Early Labour Assessment and Support at Home
Condition: Latent Phase Labour
MeSH terms: Obstetric Labor, Premature
Study type: Interventional

Summary: 
      To determine, among healthy first time mothers who are uncertain as to when to come to
      hospital in labour, if home visits by obstetrical nurses compared to telephone advice have an
      impact on reducing cesarean section rate.
    

Detailed description: 
      Nurses hired by the early labour and support at home (ELASH) study will be situated in the
      assessment/triage areas of each hospital to recruit subjects for 24 hours per day, seven days
      per week. After randomization, the study nurse will inform the triage nurses of which arm of
      the trial the patient has been assigned to. The triage nurses will then provide either of the
      following interventions.

      Telephone Triage In the telephone triage group (standard of care in both hospitals) women
      will be asked over the phone about the nature and frequency of contractions, presence of
      bloody show, status of membranes, parity, gestational age, and complications of pregnancy.
      Based on this information, the nurse will advise the woman as to whether or not to come to
      hospital. A detailed protocol which outlines telephone documentation, advice-giving and
      teaching is included in Appendix 1.

      Patients who are assessed by telephone not to be in active labour are advised not to come to
      hospital. In the event that they come anyway, they will receive a hands on assessment
      (similar to the home visit group) and if assessed not to be in active labour, they will be
      sent home and encouraged to return home and call in again if they feel that their labour is
      becoming active.

      Home visit by a Nurse Women randomised to the nurse visiting group will be told that a nurse
      will be leaving the hospital immediately. After obtaining directions to the residence and
      leaving this information with the charge nurse, the triage nurse will depart. The nursing
      assessment at home is identical to that which takes place in the triage area of the hospital.
      It includes a brief history, maternal vital signs, abdominal palpation, auscultation of the
      fetal heart rate, assessment of contractions, and an examination of the cervix. Comfort
      measures such as positioning, massage, showering, walking interspersed with resting, use of
      hot and cold packs, and relaxation techniques will be taught to the woman and her support
      persons as needed. These will be the same as those outlined in the protocols for telephone
      triage related to patient teaching. (Appendix 1) Standard advice as outlined in the telephone
      triage protocol will be given in regard to when to come in to hospital, such as if amniotic
      fluid is coloured, vaginal bleeding is occurring, contractions were more frequent than 2/10
      minutes or lasting longer than 60 seconds or simply too uncomfortable to manage at home.
      Women in this arm may be visited more than once. The nurse will be in telephone contact with
      the woman between visits. The nurse will advise the physician of the patient's status from
      the patient's home. Information related to the home visit is documented on the same form as
      the telephone documentation with the addition of information from "hands on" assessment,
      including maternal vital signs, abdominal palpation, fetal heart rate, assessment of cervical
      dilation and strength of contractions. If remaining at home after the nurse's visit, women
      will be taught how to contact the nurse on her cellular phone.
    

Intervention name(s): Labour assessment and support
Intervention type(s): Procedure
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: RCT; intervention study; labour management; assessment