Relationship between nurse staffing during labor and cesarean birth rates in U.S. hospitals

Abstract

Background: Cesarean birth increases risk of maternal morbidity and mortality. Purpose: Examine the relationship between labor and delivery staffing and hospital cesarean and vaginal birth after cesarean (VBAC) rates. Methods: Survey of U.S. labor nurses in 2018 and 2019 on adherence to AWHONN nurse staffing standards with data linked to American Hospital Association Survey data, patient discharge data, and cesarean birth and VBAC rates. Findings: In total, 2,786 nurses from 193 hospitals in 23 states were included. Mean cesarean rate was 27.3% (SD 5.9, range 11.7%–47.2%); median VBAC rate 11.1% (IQR 1.78%–20.2%; range 0%–40.1%). There was relatively high adherence to staffing standards (mean, 3.12 of possible 1–4 score). After adjusting for hospital characteristics, nurse staffing was an independent predictor of hospital-level cesarean and VBAC rates (IRR 0.89, 95% CI 0.84–0.95 and IRR 1.58, 95% CI 1.25–1.99, respectively). Discussion: Better nurse staffing predicted lower cesarean birth rates and higher VBAC rates. Conclusion: Hospitals should be accountable for providing adequate nurse staffing during childbirth.