NYC Gazette

Labor and delivery units with sufficient nurse staffing show lower cesarean birth rates, according to a study published in Nursing Outlook. Audrey Lyndon, the Vernice D. Ferguson Professor in Health Equity and executive vice dean at NYU Rory Meyers College of Nursing, stated, "Our findings highlight how crucial nurse staffing is for optimal maternal outcomes."

C-sections are common surgeries in U.S. hospitals, accounting for nearly one-third of births. While necessary at times, they pose more risks and recovery challenges than vaginal births. "If we can safely lower the C-section rate, we are improving outcomes for childbearing people and their families," said Lyndon.

Nurses provide essential support during childbirth by monitoring health and administering medication. Understaffing forces them to prioritize urgent tasks over other care needs. Kathleen Rice Simpson from Mercy Hospital St. Louis noted, “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.”

The study evaluated adherence to staffing standards by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), which recommends specific nurse-to-patient ratios during labor and after birth. Researchers surveyed 2,786 nurses across 193 hospitals in 23 states about their unit's staffing levels between 2018 and 2019.

Findings showed better-staffed hospitals had an 11 percent reduction in C-section rates compared to those not meeting national standards. Joanne Spetz from UCSF commented on the importance of aligning staffing with guidelines: “Concern about cesarean section rates in the US has been high for many years... This study points us toward one important solution: aligning labor and delivery nurse staffing with consensus- and expert-developed guidelines.”

Simpson hopes these findings will prompt hospitals to value consistent nurse staffing aligned with standards for healthy maternal outcomes.

While increased costs related to C-sections and nurse staffing are concerns for hospitals and policymakers, researchers argue adequate staffing could reduce unnecessary C-sections' expenses through shorter hospital stays and fewer complications.

“Nursing care is looked at as a cost center as opposed to a revenue center in hospitals,” Lyndon explained but emphasized its critical role in patient safety.

Spetz added that increasing nurse staff might be challenging amid shortages but could reduce overall costs by lowering surgical cesarean sections' rates.

Researchers suggest CMS establish regulatory standards for nurse staffing under its "Birthing-Friendly" designation for quality maternity care.

Additional authors include Jason Fletcher from NYU Meyers, Gay Landstrom from Trinity Health Michigan, Caryl Gay from UCSF; supported by Agency for Healthcare Research Quality (grant R01HS025715).