Hospitals Can Reduce Their Rate of C-Section Births by Adequately Staffing Their Team of Labor and Delivery Nurses

Cesarean birth (c-section) has been found to increase the risk of several maternal morbidities, such as pain, gastrointestinal complications, infection, postpartum hemorrhage, delayed healing time, and other disorders that could lead to admission to an intensive care unit. Compared to vaginal births, c-sections are associated with a higher risk of maternal mortality.

A new study led by Audrey Lyndon, the Vernice D. Ferguson Professor in Health Equity at New York University, has found that when hospitals’ labor and delivery units have a staff of nurses that meets the staffing standards set by the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN), mothers are significantly more likely to give birth vaginally, leading to an overall safer experience for mothers and their infants.

Dr. Lyndon and her co-authors from New York University, the University of California, San Francisco, Mercy Hospital in Missouri, and Trinity Health in Michigan asked a sample of 2,786 nurses from 193 hospitals across the country about their maternity units’ nurse staffing. The authors then cross-referenced their responses with hospital administrative data and each hospital’s rates of c-sections and vaginal births.

In their analysis, the research team found that when a hospital’s staff of labor and delivery nurses aligned with the AWHONN’s standards, the maternity unit had significantly lower rates of c-sections for first time mothers, as well as lower rates of vaginal births after cesarean, which is when a mother gives birth vaginally after previously giving birth via c-section. On average, c-section rates were 11 percent lower in hospitals with an adequate staff of labor and delivery nurses.

According to the authors, adequate nurse staffing could lower hospitals’ costs by decreasing unnecessary c-sections, leading to shorter hospital stays and fewer maternal morbidities that require extra care. They believe these findings provide evidence for policymakers to implement regulatory standards for nurse staffing to maintain high-quality care for new mothers.

In addition to her teaching appointment, Dr. Lyndon serves as the executive vice dean of the NYU Rory Meyers College of Nursing. She holds a Ph.D. from the University of California, San Francisco.