Evaluation of Nursing Interventions to Reduce the Primary Cesarean Rate

Abstract

To determine the effectiveness of upright positioning and frequent maternal repositioning on primary cesarean births performed for failure to progress, arrest of descent, arrest of dilatation, and/or cephalopelvic disproportion among laboring women. A quasi-experimental research design was utilized. Birth outcomes from June 2013 to December 2014 were compared to the baseline period of January 2013 to May 2013 at a rural hospital in south central Kentucky. The conceptual framework for this program evaluation was the plan-do-check-act cycle. Labor and delivery nurses attended a one-day evidence-based practice seminar on labor support and then implemented a standardized approach to positioning mothers during labor: upright positions and frequent position change every 15 to 30 minutes. Data analysis demonstrated a decrease in the number of primary cesarean births for all indications and number of primary cesarean births for arrest disorders (t = –0.75, p = .46). The primary cesarean birth rate decreased 2% from 43% to 41% over an 18 month timeframe. This downward trend suggests that upright and frequent maternal repositioning by registered nurses reduced the primary cesarean birth rate for arrest disorders.