Development of a Labor Support Course to Reduce Primary Cesareans and Support Vaginal Births

Abstract

This podium presentation provides a plan for developing a labor support program for the obstetric staff. Labor support education is an intricate component of the American College of Obstetricians and Gynecologists’ safety bundle, Safe Reduction of Primary Cesarean Births: Supporting Intended Vaginal Births. The Perinatal Quality Collaborative of North Carolina (PQCNC) provides labor support classes across the state as a component of the initiative to reduce primary cesareans. The course offers a didactic component to enhance the understanding of optimal fetal positioning in labor; interactive training for physical and emotional support in labor; review of case scenarios; and hands-on practice stations to support vaginal birth. The enhanced education and skills of the obstetric staff for labor support will optimize the likelihood of a healthy labor and vaginal birth for maternity patients. Developing a labor support course that includes didactic education on the process of labor and a tool kit of equipment that can be used on the maternity unit may result in reducing primary cesarean births. The course is primarily attended by nurses, but it is recommended that all providers on the team can benefit from attending. Information from the course can be included in patient childbirth education as well. Tracking of outcomes for postpartum women and their newborns through reduction in operative births is being evaluated in North Carolina. Patient discharge surveys can be used to qualify the effect on the labor and birth experience. Conducting case reviews to assess improvements to care and for team members’ success can be performed and will contribute to the existing research data on nurse support in labor. The Association of Women's Health, Obstetric and Neonatal Nurses ( AWHONN ) has published a nurse's guide to supporting physiological birth and the American College of Nurse-Midwives published a healthy birth initiative bundle for promoting comfort in labor. Enhanced supportive nursing care of women during labor and birth is supported by their professional organizations and is evidence based. Beyond the labor and birth outcomes, labor support can improve Apgar scores in the newborn and reduce negative childbirth experiences.