Hospital Triage and the 20-Minute Strip

One of the things I loved about working for Public Health – Muskegon County was the opportunities for continuing education. Now that I’m self-employed, a smaller budget forces me to be more judicious while I also must work around being on-call. Nevertheless, 2016 is already turning out to be a great year for learning.

In January, I had the pleasure of attending the Michigan Affiliate of the American College of Nurse Midwives (ACNM) conference on physiologic birth in Kalamazoo. In April, I took a road trip with my kids and a friend to Alabama for the International Cesarean Awareness Network (ICAN) conference. Both of these provided chances to network and connect with people making a difference for birthing women in my state and across the country. Webinars are convenient, but nothing compares to getting to hang out in-person with inspiring individuals.

I would like to share some of what I learned from each of these trainings, to plant seeds of inspiration in expectant women and birth professionals everywhere. To do this, I’ll be sharing a series of blogs, highlighting the “pearls of wisdom” I learned from so many experts in the field of childbirth.

One of the speakers at the ACNM conference was Lisa Kane Low, PhD, CNM, FACNM, FAAN, who spoke on “Promoting Physiologic Birth to Reduce Primary Cesareans.” She introduced me to birthtools.org, an ACNM website that contains 3 quality improvement (QI) bundles for reducing primary cesareans: intermittent auscultation as a standard for low-risk women, comfort & coping and promoting spontaneous labor progress.

For those of you who aren’t familiar, Rebecca Dekker of Evidence Based Birth has a great article on what intermittent auscultation is, why it should be the standard of care for low-risk women and how to get it. Basically, intermittent auscultation is checking the baby’s heartbeat every so often through a fetal stethoscope, as opposed to through an electronic fetal monitor.

Listening to Dr. Kane Low speak, I couldn’t help but wonder about the mandatory “strip” in triage. For those who are unfamiliar, most hospitals put women who arrive in labor in an area called triage in which they are monitored to check on the baby’s health and the progress of labor. After a designated time period of being attached to an electronic fetal monitor, if the baby is responding well, the mother is either admitted or discharged home based upon how much she has progressed.

I have my own story to tell about triage. With my first baby, I had been laboring for about 22 ½ hours at home when I arrived in the hospital via the longest cab ride of my life. When I get to the maternity floor, they take their time, asking questions, entering information in the computer, pretty much ignoring the fact that I’m in labor. Finally, they assign me to triage. For the first time in my labor, I was confined to a bed, told to lie on my back, and had monitors strapped to me. Eventually, a nurse checked me and announced that I was completely effaced and dilated to an 8. Finally, they believed me that I was in labor! I couldn’t wait to get out of that room, off the bed, and get those uncomfortable monitors off of me!

So, I asked the presenter what evidence there is for this triage protocol. Her answer? “Data does not support the 20 min. strip in triage.” What?!? She went on to say that the only reason this remains standard practice is due to tradition.

Look, I understand that many women present to the hospital thinking that they are in labor, only to be sent home. However, for women like myself, arriving in active labor and being subjected to this practice that has no evidence to uphold a tradition? There is hope for change, though. The Alternative Birth Center at Providence Hospital in Southfield, MI, has ditched the 20 min. triage strips with great outcomes – way to go Providence!