Timing of hospital admission at first childbirth: A prospective cohort study

BACKGROUND AND AIMS: It is difficult for women in labor to determine when best to present for hospital admission, particularly at first childbirth. While it is often recommended that women labor at home until their contractions have become regular and ≤ 5-minutes apart, little research has investigated the utility of this recommendation. This study investigated the relationship between timing of hospital admission, in terms of whether women’s labor contractions had become regular and ≤ 5-minutes apart before admission, and labor progress. METHODS: This was a cohort study of 1,656 primiparous women aged 18–35 years with singleton pregnancies who began labor spontaneously at home and delivered at 52 hospitals in Pennsylvania, USA. Women who were admitted before their contractions had become regular and ≤ 5-minutes apart (early admits) were compared to those who were admitted after (later admits). Multivariable logistic regression models were used to assess associations between timing of hospital admission and active labor status on admission (cervical dilation 6–10 cm), oxytocin augmentation, epidural analgesia and cesarean birth. RESULTS: Nearly two-thirds of the participants (65.3%) were later admits. These women had labored for a longer time period before admission (median, interquartile range [IQR] 5 hours (3–12 hours)) than the early admits (median, (IQR) 2 hours (1–8 hours), p < 0.001); were more likely to be in active labor on admission (adjusted OR [aOR] 3.78, 95% CI 2.47–5.81); and were less likely to experience labor augmentation with oxytocin (aOR 0.44, 95% CI 0.35–0.55); epidural analgesia (aOR 0.52, 95% CI 0.38–0.72); and cesarean birth (aOR 0.66, 95% CI 0.50–0.88). CONCLUSIONS: Among primiparous women, those who labor at home until their contractions have become regular and ≤ 5-minutes apart are more likely to be in active labor on hospital admission and less likely to experience oxytocin augmentation, epidural analgesia and cesarean birth.