Intrapartum Nurses Research Articles

Expanding Labor Support Education to Nurses Caring for Women in Labor.

The ability to provide emotional and physical support to a patient during one of the most significant moments of her life is a privilege afforded to intrapartum nurses who attend to laboring and delivering patients. Labor support improves birth outcomes, reduces cesarean birth rates, and decreases anesthesia use. Within the hospital context, this quality improvement project investigated the effects of educating intrapartum nurses about labor support and providing them with hands-on training. Surveys, including the Self-Efficacy Labor Support Scale, were given preeducation and posteducation to evaluate and document knowledge acquisition. Results support teaching intrapartum nurses learning evidence-based labor comfort strategies to support a woman's labor preference.

Implementing a Respectful Maternity Care Guideline During Childbirth Experiences

ObjectiveTo measure the impact of an evidence-based guideline on respectful maternity care on nurses’ attitudes and beliefs about childbirth practices. DesignA quality improvement pilot project with a pretest/posttest design examining the attitudes and beliefs of intrapartum nurses about childbirth practices of respectful care. SettingHigh-risk intrapartum unit at a tertiary care center in the southeastern United States. ParticipantsA convenience sample of 130 registered nurses were invited to participate, and nine completed the pre- and posttests. Intervention/MeasurementsThe intervention included a recorded webinar, access to printed and electronic copies of the guideline, discussions in daily huddles, and a virtual journal club. Data were collected using the 42-item Nurse Attitudes and Beliefs Questionnaire–Revised. Lower scores are reflective of attitudes and beliefs that support a medical model of care, whereas higher scores are reflective of a physiologic model of care. Descriptive statistics and the Wilcoxon signed rank test were used to analyze changes in attitudes and beliefs based on the aggregate scores of the nurse participants. ResultsAlthough there was no change in nurse attitude and beliefs about childbirth practices after 3 months (p = .058), the aggregate scores on a scale of 42 to 168 increased by 5.6 points. Two subscales of the Nurse Attitudes and Beliefs Questionnaire–Revised—Medical Model of Conflict and Women’s Autonomy—had the greatest increase in aggregate scores. ConclusionUnderstanding nurses’ attitudes and beliefs can assist in identifying barriers to the provision of respectful care, particularly during labor and birth, when patients are most vulnerable. Measurement of nurse attitudes and beliefs regarding respectful maternity care may require a longer immersion in a respectful maternity care program to allow for changes over time.

Relationships Among Individual and Hospital Characteristics and Self-Efficacy in Labor Support Among Intrapartum Nurses in Texas

ObjectiveTo explore the relationships among individual and workplace characteristics and self-efficacy in labor support among intrapartum nurses. DesignCross-sectional survey. SettingOnline distribution from April to August 2020. ParticipantsMembers of the Texas section of the Association for Women's Health, Obstetric, and Neonatal Nurses (N = 106). MethodsI conducted descriptive analysis on individual and workplace characteristics, including scores on the Self-Efficacy Labor Support Scale. I conducted backward stepwise multivariate linear regression to assess the factors associated with self-efficacy in providing labor support. ResultsYears as an intrapartum nurse had a positive association with self-efficacy in labor support. Experience with open-glottis pushing, the overall cesarean birth rate, and the use of upright positioning during labor and birth were also positively associated with self-efficacy in labor support. Conversely, lack of recognition by providers was negatively associated with self-efficacy in labor support. ConclusionFindings suggest that modifiable factors at the individual and hospital levels are associated with nurses’ self-efficacy in labor support. Hospitals must work to engage in obstetric practices that are congruent with providing labor support, including the use of experienced nurses to mentor new nurses and the creation of a unit culture to reinforce the intent of individual nurses to provide labor support.

The effect of continuous intrapartum supportive care on maternal mental health: a randomized controlled trial

ABSTRACT Supportive care during labor is the primary role of intrapartum nurses and midwives and provides comfort for women allowing them to have a positive experience. It is argued that supportive care during labor reduces fear and resultant side effects. However, evidence for different parameters of mental health is insufficient. The aim of this study was to evaluate the effect of continuous intrapartum supportive care on the fear of childbirth, perceived control and support at birth, birth trauma and maternal attachment. This is a randomized controlled study with an intervention group and a control group. The intervention group included 40 women receiving continuous intrapartum supportive care and the control group included 40 women receiving routine care. Thirty women in the intervention group and 29 women in the control group completed the study. No significant differences were detected between the two groups at baseline (p > .05). Continuous intrapartum supportive care significantly decreased fear of birth and birth trauma, and significantly increased perceived intrapartum control and support and postpartum maternal attachment (p < .01). Results from this evidence-based study suggest that continuous intrapartum supportive care could protect and maintain perinatal mental health.

Intrapartum Nurses’ Beliefs Regarding Birth, Birth Practices, and Labor Support

ObjectivesTo examine the relationships among intrapartum (IP) nurses’ beliefs regarding birth (physiologic birth/medicalized birth) and their experience, education, and certification; to assess IP nurses’ beliefs about birth practices and labor support; to describe the birth practices of the most effective IP nurses; and to elicit recommendations from IP nurses for quality improvement in IP nursing practice. DesignCross-sectional, descriptive study. SettingThree urban hospitals from one state in the northeastern United States. ParticipantsOne hundred twelve IP registered nurses who were primarily staff nurses. MethodsWe collected quantitative and qualitative data using a Web-based survey that included the Intrapartum Nurses’ Beliefs Related to Birth Practice–Modified scale. We used Burgess’s conceptual definition of laborsupport as the framework to analyze findings. ResultsParticipants favored physiologic birth and not medicalized birth, and their beliefs were associated with experience (p = .01) and certification (p = .04). Participants reported that effective IP nurses demonstrate labor practices supportive of physiologic birth. Recommendations from participants for quality improvement in IP nursing practice included ways to optimize physical support, emotional support, informational support, and advocacy for women during labor. Participants made no recommendations related to partner support. ConclusionParticipants held beliefs that favored physiologic birth and supported many labor practices that can facilitate physiologic birth. However, some labor practices associated with medicalized birth were also supported. Further quality improvement strategies to provide partner support during labor are needed.

Maternal Satisfaction with Intrapartum Nursing Care and Its Associated Factors among Mothers Who Gave Birth in Public Hospitals of North Wollo Zone, Northeast Ethiopia: Institution-Based Cross-Sectional Study.

Background Now a day, satisfaction had been identified as the major index to assess the quality of health-care provision in the world including Ethiopia. Mothers judge the quality of intrapartum care received based on their satisfaction with the services provided, thus influencing their utilization of the available health facilities. Therefore, this study aimed to assess maternal satisfaction with intrapartum care and associated factors among mothers who gave birth in public hospitals in North Wollo Zone, Northeastern Ethiopia, 2019. Methods Institutional-based cross-sectional quantitative study was conducted in public hospitals of North Wollo Zone, and a total of 398 study participants were selected by using a systematic random sampling method. Data was collected using a standardized questionnaire by direct interviewing of study participants, and data was analyzed using SPSS 24 versions to determine the frequency of variables. Logistic regression was carried out to identify factors associated with maternal satisfaction. Results From the total of 398 study participants, about 51% of women were satisfied with the hospital-based intrapartum nursing care. Being rural in residency (AOR: 2.03; 95% CI: 1.05-3.93), time to be seen by health-care providers (AOR: 2.82; 95% CI: 1.46-5.46), having history of ANC follow-up (AOR: 3.73; 95% CI: 1.12-12.57), and getting adequate meal (AOR: 3.96; 95% CI: 1.13-13.83) had showed statistical significant association with maternal satisfaction. Conclusion In this study, the overall maternal satisfaction with intrapartum nursing care was low. Therefore, improving ANC follow-up, early examined by health-care providers, and getting adequate meal while in labour and delivery might enhance women satisfaction with intrapartum nursing care services.

Maternal and system characteristics, oxytocin administration practices, and cesarean birth rate.

The cesarean birth rate in the United States is 32%, and there is discussion about the cause of high surgical birth rates. Our purpose was to determine whether mode of birth is influenced by maternal, nurse, and system factors. Secondary analysis of a data set of 163 women having postdates labor induction with oxytocin. Kaplan-Meier survival curves were calculated to compare the time for patients to reach an infusion rate of 6mU/min, consistent with endogenous oxytocin levels in active labor. We used the log-rank test to evaluate survival curve differences. Multiple logistic regression and Cox proportional hazards models were conducted and included covariates that had statistically significant bivariate relationships with the time variable, or were clinically meaningful. The mean time to reach 6mU/min was longer for women who birthed by cesarean (172.5minutes) than for women who had vaginal birth (125.0minutes, P = .024). The mean time to reach 6mU/min was also longer for women admitted on night shift (147.0minutes) than day shift (110.2minutes, P = .018). No maternal characteristics were significantly related to the time to reach a rate of 6mU/min. Even during the initial hours of labor induction, it is important that the oxytocin infusion is titrated appropriately to aid women in achieving timely vaginal birth. Intrapartum nurses should receive education about the pharmacokinetics of intravenous oxytocin to understand proper administration of this high-alert medication.

A Proactive Approach to Quantification of Blood Loss in the Perinatal Setting

ObjectiveTo educate nurses and physicians on changing practice from visual estimation of blood loss to quantification of blood loss (QBL) and to replace estimation of blood loss with QBL for at least 85% of vaginal births during a 3-month period. DesignQuality improvement project. Setting/Local ProblemA midwestern U.S. urban community hospital with 1,200 annual births, where postpartum blood loss was being measured by using visual estimation. ParticipantsA convenience sample of 43 intrapartum nurses and 17 physicians. Intervention/MeasurementsA goal was set to use the QBL method for at least 85% of vaginal births for 3 consecutive months. Study participants were surveyed at baseline to assess their knowledge of the QBL method; they then received a 10-minute educational presentation by the clinical nurse specialist (CNS) on QBL. The CNS attended births on both 12-hour shifts to give support, evaluate correct use of the new drapes, and answer questions. Midway through the project, a brief survey was distributed to participants for their feedback. The CNS conducted a chart audit to determine the compliance rate for the QBL process. ResultsData analysis indicated an average 89% compliance rate with the QBL process for the time period studied. ConclusionEducation on the QBL method increased nurses’ and physicians’ awareness of the importance of using this method as the new standard of care for assessment of postpartum blood loss. Accuracy of postpartum blood loss measurement is critical to help prevent maternal morbidity and mortality. Nurses play a key role in the development and implementation of practice changes to use QBL measurement.

Cesarean overuse and the culture of care

ObjectiveTo assess hospital unit culture and clinician attitudes associated with varying rates of primary cesarean delivery.Data Sources/Study SettingIntrapartum nurses, midwives, and physicians recruited from 79 hospitals in California participating in efforts to reduce cesarean overuse.Study DesignLabor unit culture and clinician attitudes measured using a survey were linked to the California Maternal Data Center for birth outcomes and hospital covariates.MethodsAssociation with primary cesarean delivery rates was assessed using multivariate Poisson regression adjusted for hospital covariates.Principal Findings1718 respondents from 70 hospitals responded to the Labor Culture Survey. The “Unit Microculture” subscale was strongly associated with primary cesarean rate; the higher a unit scored on 8‐items describing a culture supportive of vaginal birth (eg, nurses are encouraged to spend time in rooms with patients, and doulas are welcomed), the cesarean rate decreased by 41 percent (95% CI = −47 to −35 percent, P < 0.001). Discordant attitudes between nurses and physicians were associated with increased cesarean rates.ConclusionsHospital unit culture, clinician attitudes, and consistency between professions are strongly associated with primary cesarean rates. Improvement efforts to reduce cesarean overuse must address culture of care as a key part of the change process.

Intrapartum Nurse Perception of Labor Support After Implementation of the Coping With Labor Algorithm.

The purpose of this research project was to determine if using the Coping with Labor Algorithm would lead to changes in the perception of the intrapartum (IP) nurses' beliefs toward birth practices and frequency of labor support interventions. Twenty-three participants completed the preintervention survey, which included the IP Nurses' Belief Toward Birth Practice Scale and the Labor Support Scale. Following completion of the preintervention survey, participants received a copy of the Coping with Labor Algorithm and Toolkit and then began implementation of the Coping with Labor Algorithm. After implementation, 13 IP nurses completed the postintervention survey. The surveyed IP nurses reported positive changes in their perceived frequency of labor support and a slight change in their birth beliefs.

A Qualitative Study on Women's Experiences of Intrapartum Nursing Care at Tamale Teaching Hospital (TTH), Ghana.

Introduction: Labor and delivery process is an exciting, anxiety-provoking, but rewarding time for a woman and her family after successful delivery of a newborn. The intrapartum period is the time where mothers expect more care. Taking care of a mother through delivery with no side effects is the task of a professional midwife who is trained with the skill to take the responsibility of caring for mothers and babies. Therefore, the aim of this study was to explore mother’s experiences regarding quality of intrapartum nursing/midwifery care. Methods: Focused ethnographic study was employed. Data were collected from May to June 2016 TTH, Ghana using semi structured interview guide. Purposive sampling was employed to recruit 20 participants. Eight individual interviews were conducted in the post natal ward after 48 hours of delivery, followed by three focus group discussions two weeks after delivery when mothers visited post natal clinic. Interviews lasted for about 30-45 minutes during each session. Data were analyzed using thematic analysis. Results: The average age of women were 29 years with ranging from 19-43 years. Participants’ experiences of nursing/midwifery care during birth were influenced by reception and respect, provision of information, technical skill, providers’ behavior, pain management and availability of nurses/midwives. Conclusion: The study findings have revealed that women’s experience of care is affected by a wide range of determinants. Therefore, maternal health programs and policies in Ghana must take into account women’s perspective on the care they need and their feedback on services they receive. Nursing education should re-enforce communication/relational skills.

The Effects of Intrapartum Supportive Care on Fear of Delivery and Labor Outcomes: A Single-Blind Randomized Controlled Trial.

Supportive care during labor, the primary role of intrapartum nurses and midwives, provides comfort to prepartum women and helps facilitate a positive labor experience. It has been argued that supportive care during labor reduces fear and anxiety as well as the resultant side effects. However, evidence supporting this argument is insufficient. The aim of this study was to assess the effects of intrapartum supportive care on fear of delivery and on the key parameters of the labor process. This study used a single-blind randomized controlled trial approach. Randomized block assignment was used to assign 72 participants to either the intervention group (n = 36) or the control group (n = 36). Three women in the intervention group and six in the control group were later excluded from the study because they received emergency cesarean delivery. The intervention group received continuous supportive care, and the control group received routine hospital care. No significant differences were identified between the two groups at baseline. The intervention group reported less fear of delivery during the active and transient phases of labor, higher perceived support and control during delivery, lower pain scores during the transient phase of labor, and a shorter delivery period than the control group (p < .05). However, no significant difference in the use of oxytocin during delivery between the two groups was reported. The results of this evidence-based study suggest that continuous support during labor has clinically meaningful benefits for women and that all women should receive this support throughout their labor and delivery process.

Establishing a Nurse-Driven Nitrous Oxide Program in a Multihospital System

Establishing a Nurse-Driven Nitrous Oxide Program in a Multihospital System

Nurses' Own Birth Experiences Influence Labor Support Attitudes and Behaviors

ObjectiveTo describe the attitudes of intrapartum nurses about the importance of and intent to provide professional labor support (PLS); barriers to PLS, such as perceived subjective norms and perceived behavioral control; and relationships among attitudes, behaviors, and nurse and site characteristics. DesignA cross-sectional, mixed-methods, descriptive design was guided by the Theory of Planned Behavior. SettingThree hospital sites in one region of a single Midwestern state. ParticipantsSixty intrapartum nurses participated. MethodsThe Labor Support Questionnaire and demographic questionnaire were administered online. The Labor Support Questionnaire is used to measure attitudes about the importance of and intended behaviors associated with labor support. ResultsNurse Caring Behaviors was the highest rated PLS dimension. Participants' own personal birth experiences and length of current intrapartum experience were positively correlated with attitudes about and intent to provide PLS. Barriers to PLS included staffing, documentation, physicians, use of epidural analgesia, doulas, and birth plans. ConclusionPersonal birth and work experience influenced attitudes about and intent to provide PLS and demonstrated the relationships described in the Theory of Planned Behavior. Intrapartum nurses may benefit from an examination of their personal experiences to see how they might influence attitudes about PLS. Enhanced training and expanded labor and birth experience for novice nurses or students may improve attitudes and intended behavior with regard to PLS. Further investigations of the factors that affect integration of PLS into care are important to promote healthy birth outcomes.

Nurses Count: Tracking Performance to Improve Cesarean Delivery Rates.

Nurses Count: Tracking Performance to Improve Cesarean Delivery Rates.

Promoting Professional Labor Support through Education

<h2>Poster Presentation</h2><h3>Objective</h3> To design, implement, and evaluate a nursing theory and evidence‐based educational program on professional labor support (PLS). <h3>Design</h3> Pretest/posttest descriptive design for program evaluation research. <h3>Setting</h3> A tertiary medical center in the Midwest United States. <h3>Sample</h3> A convenience sample of intrapartum nurses employed at the participating hospital (<i>N</i> = 31). <h3>Methods</h3> Nurses were measured on study outcomes before and after attending a four‐hour continuing education program, The Professional Labor Support Course, founded on Swanson's theory of caring. Evidence‐based content information stemmed from AWHONN's position statement on nursing support of laboring women. Measured outcomes included self‐efficacy for PLS, perceived value of content information, learner satisfaction, and intended knowledge translation to nursing practice. <h3>Results</h3> A paired samples <i>t</i> test revealed a highly significant difference in self‐efficacy for PLS composite scores before and after attending the PLS course, <i>t</i>(30) = −7.92, <i>p</i> ≤ .01. Perceived value of content information revealed that 90.3% of nurses found the information clinically relevant, 80.6% of nurses reported they learned something new, 64.5% stated their practice will be changed and improved, 80.6% planned to use the information to modify patient management, and 83.9% anticipated increasing patient knowledge as a health benefit of the information. Learner satisfaction reported ratings of outstanding for learning objectives (>74%), speaker evaluation (>93%), and process evaluation (>80%) categories with 96.8% of nurses rating the overall course experience as outstanding. Intended knowledge translation revealed positioning (83.9%) as the top ranked PLS behavior nurses plan to implement in their practices. Top ranked barriers to PLS were identified as continuous monitoring, physician barriers, lack of equipment, staffing, and family influence. Top‐ranked facilitators to PLS were identified as knowledge, equipment, staffing, attitude, and patient education. <h3>Conclusion/Implications for Nursing Practice</h3> The PLS course was highly effective in leading to increased self‐efficacy for PLS and high levels of perceived value of content information and learner satisfaction. Although nurses reported plans to implement PLS, it is unknown if there will be actual knowledge translation into practice. Therefore, it would be beneficial to measure frequency of PLS following attendance. The overall study assumption is that nurses who are knowledgeable and place value on PLS will embrace PLS as best practice and ultimately lead to improved patient outcomes.

Reliability and validity of an instrument to measure the beliefs of intrapartum nurses.

Intrapartum nurses assume a central role in the birth process and make decisions driven by a set of beliefs. Therefore, the purpose of this study was to develop a valid and reliable instrument to measure birth beliefs of intrapartum nurses related to birth practice. A total of 313 intrapartum nurses accessed this online, self-administered instrument over a 3-month period. The Theory of Planned Behavior guided development of the Intrapartum Nurses' Beliefs Related to Birth Practice scale and provided a basis for the connection between beliefs and practice. This article describes the psychometric analysis of the instrument. Findings include a moderate, positive correlation with a similar instrument, a Cronbach α of 0.797, and 2 factors identifying belief systems. With further revision, this instrument may provide an accurate measure of the birth beliefs of intrapartum nurses.

Development of the Intrapartum Nurses' Beliefs Related to Birth Practice Scale.

Intrapartum (IP) nurses make decisions driven by beliefs. This study's purpose was to develop an instrument measuring birth beliefs of the IP nurse related to birth practice. The theory of planned behavior guided the development process, providing a connection between beliefs and practice. This article describes the domain identification, item generation, and instrumentation process. The Intrapartum Nurses' Beliefs Related to Birth Practice (IPNBBP) is an online, self-administered instrument with 36 Likert scale items measuring the birth beliefs of IP nurse and categorizes medicalized birth beliefs, normal birth beliefs, and beliefs outlined in the theory of planned behavior. Following psychometric testing, the IPNBBP may be used to provide a link between the beliefs and practice of IP nursing and maternal and neonatal outcomes.

Understanding the Moral Nature of Intrapartum Nursing

To explore how intrapartum nurses understand and negotiate their moral responsibilities toward women during childbirth. Qualitative critical narrative. Labor and birth unit in an urban Canadian hospital. Fourteen intrapartum registered nurses. Critical narrative analysis using a feminist ethics perspective. Nurses understood their moral responsibilities to laboring women in a variety of ways depending on the nurses' personal and professional experiences, the people involved, and the context of care. Four themes were identified: organizing and coordinating care, responding to the unpredictable, recognizing limits of responsibilities to others, and negotiating care with women and families. A key factor influencing responses to women was the degree to which expectations related to birth were deemed to be reasonable and mutually agreed upon among nurses, physicians, women, and their families. Although nurses were able to identify contextual influences that constrained their ability to maintain effective relationships with women, the influence of their own values on the care they provided was less apparent. Nurses also described limits of their responsibilities for others, which departed from the idealized expectations often reflected in professional guidelines These findings suggest a need to challenge assumptions related to the provision of choice and family centered care to create environments that can support and sustain understanding and trust between nurses and women giving birth. In addition, given the lack of shared understandings of what constitutes best care, there is a need to develop collaborative models of care that include the voices of women as a central component.

Intrapartum Nurses’ Perceived Influence on Delivery Mode Decisions and Outcomes

To examine the role of the labor and delivery nurse in a nurse-managed practice model and nurses' perceived ability to influence decisions about mode of delivery and outcomes. Cross-sectional, descriptive, qualitative study. One nurse-managed labor and delivery unit in a community-based hospital near a major metropolitan area. A purposeful sample of 13 registered nurses with intrapartum experience. Qualitative, in-depth interview data were subjected to content analysis. Experienced labor and delivery nurses perceived their role to be influential in decisions about mode of delivery. Negotiating for more time was integral to the way nurses exerted their influence, allowing for the time needed to implement practices that promote vaginal delivery. Knowledge of labor and physician practice patterns shaped the specific communication strategies used by nurses in their roles as negotiators. The responses of experienced, intrapartum nurses to actual and perceived time pressures and the subsequent impact on nurse-physician communication patterns and delivery mode outcomes are significant. Findings indicate the need to further explore how individual nursing practice may function as an independent predictor of delivery mode and how shared decision making among physicians, laboring women, and nurses affects rates of cesarean delivery.