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Caring for women in early labor: can we delay admission and meet women's needs?

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.