Reducing rates of C-section deliveries: Mobile Apps for Clinical Studies

Pregnant woman sits on the couch and lays her hand on her stomach while looking at her smart phone.

Study uses mobile app to learn more about symptoms of labor progression.

Every year in the U.S., 1.6 million people giving birth for the first time and at low risk for complications enter the hospital for delivery. More than one half are admitted to the hospital in the first phase of labor, when contractions are generally milder.  

“Research shows that admission during this first phase of labor, rather than later, more active labor, increases the risk for unnecessary cesarean section delivery,” said Ellen Tilden, Ph.D., associate professor of obstetrics and gynecology in the schools of nursing and medicine. “This is without medical benefit but is associated with increased health risks, death and cost.”

Researching the experience and biology of labor

Pregnant people may not know what phase of labor they’re in, and that is in part because the main symptoms and their underlying biology are not well researched.

This information will help people know when to go to the hospital and safely reduce hospital admission during the first phase of labor, helping to decrease the poor health effects related to C-section overuse.

Tilden and her team developed a tool to learn more about the symptoms patients experienced from the time they began to experience signs of labor until they entered the hospital. Study participants tracked the frequency and duration of contractions and recorded their symptoms and coping methods as labor progressed.

The data from Tilden’s research project using this tool has supported findings in two manuscripts and is being used in submissions for major grants.

The clinical research tool

Tilden’s team used a tool called MyCap, designed to capture study participant outcomes using mobile devices. Development of the app was funded by a program called the Mobile Apps for Clinical Studies (MACS) program at the Oregon Clinical and Translational Research Institute, or OCTRI.

“Tilden’s project demonstrates the utility of the kinds of apps that the MACS program will fund,” said Jonathan Jubera, OCTRI awards senior project manager. “The tool makes it possible for OHSU researchers to use new functionality of REDCap, which is a secure web application for building and managing online surveys and databases. The new functionality, called MyCap, captures study participant outcomes using mobile devices.”

More about the MACS program and MyCap

OCTRI’s MACS program funds the development of apps for projects that will use MyCap to collect patient-reported outcomes directly from participants — either as a stand-alone project or as a companion to an existing REDCap-based study.

Contact Jonathan Jubera ( to learn more about the MACS funding mechanism and to find out what characteristics make MyCap a good fit for a research project. For example, it works well for capturing things like daily or weekly diaries (falls, pain, food intake) that repeat at the same intervals for all participants. Also, questionnaire data types are limited to multiple choice.

MyCap doesn’t work for projects that require participants to e-Consent, include long questions that requie deep explanations and require the same survey(s) several times a day.

This funding mechanism is supported by OCTRI (Awards and Informatics) and the Innovation Development and Entrepreneurship Acceleration Fund, co-managed by OHSU Technology Transfer and Collaborations and Entrepreneurship.

More research by Tilden

The duration of spontaneous active and pushing phases of labour among 75,243 US women when intervention is minimal: A prospective, observational cohort study.

Association between first and second stage of labour duration and mode of delivery: A population-based cohort study.

Systematic Review of Self-Report Measures of Maternal Self-Efficacy.

Adapting Mindfulness-Based Cognitive Therapy for Perinatal Depression to Improve Access and Appeal of Preventive Care.


— With Jonathan Jubera