurals (77.0% vs 93.0%) than patients admitted by physicians.
02In adjusted analyses, midwife-admitted patients had about half the odds of oxytocin augmentation (aOR 0.50) and less than a third of the odds of epidural (aOR 0.29).
03Midwife-admitted patients also had lower adjusted odds of unplanned cesarean birth (aOR 0.31) and unplanned cesarean due to dystocia (aOR 0.29).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a retrospective, single-community-hospital study, so it may not apply to other hospitals or birth settings. Of 455 NTSV births, 335 met criteria; exclusions for scheduled admission or high-risk conditions may limit generalizability. Patients were predominantly White (89.5%), privately insured (77.0%), and married (71.0%), so the findings may not reflect other populations. The study compared triage admission by midwife or physician, but all patients also received nursing care, and records did not attribute intrapartum care practices to providers; the contribution of any single component cannot be separated. It did not measure continuous labor support, 1:1 nursing support, doula presence, patient preferences, contraction frequency, prelabor rupture of membranes, or racial concordance. For cesarean births, intrapartum provider type could not be identified, so outcomes after triage could not be fully attributed.
Declared interests
The authors disclosed no significant relationships or financial interest in commercial companies pertaining to the article.
The easy way to misread this
Do not read the lower intervention rates as proof that midwife triage caused them. This was an observational study, all patients also received nursing care, and records did not attribute intrapartum care practices to providers.