Decision Making About Hospital Arrival in Childbirth, United States, 2014-2015 Version 1

Childbirth is the most common reason for hospital admission in the United States (US) and the timing of admission influences the management and outcomes of labor, including rates of cesarean delivery. Although cesareans are life saving in emergency situations, the current prevalence and variability leads to excess risk for morbidity and mortality as well as higher health care costs in comparison to vaginal deliveries. Delaying hospital admission of women in latent labor is one of the most widely promoted strategies to reduce the likelihood of caesarean birth and its safety is established. Yet, trials of interventions that have aimed to reduce early admissions and the subsequent rates of medical intervention in labor have not succeeded. One proposed explanation is that the evaluated interventions exclusively focused on clinician assessment and diagnosis of active labor in hospital settings. The interventions did not fully account for women's recognition and response to the onset of labor, which is initially negotiated by the laboring women and members of her social network in settings outside the hospital. To develop efficacious strategies to reduce the likelihood of cesarean delivery, a qualitative understanding of why some women present early in labor and others later, and what can be done to promote timely hospital admission among medically low-risk nulliparous women is needed. Specific Aim I: Determine the decision-making criteria and sequence of decision criteria used by women choosing either to go to the hospital or stay at home in early labor. Specific Aim II: Determine the degree to which a symptom and labor management taxonomy accurately reflects women's experience with the recognition and response to early labor prior to hospital admission.

The purpose of this study is to determine the decision-making criteria and sequence of decision criteria used by women choosing either to go to the hospital or stay at home in early labor. Additionally, this study aims to determine the degree to which a symptom and labor management taxonomy accurately reflects women's experience with the recognition and response to early labor prior to hospital admission.

The qualitative data was collected via semi-structured, audio-recorded 30-minute interviews using a prepared interview guide conducted in inpatient postpartum units with eligible, consenting subjects.

The sample was purposively selected to represent women who either stayed at home or arrived at the hospital in early labor. Early labor was defined as less than 4 cm of cervical dilatation at the first digital vaginal examination in the hospital's obstetric triage.

Datasets: DS1: Decision Making About Hospital Arrival in Childbirth, United States, 2014-2015

Women who recently gave birth in the Northeastern United States. Smallest Geographic Unit: None

face-to-face interviewThis cross-sectional, descriptive, qualitative study was conducted in the postpartum unit of a major metropolitan academic medical center in the Northeastern United States.All audiorecorded interviews were conducted privately in the women's hospital rooms. Demographic, pregnancy, and birth data were abstracted from the clinical record. All participants were interviewed at least 12 hours after the birth of a live, healthy newborn.