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

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. <b>Specific Aim I:</b> 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. <b>Specific Aim II:</b> 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.