Adequate nursing staffing levels associated with lower cesarean section rates

Adequate nursing staffing levels associated with lower cesarean section rates

Labor and delivery units appropriately staffed by nursesCare prospects.

“Our findings underscore the importance of nurse staffing for optimal maternal outcomes,” said Audrey Lyndon, Vernice D. Ferguson Professor of Health and Executive Vice Dean at the Nyu Rory Meyers College of Nursing.

C-sections account for nearly a third of births in the U.S. and are the most common operation performed in hospitals. While C-sections can be life-saving and some are necessary for the health of the mother and child, the surgery carries more risks and a longer recovery than vaginal births and can complicate future pregnancies.

If we can safely reduce the cesarean section rate, we will improve outcomes for childbearing people and their families. “

Audrey Lyndon, lead author of the study

Nurses play an important role during childbirth, providing emotional and physical support at the bedside, monitoring the health of mother and baby, and administering medications. When hospitals are understaffed, nurses are forced to prioritize tasks that require the most immediate attention at the expense of other care.

“While nurses intuitively know that having enough nurses to provide the attentive care that mothers and babies need and deserve improves outcomes, research has helped link maternity staffing and patient outcomes,” said Kathleen Rice Simpson, a perinatal clinical nurse specialist at Mercy Hospital St. Louis and study author.

To determine whether nurse staffing affects cesarean rates, researchers examined how well maternity units adhere to staffing standards set by the Association of Women's Health, Obstetrics and Neonatal Nurses (AWHONN). The evidence-based standards call for one birth nurse in many parts of the work, two nurses at birth, and one nurse for each mother-new pair in the first few hours after birth.

Researchers surveyed 2,786 nurses from 193 hospitals in 23 states about staffing their maternity units. Their responses, collected in 2018 and 2019, were matched with hospital-level administrative data and cesarean sections and vaginal births.

Better staffing during labor and delivery was associated with lower cesarean rates and higher vaginal birth rates, including vaginal births among mothers who had prior cesarean sections. Cesarean rates were 11 percent lower in hospitals with staffing levels aligned with national standards.

"Concern about cesarean section rates in the United States has been high for many years, with little progress toward improvement. This study points us toward an important solution: aligning labor and delivery nursing with consensus and expert-developed guidelines," said Joanne Spetz, director of the Institute for Health Policy Studies at the University of California, San Francisco (UCSF). Study author.

“We hope our findings encourage hospitals to recognize the value of nursing consistent with standards to support healthy outcomes for mothers and babies,” Simpson said.

Hospitals and policymakers often point to increased costs associated with cesarean sections and nurses. The researchers note that the costs of adequate staffing during labor and delivery can be offset by the savings in avoiding unnecessary cesarean sections, including shorter hospital stays and fewer complications.

"Care is viewed as a cost center as opposed to a revenue center in hospitals. So it is often one of the first things to be cut as hospitals try to keep costs in line. However, research continues to point to patient safety across departments," Lyndon said.

“While increasing nurse staffing during a shortage period can be challenging, this investment could reduce overall costs by reducing surgical cesarean section rates and longer-term adverse outcomes for mothers and babies,” Spetz said.

To hold hospitals accountable, researchers encourage the Centers for Medicare and Medicaid Services (CMS) to consider providing high-quality maternity care as part of its "birth-friendly" designation.

Additional study authors include Jason Fletcher of NYU Meyers, Gay Landstrom of Trinity Health in Michigan and Caryl Gay of UCSF. The research was supported by the Agency for Healthcare Research and Quality (Grant R01HS025715).

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