Patient Empowerment and Agency through Intrapartum Counseling and Education (PEAICE): A randomized controlled trial.

Abstract

Introduction: As more patients decline evidence-based care from their obstetric providers, effective and accessible antenatal education is essential in reversing this course. This study aimed to assess the effectiveness of a novel low-cost physical intrapartum labor guide on personal perceptions of patient control, labor satisfaction, and obstetric/neonatal outcomes.

Methods: This was a single-institution, randomized controlled trial of patients with singleton pregnancies undergoing induction of labor. Participants were randomized at admission for induction to intrapartum guide versus standard of care counseling. Primary outcomes included personal perception of control and satisfaction during labor (assessed via the Labor Agentry Scale [LAS] and a six-question satisfaction survey, administered ≤7 days postpartum). Secondary outcomes included prespecified obstetric and neonatal outcomes. Comparisons between groups were done using Chi-square/Fisher's exact test or two-sample t-test/Wilcoxon rank-sum test. Multiple linear regression analysis was then used to examine the association of intrapartum guide education with LAS scores and neonatal outcomes. Covariate adjustment was performed to improve statistical precision and to protect against residual chance imbalance.

Results: A total of 216 patients were enrolled and randomized (108 per arm). Of those enrolled, 189 (87.5%) completed the postpartum survey ≤7 days postpartum and were thus included in the analysis. Compared to standard of care, patients in the intrapartum guide group had significantly higher mean LAS scores (58.36 [95% CI, 56.78-59.94] vs. 54.29 [95% CI, 52.45-56.13]; p = .001) and remained so when adjusting for race, ethnicity, age, insurance, and mode of delivery (β = 3.42; 95% CI, 1.19-5.65). Patients in the intrapartum guide group reported significantly higher birth satisfaction, knowledge of childbirth, and satisfaction with intrapartum education. Finally, neonates of individuals randomized to the intrapartum guide were less likely to receive assisted ventilation (12.5% vs. 23.7%; p = 0.046); however, this difference was not significant when controlling for mode of delivery (adjusted odds ratio [aOR], 0.49; 95% CI, 0.21-1.12).

Conclusion: A novel, low-cost intrapartum labor guide administered during induction of labor significantly increased patient-perceived agency and satisfaction. This represents a promising strategy for improving patient adoption and fidelity of labor education regarding evidence for interventions that potentially reduce obstetric/neonatal risk. The findings of this study warrant further study and implementation in obstetric practices.

Trial registration: ClinicalTrials.gov identifier: NCT06787521.