Labor and delivery units with sufficient nurse staffing result in fewer cesarean deliveries, according to recent findings published in the journal Nursing Outlook.
Labor and delivery units with sufficient nurse staffing result in fewer cesarean deliveries, according to recent findings published in the journal Nursing Outlook.
“Our research underscores the importance of nurse staffing for ideal maternal health outcomes,” stated Audrey Lyndon, the Vernice D. Ferguson Professor in Health Equity and executive vice dean at NYU Rory Meyers College of Nursing.
C-sections make up almost one-third of all births in the United States and are the most frequently performed surgeries in hospitals. While c-sections can be essential and life-saving for both mother and child, they involve greater risks and a longer recovery period compared to vaginal deliveries, and may lead to complications in future pregnancies.
“By safely reducing the rate of cesarean sections, we can enhance outcomes for those giving birth and their families,” added Lyndon, who led the study.
Nurses play a vital role during the birthing process, offering both emotional and physical support, monitoring the well-being of mothers and infants, and administering necessary medications. When the staffing levels in hospitals are inadequate, nurses may need to prioritize urgent tasks, which can take away from the necessary care provided to mothers and newborns.
“Although nurses instinctively recognize that sufficient staffing enhances the quality of care for mothers and infants, there has been limited research connecting maternity nurse staffing to patient outcomes,” noted Kathleen Rice Simpson, a perinatal clinical nurse specialist at Mercy Hospital St. Louis and co-author of the study.
To assess whether nurse staffing affects C-section rates, the researchers looked into how maternity units follow staffing standards set by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). These evidence-based guidelines recommend one nurse per birthing person during various labor phases, two nurses at the time of birth, and one nurse per mother-infant pair during the initial hours post-delivery.
The researchers conducted a survey among 2,786 nurses across 193 hospitals in 23 states about the staffing levels of their maternity units. Responses gathered in 2018 and 2019 were correlated with hospital administrative data, as well as rates of c-sections and vaginal deliveries.
Improved nurse staffing during labor and delivery was associated with lower rates of c-sections and higher rates of vaginal births, even among mothers who had previously undergone cesarean deliveries. Hospitals that aligned their staffing with national standards experienced a reduction of 11 percent in c-section rates.
“Concerns regarding c-section rates in the U.S. have persisted for years, with little progress made. This study points to a crucial solution: aligning labor and delivery nurse staffing with established expert guidelines,” stated Joanne Spetz, director of the Institute for Health Policy Studies at the University of California, San Francisco (UCSF) and co-author of the study.
“We hope our results will motivate hospitals to recognize the importance of staffing levels in promoting healthy outcomes for mothers and their babies,” added Simpson.
Hospitals and policymakers often cite the rising costs associated with both cesarean deliveries and nurse staffing. However, the researchers argue that investing in adequate nurse staffing during labor and delivery can lead to savings by avoiding unnecessary cesarean procedures, resulting in shorter hospital stays and fewer complications.
“Nursing is often regarded as a cost burden rather than a key contributor to revenue in hospitals, leading to staffing reductions when cutting costs. However, ongoing research indicates that adequate nurse staffing is essential for patient safety across various departments,” explained Lyndon.
“While increasing nurse staffing may be challenging amidst a shortage, this investment could lower overall expenses by decreasing the rates of surgical cesarean sections and long-term negative outcomes for mothers and infants,” stated Spetz.
To ensure accountability among hospitals, the researchers advocate for the Centers for Medicare and Medicaid Services (CMS) to contemplate implementing regulatory standards for nurse staffing as part of their “Birthing-Friendly” designation for high-quality maternal care.
Other contributors to the study include Jason Fletcher of NYU Meyers, Gay Landstrom of Trinity Health in Michigan, and Caryl Gay of UCSF. This research was funded by the Agency for Healthcare Research and Quality (grant R01HS025715).
