Marowitz Amy
J Midwifery Womens Health. 2014 Nov-Dec;59(6):645-650. doi: 10.1111/jmwh.12252. Epub 2014 Oct 21.
Early labor poses challenges for women and their health care providers. Qualitative research shows that women may have a hard time determining when labor begins and when to seek care, are unprepared for the realities of this part of labor, find it difficult to manage early labor at home, and often desire admission before active labor. Yet a primary clinical management goal in early labor is the delay of admission until active labor. This is based on evidence that admission before active labor is associated with higher rates of cesarean birth and interventions such as oxytocin augmentation and epidural analgesia. The reasons for the higher rates of intervention are not known, but may include the effect of the hospital environment, inherent problems with the labor, misdiagnosis of active labor, provider impatience, and institutional policies not compatible with the care of women in early labor. Programs to decrease early admission have had mixed results. Thus, a tension exists between the goal of delaying admission until active labor in order to decrease the incidence of unnecessary interventions and women's difficulty with managing this part of labor at home. In this case report, the midwife provides a significant amount of care and support before admission through phone calls and outpatient visits; however, admission occurred prior to active labor. Supportive care continued in the hospital, and the labor and birth occurred with little intervention. Strategies that can be used to optimize the management and experience of early labor are presented.
早产对产妇及其医护人员来说都颇具挑战。定性研究表明，产妇可能难以确定何时开始分娩以及何时寻求医疗护理，对分娩这一阶段的实际情况毫无准备，发现在家应对早产很困难，并且常常希望在进入活跃期分娩前就入院。然而，早产阶段的一个主要临床管理目标是推迟入院，直至进入活跃期分娩。这是基于有证据表明，在进入活跃期分娩前入院与剖宫产率升高以及诸如催产素加强宫缩和硬膜外镇痛等干预措施相关。干预率较高的原因尚不清楚，但可能包括医院环境的影响、分娩本身存在的问题、对活跃期分娩的误诊、医护人员的不耐烦以及与早产产妇护理不相容的机构政策。降低过早入院率的项目效果不一。因此，在为降低不必要干预的发生率而将入院推迟至活跃期分娩的目标与产妇在家应对这一分娩阶段的困难之间存在矛盾。在本病例报告中，助产士在入院前通过电话和门诊就诊提供了大量护理和支持；然而，产妇在进入活跃期分娩前就入院了。在医院里支持性护理仍在继续，分娩过程中几乎没有进行干预。本文介绍了可用于优化早产管理及体验的策略。
