'How can I help?': an investigation of a telephone triage service in an Italian birth centre

Background: There is an increasing interest on telephone triage in maternity services, especially in the context of early labour stage care. The existing literature shows a dearth of study concerning telephone triage and its... [ view full abstract ]

Background: There is an increasing interest on telephone triage in maternity services, especially in the context of early labour stage care. The existing literature shows a dearth of study concerning telephone triage and its outcome for low-risk childbearing women in the Italian context. This research aimed to evaluate the telephone triage provided by midwives in one of the few midwife-led units (MLUs) in Italy.

Methods: A retrospective observational study on the telephone triage service offered at the Margherita birth centre of the Careggi University Hospital in Florence. Data were collected from all the accessible forms of the telephone triage provided by midwives to women in two different semesters (March-August 2013 and March-August 2014). Data collection included information regarding users’ characteristics, reasons for calling, frequency of calls and intrapartum outcomes. Data analysis involved parametric and non-parametric statistical test performed with the Epiinfo© software and considering as significant a p-value <.05.

Results: 985 forms concerning 464 women were analysed. The telephone triage service was used by the 65% of all women accessing the MLU. No differences emerged in women’s use of service in the two periods analysed. Users resulted mostly Italian, with greater presence of foreigners in 2013 compared to 2014 (OR 1.72, CI 95 1.03-2.87, p = 0.04). No differences emerged between the frequency of calls occurred during the day compared to the night. The main motives for calling were the presence of uterine activity, doubts regarding vaginal loss and concerns about fetal movements. Women who called because of contractions more than 3 times were more likely to be transferred compared to those who contacted the unit less than 3 times (OR 4.96, CI 95 2.10-11.66, p < 0.001).

Discussion:  The high use of telephone triage in the Italian MLU shows the importance of offering this service to meet women’s needs. The need for reassurance on uterine activity and understanding of the ongoing labour process emerges as pivotal.

Conclusion: this is the first study focusing on the features of telephone triage in an Italian MLU, originally contributing to the international debate on telephone triage in early labour and illuminating unexplored aspects.