Date of Completion

Spring 5-11-2025

Document Type

Open Access Project

Degree Name

Doctor of Nursing Practice (DNP)

Faculty Advisor

Dr. Eileen Stuart-Shor

Practice Site Mentor

Jennifer Seymour, CNM

Committee Mentor

Dr. Elizabeth Bostock

Abstract

Background

Homebirth and birth center midwives aspire to avoid unplanned transfers to hospital. Inadequate coping with the pain of labor increases the need for transfer from community birth to hospital. However when the laboring person determines that she cannot cope with the pain, escalation of care for pain management may be needed. Transfer from the community setting to the hospital for escalation of pain management can be a challenge for the laboring woman, the birth center labor team, and the receiving hospital.

Local Problem

In St. Lawrence County, New York, there is one freestanding birth center. The current transfer rate due to requests for traditional pharmacologic pain medicine is 22%, which is below the national rate (26%) but unacceptably high. Prior to this project, the birth center did not have a comprehensive, multi-modal labor pain management protocol.

Methods

Effective interventions for labor coping/pain management were identified in a systematic review of the literature. An evidence-based algorithm to assess coping and improve patients' perception of pain emerged as an effective strategy. The Biopsychosocial Model of Health was used to develop a novel pathway for implementing labor pain coping strategies.

Intervention

A multi-modal labor coping pathway (LCP) was developed based on best practices described in the literature. A workshop was conducted with the labor team to educate them on the LCP. The modalities/options on the LCP were reviewed with each patient during prenatal visits and a birth plan was developed for the patient via shared decision making. The individualized birth plan was initiated for every patient admitted to the birth center for labor over a period of five months and data was gathered regarding timing and efficacy of the interventions.

Results

Most patients completed a birth plan in advance of admission to the unit (88%, n=64) and birth center staff successfully implemented the pathway (%) when the patient’s self-reported coping exceeded the threshold. Post-intervention compared to pre-intervention unintended transfer rates for escalation of pain management were reduced by 65%.

Conclusion

The project met and exceeded the project goals. Patients responded favorably to the birth plans and post-birth surveys, and Potsdam Birth House staff unanimously agreed that the LCP should be adopted as policy from this point forward. Additional PDSA cycles may be warranted in the future to identify if certain modalities were more effective than others , and if some enhanced coping strategies worked better at one stage of labor than another.

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