{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T13:27:42Z","timestamp":1761744462214,"version":"3.37.3"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,2,15]],"date-time":"2017-02-15T00:00:00Z","timestamp":1487116800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Birth"],"published-print":{"date-parts":[[2017,6]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>Friedman, the United Kingdom's National Institute for Health and Care Excellence (NICE<\/jats:styled-content>), and the American College of Obstetricians and Gynecologists\/Society for Maternal\u2010Fetal Medicine (ACOG<\/jats:styled-content>\/SMFM<\/jats:styled-content>) support different active labor diagnostic guidelines. Our aims were to compare likelihoods for cesarean delivery among women admitted before vs in active labor by diagnostic guideline (within\u2010guideline comparisons) and between women admitted in active labor per one or more of the guidelines (between\u2010guideline comparisons).<\/jats:p><\/jats:sec>Design<\/jats:title>Active labor diagnostic guidelines were retrospectively applied to cervical examination data from nulliparous women with spontaneous labor onset (n\u00a0=\u00a02573). Generalized linear models were used to determine outcome likelihoods within\u2010 and between\u2010guideline groups.<\/jats:p><\/jats:sec>Results<\/jats:title>At admission, 15.7%, 48.3%, and 10.1% of nulliparous women were in active labor per Friedman, NICE<\/jats:styled-content>, and ACOG<\/jats:styled-content>\/SMFM<\/jats:styled-content> diagnostic guidelines, respectively. Cesarean delivery was more likely among women admitted before vs in active labor per the Friedman (AOR<\/jats:styled-content> 1.75 [95% CI<\/jats:styled-content> 1.08\u20102.82] or NICE<\/jats:styled-content> guideline (AOR<\/jats:styled-content> 2.55 [95% CI<\/jats:styled-content> 1.84\u20103.53]). Between guidelines, cesarean delivery was less likely among women admitted in active labor per the NICE<\/jats:styled-content> guideline, as compared with the ACOG<\/jats:styled-content>\/SMFM<\/jats:styled-content> guideline (AOR<\/jats:styled-content> 0.55 [95% CI<\/jats:styled-content> 0.35\u20100.88]).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Many nulliparous women are admitted to the hospital before active labor onset. These women are significantly more likely to have a cesarean delivery. Diagnosing active labor before admission or before intervention to speed labor may be one component of a multi\u2010faceted approach to decreasing the primary cesarean rate in the United States. The NICE<\/jats:styled-content> diagnostic guideline is more inclusive than Friedman or ACOG<\/jats:styled-content>\/SMFM<\/jats:styled-content> guidelines and its use may be the most clinically useful for safely lowering cesarean rates.<\/jats:p><\/jats:sec>","DOI":"10.1111\/birt.12274","type":"journal-article","created":{"date-parts":[[2017,2,15]],"date-time":"2017-02-15T09:16:51Z","timestamp":1487150211000},"page":"128-136","source":"Crossref","is-referenced-by-count":16,"title":["Likelihood of cesarean delivery after applying leading active labor diagnostic guidelines"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4648-2239","authenticated-orcid":false,"given":"Jeremy L.","family":"Neal","sequence":"first","affiliation":[{"name":"Vanderbilt University School of Nursing Nashville TN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy K.","family":"Lowe","sequence":"additional","affiliation":[{"name":"College of Nursing University of Colorado Aurora CO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia C.","family":"Phillippi","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Nursing Nashville TN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon L.","family":"Ryan","sequence":"additional","affiliation":[{"name":"Clinical Nursing, The Ohio State University College of Nursing Columbus OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy M.","family":"Knupp","sequence":"additional","affiliation":[{"name":"Nursing Quality Improvement & Patient Safety at The Ohio State University Wexner Medical Center Columbus OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary S.","family":"Dietrich","sequence":"additional","affiliation":[{"name":"Schools of Nursing and Medicine at Vanderbilt University Nashville TN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen F.","family":"Thung","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology The Ohio State University Columbus OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,2,15]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(54)90311-7"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-195512000-00001"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1969.tb05788.x"},{"key":"e_1_2_7_5_1","first-page":"179","article-title":"Computer analysis of labor progression. 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