Effect on Birth Outcomes of a Formalized Approach to Care in Hospital Labor Assessment Units: International, Randomized Controlled Trial
Bibliographic record
Abstract
High maternal anxiety contributes to a prolonged latent phase and intrapartum complications. Reframing negative thoughts of women in labor to positive ones may reduce anxiety and the likelihood of subsequent complications. This international multicenter, randomized, controlled trial evaluated the likelihood that formalized nursing and midwifery intervention in hospital labor assessment units could increase the rate of spontaneous vaginal birth and improve other maternal and neonatal outcomes. A total of 5002 pregnant women >34-weeks gestation experiencing contractions, but not in active labor, were enrolled in the trial from 2003 to 2007 in 20 North American and UK hospitals. The participants were randomized to receive usual nursing care (n = 2501) or structured care (n = 2501). Structured care was a formalized approach to assessment of and interventions for maternal emotional state, pain, and fetal position. A small increase was found in rate of spontaneous vaginal birth among women in the structured care group (64.0%, n = 1597) compared with the usual care controls (61.3%, n = 1533); the odds ratio was 1.12, with a 95% confidence interval of 0.96 to 1.27. Fewer women in the structured care group (n = 403, 19.5%) rated the helpfulness of nurses or midwives in the labor assessment unit as less than very helpful compared with those who received usual care (n = 544, 26.4%); odds ratio 0.67, with a 98.75% confidence interval of 0.50 to 0.85. Similarly, fewer women receiving structured care (n = 233, 11.3%) reported disappointment with the amount of attention received from staff than those who received usual care (n = 407, 19.7%). No differences were found for indicators of maternal and fetal health during the hospital stay, intrapartum interventions, or other measured outcomes. These findings indicate that structured approach to care in hospital labor assessment units does not significantly increase the likelihood of spontaneous vaginal birth, but is associated with increased maternal satisfaction.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".