Pregnancy Outcomes Improved By 'Laborist' Obstetrical Care

Main Category: Pregnancy / Obstetrics
Article Date: 13 Feb 2013 - 1:00 PST


In a study to be presented on February 16 between 8 a.m., and 10 a.m. PST, at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting ™, in San Francisco, researchers will report findings that suggest shifting from a traditional model of obstetrical care to a laborist model improves pregnancy outcomes.

The "laborist" concept has been around for nearly a decade. In this model, obstetricians provide 24-hour a day on-site staffing of labor units. While it has been assumed that laborists improve obstetric care, there had been no studies done to test whether it does and how much it helps. Sindhu K. Srinivas, MD, MSCE and director of obstetrical services at the Hospital of the University of Pennsylvania, and her team worked with a non-profit organization, the National Perinatal Information Center and 24 of their member hospitals to determine the effectiveness of the laborist model.

"Many hospitals have moved toward adopting the laborist model, and it's critically important to determine whether it is improving pregnancy outcomes," explained Srinivas.

The study matched 8 laborist hospitals to 16 non-laborist hospitals accounting for location, volume of deliveries, the presence of a neonatal ICU and teaching status.

"The hospitals selected were diverse in terms of volume with 30 percent of the data coming from hospitals with more than 5,000 births a year, 44 percent from hospitals with 2,500 to 5,000 births per year and 25 percent from hospitals with less than a 2,500 births per year," said Srinivas.

The study showed that using the laborist model resulted in 15 percent fewer labor inductions, reduced maternal length of stay (0.09 days), and a significant reduction in preterm delivery (17 percent).

"We thought the laborist model would improve pregnancy outcomes and now we have data that demonstrates that," said Srinivas. We need to do more research to understand the mechanism by which these outcomes are improved but this is a start."

Abstract 79: Does the laborist model improve obstetric outcomes?

Objective: The "laborist" concept was introduced nearly a decade ago and was offered as a plausible model of improved obstetric (OB) care delivery based on the premise of continuous coverage without competing duties. While the use of this model has gained acceptance, no studies have evaluated whether this model of care altersOBoutcomes. Our objective was to evaluate the effectiveness of the laborist model compared to traditional OB care using select OB outcomes.

Study Design: A2010 survey of the 74 National Perinatal Information Center (NPIC) member hospitals demonstrated that nearly 40% utilize laborists. A cohort study was performed matching 8 laborist to 16 non-laborist hospitals on geography, volume, NICU, and teaching status based on the year laborists were implemented in laborist hospitals. Maternal and neonatal discharge data from all 24 hospitals was obtained. Investigators were blinded to hospital identity. A multiple time series statistical approach was used to evaluate the association between laborists and each outcome controlling for patient level characteristics, secular time trends, and baseline rates of each outcome at individual hospitals.

Results: 626,772 patients were evaluated (n=24 hospitals). Implementation of laborists resulted in fewer labor inductions (AOR 0.85 [0.82-0.88], p<0.001), reduced maternal prolonged length of stay (AOR 0.92 [0.89-0.94], p<0.001), and decreased term NICU admissions (AOR 0.75 [0.67-0.83], p_0.001). Additionally, there was a significant reduction in preterm delivery (AOR 0.82 [0.78-0.86], p<0.001). Fewer babies were born at_2500 g (AOR 0.94 [0.90-0.99] p<0.02). Concurrently, cesarean delivery rates were marginally increased (AOR 1.05 [1.02-1.08], p<0.002).

Conclusion: Implementation of laborists improved OB outcomes. This is the first study to evaluate and demonstrate that the laborist model has an impact on OB care. Further evaluation is needed to understand the mechanism by which laborists impact outcomes in order to guide care delivery recommendations that optimize the quality of OB care.

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