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Contact Information:

Miss Helen Spiby

Study Location:

Mother and Infant Research Unit

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Improving care at the primary/secondary interface: a trial of community-based support in early labour

Not Recruiting

Open to: Female

Age: Adult

Medical Conditions

Pregnancy, labour

This information is provided directly by researchers and we recognise that it isn't always easy to understand. We are working with researchers to improve the accessibility of this information.

Not provided at time of registration

In some parts of the UK, women having their first baby have a 40-50% chance of having a caesarean section or instrumental (forceps or ventouse) delivery. These increasing rates are of concern to childbearing women, their families, and to the health services as they are associated with more ill health in women and their babies.Some existing studies (which are small, or not very rigourous) have suggested that women who attend hospital very early in their labour are more likely to have a range of interventions including artificial rupture of membranes, epidurals, and caesarean and instrumental births. Some 10-33% of women admitted to delivery suite are not in labour, and do not need to be in hospital. This study will test these observations using a large randomised controlled trial. The aim is to examine whether or not a home visit by a community midwife when a pregnant woman thinks she may be in labour will have any impact on the rates of caesarean and other instrumental births, and other outcomes such as use of pain relief, the woman's views, and the health service resources used, compared with normal care. Women expecting their first baby, and whose pregnancy is progressing normally, will be told about the study during their pregnancy, by their own community midwife. If they are interested in participating, and after giving formal consent at around 32 weeks, they will be randomly allocated to one of two groups.Women in the intervention group will be offered a home visit by a community midwife when they think they are in labour, while women in the control group will be asked to telephone the hospital for advice and to go into delivery suite if advised, as is normal practice across the UK. The midwife doing the home visit will offer support to the woman including breathing and relaxation techniques, carry out an assessment to see how labour is progressing, and offer advice about the appropriate time to go to hospital. Information about the two groups will be gathered directly from the women themselves, in pregnancy and 6 weeks after birth, from hospital notes, and from the midwives involved in the study. This information will be used to compare the outcomes for women in the two groups, to examine their views, to calculate the costs to the health services, and to the families. It is already known that caesarean section costs the health services more than twice the cost of a normal birth.

Randomised controlled trial

Start dates may differ between countries and research sites. The research team are responsible for keeping the information up-to-date.  

The recruitment start and end dates are as follows:

01 Jan 2005

31 Dec 2005


Intervention Type : Other
Intervention Description : 1. Intervention: support and assessment for nulliparous women at home in early labour by community midwives2. Control: standard care which usually comprises telephone advice to attend the hospital delivery suite to determine whether labour has established

You can take part if:

Healthy nulliparous women

You may not be able to take part if:

Not provided at time of registration

Below are the locations for where you can take part in the trial. Please note that not all sites may be open.

  • Mother and Infant Research Unit
    LS2 9LN

Miss Helen Spiby

The study is sponsored by NHS Service Delivery and Organisation Programme (SDO) (UK) and funded by NHS Service Delivery and Organisation R&D Programme (UK), Ref: SDO/40/2003 .

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for Trial ID: ISRCTN11168521

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