Hospitals that staffed maternity wards at recommended standards had fewer cesarean births, according to a study published in Nursing Outlook.
Cesarean rates were 11 percent lower in labor and delivery wards that follow Association of Women’s Health, Obstetric and Neonatal Nurses’ standards, which call for one nurse per patient during parts of the delivery; two nurses at birth, and one for each mother-child in the hours after birth.
“While nurses intuitively know that having enough nurses to provide the attentive care that mother and babies need and deserve improves outcomes, research has been minimal in linking maternity nurse staffing and patient outcomes,” said Kathleen Rice Simpson, a perinatal clinical nurse specialist at Mercy Hospital St. Louis and study author, in a statement released by New York University. “We hope our findings will encourage hospitals to see the value in nurse staffing consistent with standards to support healthy outcomes for mothers and babies.”
Researchers surveyed 2,786 nurses from nearly 200 hospitals in 23 states about staffing levels in their maternity units in 2018 and 2019. Their responses were matched to hospitals’ data on rates of C-sections and vaginal births. Better staffing was linked to lower C-section rates and higher vaginal birth rates, including among women who had previous C-sections.
While hospitals point to increased costs for both increased staffing and cesarean births, the study’s authors note that adequate staffing can reduce costs by avoiding unnecessary C-sections, reducing hospital stays and complications.
“Nursing care is looked at as a cost center as opposed to a revenue center in hospitals, so it’s often one of the first things cut when hospitals are trying to keep costs in line. But research continues to show that nurse staffing is a key contributor to patient safety across departments,” said Audrey Lyndon, the Vernice D. Ferguson Professor in Health Equity and executive vice dean at NYU’s Rory Meyers College of Nursing.
The authors encourage the Centers for Medicare and Medicaid Services to establish standards for nurse staffing as part of its “Birthing-Friendly” designation for high-quality maternity care.
“When there are not enough nurses based on census and acuity, labor nurses must prioritize the care that requires the most immediate attention such as medication administration, oxytocin titration, maternal and fetal assessment at predetermined intervals, and medical record documentation, at the expense of other types of care,” they wrote, citing a previous study by the authors.
