In Response:

Abstract

We thank Jennifer Carraher for her thoughtful comments on our article, “Variation in Cesarean Birth Rates by Labor and Delivery Nurses” ( Edmonds, O'Hara, Clarke, & Shah, 2017 Edmonds J.K. O’Hara M. Clarke S.P. Shah N. Variation in cesarean birth rates by labor and delivery nurses. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2017; 46: 486-493https://doi.org/10.1016/j.jogn.2017.03.009 Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar ). The intent of our article is to direct further inquiry into the influences labor and delivery nurses may have on cesarean rates and other childbirth outcomes to improve care. We appreciate the opportunity to clarify certain points raised by Ms. Carraher in this short reply. First, we agree with her that the lack of institutional and cultural variables in our analysis makes our study preliminary. However, given our single-site study, we did not encounter confounding from between-hospital characteristics, such as differences in nurse–patient assignment methods, nurse staffing measures, and different models of care. We recognize the potential broader influence of these variables and make the suggestion that in future multisite research, investigators should address how the structures and cultures of different units influence the provision of intrapartum nursing care, particularly given important differences in practice culture among hospitals. Joyce K. Edmonds, PhD, MPH, RN, Assistant Professor, Connell School of Nursing, Boston College, Chestnut Hill, MA. Michele O’Hara, MSN, RN, NE-BC, Nursing Director, Department of Labor and Delivery, Massachusetts General Hospital, Boston, MA. Sean P. Clarke, PhD, RN, FAAN, Professor and Associate Dean, Connell School of Nursing, Boston College, Chestnut Hill, MA. Neel T. Shah, MD, MPP, Assistant Professor, Beth Israel Deaconess Medical Center, Harvard T. H. Chan School of Public Health, Boston, MA. On “Variation in Cesarean Birth Rates by Labor and Delivery Nurses”Journal of Obstetric, Gynecologic & Neonatal NursingVol. 47Issue 2PreviewThe research article “Variation in Cesarean Birth Rates by Labor and Delivery Nurses” (Edmonds, O’Hara, Clarke, & Shah, 2017) raised a number of fundamental concerns about a priori conclusion-based research, the most primary being that labor and delivery nurses “influence the likelihood of cesarean birth” (p. 486). Full-Text PDF Variation in Cesarean Birth Rates by Labor and Delivery NursesJournal of Obstetric, Gynecologic & Neonatal NursingVol. 46Issue 4PreviewTo examine variation in the cesarean birth rates of women cared for by labor and delivery nurses. Full-Text PDF