University of Maryland School of Nursing, Baltimore (Dr Breman and Mr Barr); Vanderbilt School of Nursing, Nashville, Tennessee (Dr Phillippi); School of Nursing and School of Medicine, Oregon Health and Science University, Portland (Dr Tilden); Perinatal Behavioral Health Clinic, Weymouth, Massachusetts (Dr Paul); and Emory University School of Nursing, Atlanta, Georgia (Dr Carlson).
J Perinat Neonatal Nurs. 2021;35(2):123-131. doi: 10.1097/JPN.0000000000000552.
Triage and the timing of admission of low-risk pregnant women can affect the use of augmentation, epidural, and cesarean. The purpose of this analysis was to explore these outcomes in a community hospital by the type of provider staffing triage. This was a retrospective cohort study of low-risk nulliparous women with a term, vertex fetus laboring in a community hospital. Bivariate and multivariable statistics evaluated associations between triage provider type and labor and birth outcomes. Patients in this sample (N = 335) were predominantly White (89.5%), with private insurance (77.0%), and married (71.0%) with no significant differences in these characteristics by triage provider type. Patients admitted by midwives had lower odds of oxytocin augmentation (adjusted odds ratio [aOR] = 0.50, 95% confidence interval [CI] = 0.29-0.87), epidural (aOR = 0.29, 95% CI = 0.12-0.69), and cesarean birth (aOR = 0.308, 95% CI = 0.14-0.67), compared with those triaged by physicians after controlling for patient characteristics and triage timing. This study provides additional context to midwives as labor triage providers for healthy, low-risk pregnant individuals; however, challenges persisted with measurement. More research is needed on the specific components of care during labor that support low-risk patients to avoid medical interventions and poor outcomes.
分诊和低危孕妇入院时间的选择会影响催产素、硬膜外麻醉和剖宫产的使用。本分析的目的是通过分诊提供者类型来探讨社区医院的这些结局。这是一项对在社区医院分娩的低危初产妇、足月、头位胎儿的回顾性队列研究。采用双变量和多变量统计方法评估了分诊提供者类型与分娩结局之间的关联。该样本中的患者（N=335）主要为白人（89.5%），有私人保险（77.0%），已婚（71.0%），但这些特征在分诊提供者类型之间没有显著差异。由助产士收治的患者使用催产素催产的可能性较低（调整后的优势比 [aOR] = 0.50，95%置信区间 [CI] = 0.29-0.87），硬膜外麻醉（aOR = 0.29，95% CI = 0.12-0.69）和剖宫产（aOR = 0.308，95% CI = 0.14-0.67），而通过医生分诊的患者则没有，这在控制了患者特征和分诊时间后得到了证实。本研究为健康、低危孕妇提供了更多关于助产士作为分娩分诊提供者的背景信息；然而，在测量方面仍存在挑战。需要更多的研究来了解支持低危患者避免医疗干预和不良结局的分娩过程中的具体护理内容。
