Therapeutic Rest to Delay Admission in Early Labor: A Prospective Study on Morphine Sleep

Objective: Therapeutic rest in labor involves administration of parenteral analgesics in early or prodromal labor to relieve the patient's discomfort and allow for progression of labor while the patient rests. No prospective studies exist which examine the safety and clinical utility of therapeutic rest in early labor, and no published studies examine the potential benefits of therapeutic rest from the perspective of either patient satisfaction or cost-effectiveness. The investigators aim to determine whether therapeutic rest using morphine and promethazine is associated with variations in labor characteristics, or obstetric or neonatal outcomes as well as patient satisfaction with this form of pain management.

Methods: This will be a prospective cohort study. Women who are eligible for therapeutic rest (reactive non-stress test, normal amniotic fluid, in prodromal or early labor as defined by obstetric provider, and plan to discharge home after evaluation) will be recruited for the study. Participants will receive routine obstetric care by providers who are unaware of patient enrollment. A research assistant will then approach all participants in the postpartum period, prior to discharge from the hospital or with a phone call if permitted by the patient, to complete a questionnaire including patient satisfaction items. Chart review will be performed to determine differences in hospital stay and common obstetric and neonatal outcomes to compare these data among women who do and do not choose to receive therapeutic rest. These results will provide insight into a common clinical practice, helping to not only guide management at institutions where therapeutic rest is commonly utilized but also potentially encourage its initiation at hospitals were therapeutic rest is not available.

Inclusion criteria

• Singleton pregnancies between 37w0d and 41w6d gestation
• Presentation to triage for rule out labor as primary indication and found to be in early labor
• Offered therapeutic rest by obstetric provider with plan to discharge home after evaluation

Exclusion criteria

• Allergy to morphine sulfate or promethazine
• Being without an attendant to safely transport the patient home
• Present to triage for other indication (decreased fetal-movement, premature rupture of membranes, hypertension, etc.)
• Multiple gestation
• Known fetal anomaly
• Placenta previa, active maternal Herpes Simplex Virus disease, or any other contraindication to vaginal delivery
• Recommendation for direct admission to L&D for maternal or fetal indication.