Date

5-2015

Document Type

Dissertation

Degree Name

Ph.D.

Institution

Oregon Health & Science University

Abstract

Background: Because of a preponderance of evidence that medically low-risk women admitted to the hospital during the latent phase of labor are at risk for increased interventions and procedures, such as cesarean delivery, without a corresponding improvement in maternal or neonatal outcomes, there is a need to quantify the consequences of latent labor hospital admission, explore interventions successful in decreasing latent labor admission, and to consider which theoretical framework may best support understanding how interventions might lead to decreased latent labor admission. Therefore, the overall purpose of this doctoral work was to better define the ramifications of latent labor hospital admission and, subsequently, to build knowledge regarding one intervention with the potential to decrease latent labor hospital admission. To achieve this purpose, this dissertation engaged four complementary research projects. These included: 1) estimating costs and outcomes incurred through latent labor hospital admission in the U.S.; 2) describing one antenatal care model with promise for decreasing latent labor hospital admission; 3) conducting comparative effectiveness research examining if participation in this antenatal care model is associated with decreasing latent labor hospital admission; and 4) synthesizing the literature regarding one theoretical framework which may influence how this antenatal intervention might decrease latent labor hospital admission. Methods: First, the cost-effectiveness and utility analysis included in this body of work estimated the annual outcomes and costs of latent labor hospital admission among a medically low-risk U.S. population. Second, review of the group prenatal care model and its association with important perinatal outcomes was provided. Third, a comparative effectiveness, retrospective, case control study was used to measure the association of participation with group prenatal care (vs. standard prenatal care) with phase of labor at hospital admission, with mode of delivery, and with indicators of maternal (e.g., estimated blood loss) and neonatal (e.g., Apgar scores) morbidity. Participants were medically low-risk pregnant and birthing women receiving nurse-midwifery care in an urban, University clinic and hospital in the Pacific Northwest region of the United States. Finally, the literature regarding how childbirth self-efficacy has been utilized for perinatal outcomes research was synthesized to inform the examination of this conceptual framework for potential fit with group prenatal care. Results: The results of this body of work demonstrated that the outcomes and cost consequences of admitting medically low-risk U.S. women to the hospital during latent labor are substantial, described the group prenatal care model and known associations, and demonstrated that women who participated in group prenatal were 73% more likely to be admitted in active labor (OR, 1.73; 95% CI, 1.0-2.9, P = 0.05) than women who participated in standard care with no statistically significant differences in morbidity outcomes between groups. Additionally this body of work successfully synthesized the literature regarding childbirth self-efficacy’s influence on perinatal outcomes research and conceptualized strengths and weaknesses of this theoretical framework for enlightening group prenatal care. Conclusions: Framed by the more frequent intervention and procedure rates as well as the increased maternal morbidity and cost consequences of admitting medically low-risk U.S. women to the hospital in latent labor, there is clear need for evidence that identifies interventions successful in safely promoting active labor hospital admission in this population. Group prenatal care is one intervention which has been associated with several improved perinatal outcomes. This dissertation found association between group prenatal care and both higher rates of active labor admission as well as approximately 1 cm more advanced cervical dilation at hospital admission without statistically significant differences in mode of delivery or morbidity outcomes. This dissertation study also proposed that childbirth self-efficacy is likely a core, but not singular, theoretical framework for conceptualizing group prenatal care function and effect. Findings from this body of work contribute to the body of literature defining risk-appropriate care for healthy pregnant women in the U.S.

Identifier

doi:10.6083/M46H4G5D

School

School of Nursing

Available for download on Tuesday, May 29, 2018

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