Identifying when active labour starts: can we improve the judgement?

Abstract

First paragraph: There is growing concern about rising intervention rates in childbirth. In the UK a recent consensus statement, Making normal birth a reality, highlighted the importance of avoiding interventions where possible (Maternity Care Working Party 2007), yet intervention may be increased simply by early admission to the delivery suite. Several studies have identified that women admitted when they are not yet in active labour experience increased intervention in labour compared to those who are admitted in the active phase (Hemminki & Simukka 1986, Holmes et al 2001, Jackson et al 2003, Klein et al 2003). This poses a considerable problem, both for women and for the health service. The Birthrate audit first published over ten years ago (Ball & Washbrook 1996) reported that around one third of women admitted to UK labour wards were subsequently found not to be in labour. More recent publications have suggested that admission of women who are not yet in labour or who are in early labour is a continuing trend, despite the introduction of a range of initiatives, such as triage or telephone triage (Spiby et al 2006).