<\/p>\n\n\n\n
When a pregnant woman is admitted <\/a>to the hospital before<\/em> active labor starts (6cm is the benchmark for active labor as established<\/a> by the American College of Obstetricians and Gynecologists in 2014), her risk of having a C-section <\/a>goes up<\/a> [1][2][3]. This is a result of multiple factors, among them a slowdown of the hormones that drive labor forward, due to being in an unfamiliar, not-homelike environment. <\/p>\n\n\n\n When her labor slows while she\u2019s at the hospital, her labor is more likely to be <\/a>put on a “timeline,” and she’ll be more likely to be offered multiple interventions<\/a> to “speed things up” as opposed to a “watchful waiting” that respects, allows, and facilitates her body\u2019s timing and need for warmth, security, and support [4]. Furthermore, as a 2017 committee opinion <\/a>of the American College of Obstetricians and Gynecologists acknowledges, \u201cMany common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor\u201d [5]. The end result can be a medically unnecessary C-section, with its attendant risks. <\/p>\n\n\n\n Unfortunately, once a woman has had one<\/em> C-section, she may be encouraged to have another if she conceives again. Not all medical practitioners are on board with and comfortable in recommending vaginal birth after Cesarean (VBAC)<\/a>. What\u2019s more, the risk of rare but serious complications such as uterine rupture<\/a> naturally ticks up with each additional C-section, potentially limiting a family\u2019s size out of an abundance of caution for the mother\u2019s health.<\/p>\n\n\n\n But what if an early labor lounge (ELL) could disrupt or prevent the cascade of interventions in labor, and change a family\u2019s whole future, by keeping the mother off the hospital’s timeline in the first place? What if broader incorporation of ELLs could help bring the U.S. C-section rate of 33% of births<\/a> in line with the World Health Organization\u2019s target <\/a>of 10-15% of births?<\/p>\n\n\n\n But what if an early labor lounge (ELL) could disrupt the cascade of interventions and change a family\u2019s whole future, by keeping the mother off the hospital’s timeline in the first place?<\/p><\/blockquote><\/figure>\n\n\n\n The existing research on early labor lounges centers on a community hospital in Massachusetts that welcomes 3,500 babies per year, with 25% of births attended by midwives. According to the hospital\u2019s website<\/a>, ELLs may be particularly important for first-time moms, who are more likely to have longer early labor than moms who have had at least one child. Any low-risk laboring woman who is not yet in active labor (6cm dilated or beyond) and is not receiving IV pain medication or anesthesia (since these would require hospital admission for fetal monitoring) could be a candidate. <\/p>\n\n\n\n The Massachusetts hospital\u2019s website even mentions the possibility of early labor lounge use for low-risk laboring women who are being induced<\/a>, though presumably this would reference non-medication induction<\/a>, since any woman receiving Pitocin would need to have fetal monitoring. <\/p>\n\n\n\n The core concept of an early labor lounge is having a physical place where pregnant women in the early stages of labor can be close to the Labor & Delivery unit (in case something changes quickly), but not formally admitted to the hospital. The goal is to remove any pressure to progress at a certain pace. What this looks like in practicality can vary. <\/p>\n\n\n\n The core concept of an early labor lounge is having a physical place where pregnant women in the early stages of labor can be close to the Labor & Delivery unit (in case something changes quickly), but not formally admitted to the hospital. The goal is to remove any pressure to progress at a certain pace.<\/p><\/blockquote><\/figure>\n\n\n\n The website for the Massachusetts hospital mentioned above lays out the details of what an ELL could look like. \u201cIt is a home-like, relaxing space with low-lighting, soothing music, yoga mats, birthing balls, comfortable chairs and rebozos. Additionally, there are heating packs, tennis balls and rolling pins for massage and tools for acupressure.\u201d If you’ve ever worked with a doula<\/a>, you’ll recognize the value of these different tools and tweaks to the environment. Early labor lounges<\/a> offer these benefits to laboring women with or without a doula (though a doula would still arguably be helpful to emotionally and\/or physically coach a mother and her support person) [6]. <\/p>\n\n\n\n This 2019 research article<\/a> about the Massachusetts hospital (and a study<\/a> of the clinicians who staffed and encouraged women to use it) had a main lounge area and then several \u201cwalking stations\u201d throughout the hospital. The 20 by 12 foot lounge area has yoga mats, hot packs, a shower, acupressure, and a \u201cwell-stocked nutrition area,\u201d along with instructions for each tool or area [7]. We\u2019ve touched before on the value of eating and drinking during labor<\/a> (especially early labor, which may last hours or more than a day), though many hospitals retain outdated policies or order sets (orders automatically placed when a laboring woman is admitted to the hospital) about not eating or only consuming \u201cclear liquids\u201d during labor. <\/p>\n\n\n\n This 2017 poster presentation<\/a> about the same community hospital mentioned in the 2019 study additionally references being \u201cdesigned for activities that promote labor progress, including yoga, birthing balls, meditation, and rebozos.\u201d <\/p>\n\n\n\n Kaiser Permanente healthcare system in California, whose locations welcome 40,000 babies each year, has instituted a \u2018guided walking and movement tour<\/a>,\u2019 through their halls for women who are in early labor or women in any stage of labor who are trying to get their baby into optimal position. The walk prompts women to move through various positions, including lunges, squats, hip circles, and more. <\/p>\n\n\n\n 2021 research<\/a> found that low-risk women without an epidural were less likely to end up with a C-section if they were in upright positions during early labor (think walking, movement, position changes). Early labor lounges support these very things [8]. Preliminary data, like this small 2021 trial<\/a>, suggests that, when paired with other initiatives, early labor lounges can help prevent early labor admissions and ensure that evidence-based guidelines are being followed [9]. In the 2019 community hospital study<\/a>, 29 women out of the 67 in the study utilized the early labor lounge, and just 7% went on to have Cesarean sections [2].\u00a0<\/p>\n\n\n\n Importantly, ELLs normalize the possibility that a woman ends up going home and returning another time. One nurse interviewed about the community hospital ELL observed<\/a>, \u201cI think the midwives have helped support the decision that it’s okay to go home after using the lounge. These were the words of one of the midwives the other day. \u2018You might end up driving home and pulling in your driveway and deciding you have to turn around and come back. That’s okay. At this point we could say, after two exams, two hours apart, that you are not in active labor.\u2019\u201d<\/p>\n\n\n\n There are multiple potential roadblocks for hospitals considering implementing an early labor lounge. Among them are the establishment of protocols on when to refer laboring women to an ELL, and the education of all staff and referring practitioners (think midwives and OB\/GYN practices who have privileges at the hospital) on how to refer. <\/p>\n\n\n\n There are also questions about how to bill for ELL use when women have not yet been admitted to the hospital, ensuring that adequate staff are available (even as maternity care deserts<\/a> are on the rise across the country and many hospitals are dealing with critical nurse shortages), and concerns that ELLs will be underutilized [10]. Similar to billing questions, there are unknowns around who assumes liability in case \u201csomething should happen\u201d during the time a woman is using an ELL. <\/p>\n\n\n\n But the core question is whether women couldn\u2019t just do most of the same things at home? For that, the answer is \u201cit depends.\u201d A woman who has adequate physical and emotional support, especially if she has had children before and\/or has the help of a doula, could very probably labor at home until she is in active labor. <\/p>\n\n\n\n However, early labor lounges promote evidence-based best practices that are, at least theoretically, available to every<\/em> low-risk woman, whether or not she has the financial means or access to a doula. What\u2019s more, the presence of an early labor lounge within a hospital\u2019s campus says something important about their commitment to driving down C-section rates, which is universally a good sign. <\/p>\n\n\n\n Certainly, more research is needed to demonstrate on paper just how effective ELLs are in reducing early labor admissions and secondarily in reducing C-sections. Even if a woman plans to labor at home as long as possible, the existence of an ELL in her local area may help guide her decision on which hospital will be most likely to facilitate a vaginal birth. <\/p>\n\n\n\n Fortunately, even if a local hospital doesn\u2019t have an ELL, there are other options to help prevent unnecessary C-sections. Doulas are proven to improve vaginal birth rates, as is a midwifery model of care<\/a>. Ensuring that only medically necessary inductions are done is another way to help prevent down-the-line interventions that could lead to C-sections. Birth centers<\/a> can be another great option for low-risk mothers. An increasing number of women are also choosing homebirth<\/a>. <\/p>\n\n\n\n At the end of the day, the vast majority of women continue to give birth in a hospital setting. When it comes to ensuring the broadest possible access to care that facilitates vaginal births, ELLs appear to be a step in the right direction. <\/p>\n\n\n\nWho can use an early labor lounge?<\/span><\/h2>\n\n\n\n
What\u2019s in an early labor lounge?<\/span><\/h2>\n\n\n\n
What are the benefits of an early labor lounge?<\/span><\/h2>\n\n\n\n
Why doesn\u2019t every hospital have an early labor lounge?<\/span><\/h2>\n\n\n\n
Can\u2019t women do ELL activities at home? <\/span><\/h3>\n\n\n\n
Besides early labor lounges, how else can we drive down C-section rates?<\/span><\/h2>\n\n\n\n
References<\/strong><\/span><\/h4>\n\n\n\n[1] Mikolajczyk RT, Zhang J, Grewal J, Chan LC, Petersen A, Gross MM. Early versus Late Admission to Labor Affects Labor Progression and Risk of Cesarean Section in Nulliparous Women. Front Med (Lausanne). 2016 Jun 27;3:26. doi: 10.3389\/fmed.2016.00026. PMID: 27446924; PMCID: PMC4921453.<\/p>\n\n\n\n[2] Breman RB, Low LK, Paul J, Johantgen M. Promoting active labor admission: Early labor lounge implementation barriers and facilitators from the clinician perspective. Nurs Forum. 2020 Apr;55(2):182-189. doi: 10.1111\/nuf.12414. Epub 2019 Nov 19. PMID: 31746009.<\/p>\n\n\n\n[3] Seravalli V, Strambi N, Castellana E, Salamina MA, Bettini C, Di Tommaso M. Hospital Admission in the Latent versus the Active Phase of Labor: Comparison of Perinatal Outcomes. Children (Basel). 2022 Jun 20;9(6):924. doi: 10.3390\/children9060924. PMID: 35740861; PMCID: PMC9221807.<\/p>\n\n\n\n[4] Neal JL, Lamp JM, Buck JS, Lowe NK, Gillespie SL, Ryan SL. Outcomes of nulliparous women with spontaneous labor onset admitted to hospitals in preactive versus active labor. J Midwifery Womens Health. 2014 Jan-Feb;59(1):28-34. doi: 10.1111\/jmwh.12160. Epub 2014 Feb 11. PMID: 24512265; PMCID: PMC4104945.<\/p>\n\n\n\n[5] Committee on Obstetric Practice. Committee Opinion No. 687: Approaches to Limit Intervention During Labor and Birth. Obstet Gynecol. 2017 Feb;129(2):e20-e28. doi: 10.1097\/AOG.0000000000001905. PMID: 28121831.<\/p>\n\n\n\n[6] Paul JA, Yount SM, Breman RB, LeClair M, Keiran DM, Landry N, Dever K. Use of an Early Labor Lounge to Promote Admission in Active Labor. J Midwifery Womens Health. 2017 Mar;62(2):204-209. doi: 10.1111\/jmwh.12591. Epub 2017 Mar 30. PMID: 28371224.<\/p>\n\n\n\n[7] Breman RB, Low LK, Paul J, Johantgen M. Promoting active labor admission: Early labor lounge implementation barriers and facilitators from the clinician perspective. Nurs Forum. 2020 Apr;55(2):182-189. doi: 10.1111\/nuf.12414. Epub 2019 Nov 19. PMID: 31746009.<\/p>\n\n\n\n
References Continued<\/span><\/h4>\n\n\n\n[8] Kibuka M, Price A, Onakpoya I, Tierney S, Clarke M. Evaluating the effects of maternal positions in childbirth: An overview of Cochrane Systematic Reviews. Eur J Midwifery. 2021 Dec 21;5:57. doi: 10.18332\/ejm\/142781. PMID: 35005482; PMCID: PMC8678923.<\/p>\n\n\n\n[9] Telfer M, Illuzzi J, Jolles D. Implementing an Evidence-Based Bundle to Reduce Early Labor Admissions and Increase Adherence to Labor Arrest Guidelines: A Quality Improvement Initiative. J Dr Nurs Pract. 2021 May 18:JDNP-D-20-00026. doi: 10.1891\/JDNP-D-20-00026. Epub ahead of print. PMID: 34006599.<\/p>\n\n\n\n[10] Telfer M, Illuzzi J, Jolles D. Implementing an Evidence-Based Bundle to Reduce Early Labor Admissions and Increase Adherence to Labor Arrest Guidelines: A Quality Improvement Initiative. J Dr Nurs Pract. 2021 May 18:JDNP-D-20-00026. doi: 10.1891\/JDNP-D-20-00026. Epub ahead of print. PMID: 34006599.<\/p>\n","protected":false},"excerpt":{"rendered":"Et pourraient-ils r\u00e9duire consid\u00e9rablement le nombre de c\u00e9sariennes ?","protected":false},"author":85,"featured_media":23760,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_kad_blocks_custom_css":"","_kad_blocks_head_custom_js":"","_kad_blocks_body_custom_js":"","_kad_blocks_footer_custom_js":"","csco_singular_sidebar":"","csco_page_header_type":"","csco_page_load_nextpost":"","csco_post_video_location":[],"csco_post_video_url":"","csco_post_video_bg_start_time":0,"csco_post_video_bg_end_time":0,"footnotes":""},"categories":[5378,5185],"tags":[6199],"class_list":{"0":"post-23758","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-labor-delivery","8":"category-pregnancy-childbirth","9":"tag-labor","10":"cs-entry","11":"cs-video-wrap"},"acf":[],"yoast_head":"\n