title: Are most patients on the labour floor in active labour? A descriptive study of a Canadian obstetrical unit.
abstract: BACKGROUND
  In its guideline on intrapartum fetal surveillance, the Society of Obstetricians and Gynaecologists of Canada (SOGC) recommended the availability of 1:1 nursing care (1 nurse to 1 patient) for women in active labour. The common perception is that the majority of women in labour and delivery units are in active labour. Identifying the proportion of women in active labour versus those who are not in active labour is crucial for the allocation of nursing care resources.
  
  
  OBJECTIVE
  We sought to obtain a quantitative description of our obstetrical population to determine the distribution of women in the labour and delivery (L&D) unit, the obstetrical triage unit, and the labour, delivery, recovery, and postpartum (LDRP) unit and to determine the proportion of women in active labour who were receiving 1:1 nursing care.
  
  
  METHODS
  We randomly sampled and surveyed nursing care activities and patient distribution in a 1-hour period each day over a period of 4 months; each hour of the day was assessed on 5 separate occasions. The 3 units (L&D, LDRP, and obstetrical triage) were surveyed simultaneously.
  
  
  RESULTS
  In the L&D unit, 31% of women were in active labour; of those, 92% received 1:1 nursing care. The remaining women (69%) were either in the early phase of labour, had significant obstetrical complications, were undergoing Caesarean section, or had just delivered. In the LDRP unit, 13% of women were in active labour, and 87% were postpartum. Almost one-half the women (45%) in the obstetrical triage unit were being assessed for possible labour or possible rupture of membranes, while the remainder were being assessed for other pregnancy-related problems.
  
  
  CONCLUSIONS
  Contrary to common perception, the majority of women in the L&D unit were admitted for reasons other than active labour but required care in that unit. The concept of providing 1:1 nursing care solely to women in active labour would leave the labour units understaffed. We recommend that institutions use a more precise classification system, rather than the presence or absence of labour, to determine individual patient risk and the appropriate nursing resource requirements.
authors.affiliation: Labour and Delivery Unit, St Boniface General Hospital, Winnipeg, Manitoba, Canada.
authors.forename: Christiane
authors.initials: C
authors.lastname: Raby
authors.forename: Michael
authors.initials: M
authors.lastname: Helewa
authors.forename: Gail
authors.initials: G
authors.lastname: Hazlitt
authors.forename: Marion
authors.initials: M
authors.lastname: Wilson
authors.forename: Janet
authors.initials: J
authors.lastname: Brako
authors.forename: Dorothy
authors.initials: D
authors.lastname: Lahr
authors.forename: Jackie
authors.initials: J
authors.lastname: Brookes
authors.forename: Debbie
authors.initials: D
authors.lastname: Robinson
authors.forename: Robert
authors.initials: R
authors.lastname: Ariano
mesh_terms: D002585:Cesarean Section; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D009775:Obstetrics and Gynecology Department, Hospital / Q000706:statistics & numerical data*; D018743:Perinatal Care / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications; D012307:Risk Factors; D014592:Uterine Hemorrhage