Labour assessment programs to delay admission to labour wards

Pregnant women coming into hospital with signs of labour, may benefit from formal assessment by a specialised program.

Hospital labour assessment programs are specialised programs that confirm whether women coming into hospital with signs of labour, are in active labour (with the neck of the womb opening), before going to labour ward. Women with full term pregnancies in these programs spend time in the assessment unit, walk in the grounds, go home or are admitted to labour ward. The review found they have shorter labour ward stays, feel more control and use fewer drugs to progress labour or for pain relief. There is not enough evidence on other effects on the mother or baby or on unplanned out-of-hospital birth.

Authors' conclusions: 

Labour assessment programs, which aim to delay hospital admission until active labour, may benefit women with term pregnancies.

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Background: 

The aim of labour assessment programs is to delay hospital admission until labour is in the active phase, and thereby to prevent unnecessary interventions in women who are not in established labour.

Objectives: 

The objective of this review was to assess the effects of labour assessment programs that aim to delay hospital admission until labour is in the active phase.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group trials register (January 2004).

Selection criteria: 

Randomised trials which compare labour assessment programs with direct admission to labour wards.

Data collection and analysis: 

Trial quality was assessed.

Main results: 

One study of 209 women was included. The trial was of excellent quality. Women who were randomised to the labour assessment unit spent less time in the labour ward (weighted mean difference -5.20 hours, 95% confidence interval -7.06, -3.34), were less likely to receive intrapartum oxytocics (odds ratio 0.45, 95% confidence interval 0.25 to 0.80) and analgesia (odds ratio 0.36, 95% confidence interval 0.16 to 0.78), than women who were admitted directly to the labour ward. Women in the labour assessment group reported higher levels of control during labour (weighted mean difference 16.00, 95% confidence interval 7.52 to 24.48). There is insufficient evidence to assess effects on rate of caesarean section and other important measures of maternal and neonatal outcome.

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