Labor Nurses Research Articles

Labor Nurses' Experiences During the COVID-19 Pandemic

Abstract Purpose: The purpose of this study was to describe labor and delivery nurses' experiences in caring for patients during the COVID-19 pandemic. Methods: We used a descriptive phenomenological design and purposeful sampling to recruit experienced labor and delivery nurses for flexible semi-structured face-to-face audiotaped interviews. Constant comparison was used to analyze data. Results: Ten nurses employed in a labor and delivery unit in two acute care hospitals in southern Texas participated and were interviewed from June through August 2022. The mean age of nurse participants was 36.5 years. Seven had over 5 years' experience as a labor and delivery nurse before the pandemic. Five distinct themes were identified: Psychological stress during COVID-19; Feelings of satisfaction and gratitude; Resilience and readiness for positive change; Patient-centered care; and Interprofessional collaboration. Clinical Implications: These findings build on our understanding of key determinants contributing to labor and delivery nurses' ability to adjust to the unprecedented and chaotic working conditions during the COVID-19 pandemic and highlighted several factors that could influence nurses' resilience and job satisfaction.

Nurse-Reported Staffing Guidelines and Exclusive Breast Milk Feeding.

Nursing care is essential to overall quality of healthcare experienced by patients and families-especially during childbearing. However, evidence regarding quality of nursing care during labor and birth is lacking, and established nurse-sensitive outcome indicators have limited applicability to maternity care. Nurse-sensitive outcomes need to be established for maternity care, and prior research suggests that the initiation of human milk feeding during childbirth hospitalization is a potentially nurse-sensitive outcome. The aim of this study was to determine the relationship between nurse-reported staffing, missed nursing care during labor and birth, and exclusive breast milk feeding during childbirth hospitalization as a nurse-sensitive outcome. 2018 Joint Commission PC-05 Exclusive Breast Milk Feeding rates were linked to survey data from labor nurses who worked in a selected sample of hospitals with both PC-05 data and valid 2018 American Hospital Association Annual Survey data. Nurse-reported staffing was measured as the perceived compliance with Association of Women's Health, Obstetric and Neonatal Nurses staffing guidelines by the labor and delivery unit. Data from the nurse survey were aggregated to the hospital level. Bivariate linear regression was used to determine associations between nurse and hospital characteristics and exclusive breast milk feeding rates. Generalized structural equation modeling was used to model relationships between nurse-reported staffing, nurse-reported missed care, and exclusive breast milk feeding at the hospital level. The sample included 184 hospitals in 29 states and 2,691 labor nurses who worked day, night, or evening shifts. Bivariate analyses demonstrated a positive association between nurse-reported staffing and exclusive breast milk feeding and a negative association between missed nursing care and exclusive breast milk feeding. In structural equation models controlling for covariates, missed skin-to-skin mother-baby care and missed breastfeeding within 1 hour of birth mediated the relationship between nurse-reported staffing and exclusive breast milk feeding rates. This study provides evidence that hospitals' nurse-reported compliance with Association of Women's Health, Obstetric and Neonatal Nurses staffing guidelines predicts hospital-exclusive breast milk feeding rates and that the rates are a nurse-sensitive outcome.

Time and Effort by Labor Nurses to Achieve and Maintain a Continuous Recording of the Fetal Heart Rate via External Monitoring

ObjectiveTo describe the time and effort of labor and delivery (L&D) nurses working to achieve a continuous recording of the fetal heart rate via external fetal monitoring, as well as the types of aids involved in that process. DesignDescriptive study using a cross-sectional survey methodology. Setting/Local ProblemNurses on our L&D units were frequently repositioning laboring women and fetal monitors, and utilizing various aids to achieve continuous monitoring. No evidence to support a best practice for achieving continuous fetal monitoring was identified. ParticipantsL&D nurses practicing in New Jersey. Intervention/MeasurementsAn online survey was used to collect data from labor nurses to identify if they used aids and what types of aids they used in their practice to achieve and maintain a continuous recording of the fetal heart rate via external fetal monitoring, as well as the amount of time that they spent doing so at the bedside. ResultsOf the 134 nurses who participated in the survey, 50% reported spending 1 to 2 hours repositioning an individual, and 48.9% reported spending 1 to 2 hours per 12-hour shift manipulating the ultrasound transducer. Thus, up to one third of the shift was spent working to achieve a continuous recording of the fetal heart rate via external fetal monitoring. More than 99% (n = 133) of participants reported the use of aids. The most popular aids included supplemental monitoring equipment such as extra fetal monitor straps or improvised aids such as washcloths. ConclusionL&D nurses spend at least some time at the bedside manipulating the ultrasound transducer to achieve and maintain a continuous recording of the fetal heart rate via external fetal monitoring. Various aids are used to do so. Understanding the amount of time nurses spend at the bedside and the aids used for this purpose may provide a better understanding of the work of L&D nurses.

Emotional Intelligence among Nurses working in a Tertiary Care Hospital, Kerala, South India

The nursing profession is labor intensive and nurses needs to regulate their emotions for the sake of their patients, their families and health care team member’s needs. The aim of the present study was to determine the level of emotional intelligence among nurses working in a selected tertiary care private hospital. A quantitative cross-sectional survey method, data was collected using a self-reported-questionnaires developed by Schutte from 717 registered nurses working in a tertiary care private hospital. A convnininece sampling technique was used to recruit the study participants. Data was analyzed using SPSS Version 24. The mean age of participants was 31.26±4.86 years; 93.4% (670) were females and 6.6% (47) were males. The total EI score ranged from 46 to 155 with a mean of 127.2311±10.1. Out of all, only 12% of the participants had above average, 3.5% had less than average and the remaining 84% had moderate levels of levels of EI levels. A statistically significant relationship was found between emotional intelligence and type of educational qualification and the total years of professional experience in the current area of work at 0.01 level. The moderate level of EI among majority of the participants revealed in the present study necessitates the need for conscious effort, education and training to improve the EI levels among nurses.

Chronic Abruption Oligohydramnios Sequence

Abruption is a significant cause of both maternal morbidity and neonatal morbidity and mortality, particularly when it occurs preterm. Women with chronic abruption experience relatively light, chronic, intermittent bleeding. They are at risk of developing clinical manifestations of ischemic placental disease over time, such as oligohydramnios (termed chronic abruption-oligohydramnios sequence [CAOS]), fetal growth restriction, and preeclampsia. They are also at risk of preterm prelabor rupture of membranes. CAOS is manifested by chronic bleeding, placental insufficiency, and oligohydramnios. Oligohydramnios is presumably due to hypoxic fetal response and decreased urine output. At 22 weeks, 3 days gestation, the patient was seen in our maternal fetal medicine (MFM) clinic as a consultation from another hospital about an hour away. Her personal life had been very difficult: She was going through a divorce, had two other children whose father was not involved, had an unplanned pregnancy, her brother had just committed suicide, and her father was missing for more than 3 months. Not only was she at risk for having a severely premature newborn to care for, but she had many personal obstacles that our team had to consider to make a prolonged hospital stay work for her and her family. Our MFM clinic discussed the plan with the patient: hospitalization at 23 weeks with bedrest until the planned birth at 34 weeks. Our multidisciplinary team (MFM, neonatology, NICU nurses, labor nurses, a social worker, a psychiatrist, dietary, family patient experience specialist) developed a comprehensive, holistic care plan that enabled us to not only provide quality maternal and fetal care but also provide her family with care during her 10-week stay at our facility. Her baby was born at 33 weeks, 1 day gestation, just a little more than 10 weeks after arriving on our unit. A multidisciplinary team provided this patient with the best possible outcome. Our unit also did our best to provide this long-term patient with continuity of care by assigning a group of nurses who knew her well and could provide consistent and supportive care related to her specific needs.

Missed Nursing Care During Labor and Birth and Exclusive Breast Milk Feeding During Hospitalization for Childbirth.

The purpose of this study was to determine associations between missed nursing care and nurse staffing during labor and birth, and exclusive breast milk feeding at hospital discharge. Labor and birth nurses in three states were surveyed about missed nursing care and their maternity units' adherence to the AWHONN (2010) nurse staffing guidelines for care during labor and birth, using the Perinatal Misscare Survey. Nursing responses were aggregated to the hospital level and estimated associations between missed nursing care, nurse staffing, and hospitals' exclusive breast milk feeding rates were measured using The Joint Commission's Perinatal Care Measure (PC-05). Surveys from 512 labor nurses in 36 hospitals were included in the analysis. The mean exclusive breast milk feeding rate was 53% (range 13%-76%). Skin-to-skin care, breastfeeding within 1 hour of birth, and appropriate recovery care were on average occasionally missed (2.33 to 2.46 out of 4; 1 = rarely, 2 = occasionally, 3 = frequently, or 4 = always) and were associated with PC-05 [B(CI) -17.1(-29, -6.3), -17.9(-30.5, -6.2), and -15.4(-28.7, -2.1), respectively]. Adherence with overall staffing guidelines was associated with PC-05 [12.9(3.4, 24.3)]. Missed nursing care was an independent predictor of PC-05 [-14.6(-26.4, -2.7)] in a multilevel model adjusting for staffing guideline adherence, perceived quality, mean age of respondents, and nurse burnout. Exclusive breast milk feeding is a national quality indicator of inpatient maternity care. Nurses have substantial responsibility for direct support of infant feeding during the childbirth hospitalization. These results support exclusive breast milk feeding (PC-05) as a nurse-sensitive quality indicator.

Enfermeiro do trabalho na prevenção de riscos biológicos ocupacionais: uma revisão de literatura no âmbito hospitalar

O enfermeiro do trabalho atribui-se de forma significativa no âmbito hospitalar o desenvolvimento de ações para medidas de segurança, detecção e minimização dos riscos ocupacionais de acordo com a atividade realizada e os agravos biológicos a que estão expostos os profissionais de enfermagem, com o objetivo de melhorar as condições laborais. Trata-se de uma pesquisa bibliográfica de abordagem qualitativa, com objetivo de descrever a atuação do enfermeiro do trabalho para a redução do risco biológico no âmbito hospitalar. Após a associação de todos os descritores foram encontrados 151 artigos, excluídos 138 e selecionados 13. Posterior à leitura reflexiva emergiram quatro categorias: Principais eventos adversos biológicos; O Enfermeiro do Trabalho na prevenção dos riscos ocupacionais. Dentre os riscos a que os trabalhadores estão expostos ressalta-se a infecção hospitalar, a potencial transmissão do Vírus da Imunodeficiência Adquirida (HIV), do Vírus da Hepatite B (HBV) e da Hepatite C (HCV), além de outras ocorrências danosas a saúde do trabalhador. O papel do Enfermeiro do trabalho passou por transformações e evoluções, sendo hoje considerado um profissional de extrema importância para qualquer organização, à medida que por meio de sua orientação e atenção, seja prevenido os acidentes e doenças laborais e também aconteça a promoção da saúde dos trabalhadores. Conclui-se que o enfermeiro tem a formação voltada para o gerenciamento além de estar apto a realizar procedimentos de menor e maior complexidade bem como prescrever ações, adotando medidas de precaução universal de biossegurança. Sua atuação prevê um planejamento estratégico, o que facilita para a elaboração de pesquisa de acidentes ocupacionais e consequentemente a prevenção destes.

Adaptation of the MISSCARE Survey to the Maternity Care Setting

Missed nursing care is an important measure of nursing care quality that is sensitive to nurse staffing and is associated with patient outcomes in medical–surgical and pediatric inpatient settings. Missed nursing care during labor and birth has not been studied, yet childbirth represents the most common reason for hospitalization in the United States. The Missed Nursing Care (MISSCARE) Survey, a measure of medical–surgical nursing quality with substantial evidence for validity and reliability, was adapted to maternity nursing care using data from focus groups of labor nurses, physicians, and new mothers and an online survey of labor nurses. Content validity was evaluated via participant feedback, and exploratory factor analysis was performed to identify the factor structure of the instrument. The modified version, the Perinatal Missed Care Survey, appears to be a feasible and promising instrument with which to evaluate missed nursing care of women during labor and birth in hospitals.

Effects of current emotional labor on quality of professional life in operation room nurses

Objective To explore the status quo of emotional labor in operation room nurses and to analyze its effects on quality of professional life, so as to provide a reference for improving physical and mental health of operation room nurses and driving the building and development of the specialized nurse team. Methods Totally 203 operation room nurses from 4 general ClassⅢ Grade A hospitals in Jiangxi province from May to June 2018 were selected using convenient sampling, and the status quo of their emotional labor was investigated with the general information questionnaire, Nurse's Emotional Labor Scale and Nurse's Quality of Professional Life Scale. Results The total average score of emotional labor of the operation room nurses was (3.68±0.55) , including (3.57±0.76) for deep acting, (4.28±0.80) for emotional expression and (3.50±0.74) for surface acting from high to low. Univariate analysis revealed that there was statistically significant difference in surface acting scores between operation room nurses with different length of service, in deep acting scores between operation room nurses with different age, professional title and clinical teaching and in emotional expression scores between operation room scores with different educational background (P<0.05) . Emotional labor was correlated with the various factors of quality of professional life. Surface acting had negative predictive power for kindness satisfaction (β=-0.317, P<0.01) , and positive predictive power for job burnout (β=0.337, P<0.01) and secondary trauma (β=0.264, P<0.01) . Deep acting had positive predictive power for kindness satisfaction, and negative predictive power for job burnout (β=0.303, P<0.01) and secondary trauma (β=0.281, P<0.01) . Emotional expression requirements had positive predictive power for kindness satisfaction (β=0.191, P<0.01) . Multivariate linear regression analysis showed that surface acting, deep acting and emotional expression requirements were the main influencing factors to kindness satisfaction, and that surface acting and deep acting were the main influencing factors to job burnout and secondary trauma. Conclusions The emotional labor of operation room nurses stays at a medium level, and the emotional labor strategy mostly frequently used is deep acting. Surface acting, deep acting and emotional expression requirements in emotional labor have predictive power for quality of professional life, and managers should pay attention to the education and training of emotional labor for operation room nurses. Key words: Nurses; Operation room; Emotional labor; Quality of professional life

Improving Perioperative Knowledge, Self-Efficacy, and Performance in Labor and Delivery Nurses: A Quality Improvement Project.

The obstetrical unit utilized a training product (Periop 101: A Core Curriculum OB) to enhance the knowledge, self-efficacy, and performance of nurses circulating for cesarean births. Knowledge was measured using product provided testing. Self-efficacy was assessed using a modified perioperative self-efficacy scale, and performance was evaluated by analyzing documentation accuracy and incident reports. Results demonstrated improvements in perioperative knowledge, self-efficacy, and documentation as well as a reduction in incident reports.

Adherence to the AWHONN Staffing Guidelines as Perceived by Labor Nurses

ObjectiveTo evaluate the degree to which registered nurses perceive their labor and delivery units to be adhering to Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) staffing guidelines. DesignProspective, cross-sectional study via an online survey of labor nurses recruited from hospitals in three states. Setting/Local ProblemIn late 2016 and early 2017, labor nurses in selected hospitals in California, Michigan, and New Jersey were contacted via e-mail invitation to participate in a study about nursing care during labor and birth. Nurse leaders in each hospital facilitated the invitations. ParticipantsA total of 615 labor nurses from 67 hospitals. Intervention/MeasurementsDescriptive statistics and linear regression models were used for data analysis. ResultsMost nurses reported that the AWHONN nurse staffing guidelines were frequently or always followed in all aspects of care surveyed. Hospitals with annual birth volumes of 500 to 999 range were significantly more likely than hospitals with 2,500 or more annual births to be perceived as compliant with AWHONN staffing guidelines. ConclusionWhen the AWHONN staffing guidelines were first published in 2010, there was concern among some nurse leaders that they would not be adopted into clinical practice, yet nurses in our sample overwhelmingly perceived their hospitals to be guideline compliant. There remains much more work to be done to determine nurse-sensitive outcomes for maternity care and to ensure that all women in labor in the United States are cared for by nurses who are not overburdened or distracted by being assigned more women than can be safely handled.

ACOG Practice Bulletin No. 209 Summary: Obstetric Analgesia and Anesthesia

Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician's care. Many women desire pain management during labor and delivery, and there are many medical indications for analgesia and anesthesia during labor and delivery. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor. A woman who requests epidural analgesia during labor should not be deprived of this service based on the status of her health insurance. Third-party payers that provide reimbursement for obstetric services should not deny reimbursement for labor analgesia because of an absence of "other medical indications." Anesthesia services should be available to provide labor analgesia and surgical anesthesia in all hospitals that offer maternal care (levels I-IV) (). Although the availability of different methods of labor analgesia will vary from hospital to hospital, the methods available within an institution should not be based on a patient's ability to pay.The American College of Obstetricians and Gynecologists believes that in order to allow the maximum number of patients to benefit from neuraxial analgesia, labor nurses should not be restricted from participating in the management of pain relief during labor. Under appropriate physician supervision, labor and delivery nursing personnel who have been educated properly and have demonstrated current competence should be able to participate in the management of epidural infusions.The purpose of this document is to review medical options for analgesia during labor and anesthesia for surgical procedures that are common at the time of delivery. Nonpharmacologic options such as massage, immersion in water during the first stage of labor, acupuncture, relaxation, and hypnotherapy are not covered in this document, although they may be useful as adjuncts or alternatives in many cases.

ACOG Practice Bulletin No. 209: Obstetric Analgesia and Anesthesia.

Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician's care. Many women desire pain management during labor and delivery, and there are many medical indications for analgesia and anesthesia during labor and delivery. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor. A woman who requests epidural analgesia during labor should not be deprived of this service based on the status of her health insurance. Third-party payers that provide reimbursement for obstetric services should not deny reimbursement for labor analgesia because of an absence of "other medical indications." Anesthesia services should be available to provide labor analgesia and surgical anesthesia in all hospitals that offer maternal care (levels I-IV) (). Although the availability of different methods of labor analgesia will vary from hospital to hospital, the methods available within an institution should not be based on a patient's ability to pay.The American College of Obstetricians and Gynecologists believes that in order to allow the maximum number of patients to benefit from neuraxial analgesia, labor nurses should not be restricted from participating in the management of pain relief during labor. Under appropriate physician supervision, labor and delivery nursing personnel who have been educated properly and have demonstrated current competence should be able to participate in the management of epidural infusions.The purpose of this document is to review medical options for analgesia during labor and anesthesia for surgical procedures that are common at the time of delivery. Nonpharmacologic options such as massage, immersion in water during the first stage of labor, acupuncture, relaxation, and hypnotherapy are not covered in this document, although they may be useful as adjuncts or alternatives in many cases.

False Alarms and Overmonitoring: Major Factors in Alarm Fatigue Among Labor Nurses.

Nurses can be exposed to hundreds of alarms during their shift, contributing to alarm fatigue. The purposes were to explore similarities and differences in perceptions of clinical alarms by labor nurses caring for generally healthy women compared with perceptions of adult intensive care unit (ICU) and neonatal ICU nurses caring for critically ill patients and to seek nurses' suggestions for potential improvements. Nurses were asked via focus groups about the utility of clinical alarms from medical devices. There was consensus that false alarms and too many devices generating alarms contributed to alarm fatigue, and most alarms lacked clinical relevance. Nurses identified certain types of alarms that they responded to immediately, but the vast majority of the alarms did not contribute to their clinical assessment or planned nursing care. Monitoring only those patients who need it and only those physiologic values that are warranted, based on patient condition, may decrease alarm burden.

56: Nurse-specific cesarean rates: why and how

Among nationwide efforts to safely reduce nulliparous, term, singleton, vertex (NTSV) cesarean rates, the value of labor support from nurses has prompted discussion of the need to consider “nurse-specific cesarean rates”. Calculation of nurse-specific rates is problematic due to the duration of labor and the difficulty of determining which nurse was primarily responsible for the delivery route. We present our strategy for deriving nurse-specific rates, using information available in the electronic medical record (EMR). Excluding scheduled cesarean deliveries, for every NTSV delivery in FY18 through April we extracted delivery route, cesarean indication, delivery time, time of maximum cervical dilation, time of first and last vital sign check for each nurse, time of first documentation of pushing and name of the delivery nurse from the EMR. We calculated the number of minutes between first and last vital sign check and summed all minutes spent with the patient for each nurse. The nurse spending the most time with the patient prior to complete dilation was designated ‘Labor Nurse’. The nurse who first documented pushing with the patient was designated ‘Pushing Nurse’. We present results for nurses with at least 10 NTSV deliveries during the study period. There were 2280 NTSV deliveries and 142 nurses provided care during labor; 85 met inclusion criteria. Figures 1 and 2 show the nurses with the 10 highest and lowest cesarean rates by labor vs pushing nurse role. Sharing the results with staff nurses, we were able to create a list of ‘mentor nurses’ for labor and pushing, and also identified a group of nurses that might benefit from remediation through observing mentor nurses. The data extracted from the EMR to carry out these analyses has been made into an auto-generated weekly report. Calculating nurse-specific cesarean rates is complex. We describe a feasible method based on existing information from the EMR. The data abstraction process can be automated and shared for ongoing quality improvement efforts.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Measuring labor and delivery unit culture and clinicians' attitudes toward birth: Revision and validation of the Labor Culture Survey.

Cesarean delivery rates in the United States vary widely between hospitals, which cannot be fully explained by hospital or patient factors. Cultural factors are hypothesized to play a role in cesarean overuse, yet tools to measure labor culture are lacking. The aim of this study was to revise and validate a survey tool to measure hospital culture specific to cesarean overuse. A panel of clinicians and researchers compiled an item bank from validated surveys, added newly created items, and performed four rounds of iterative revision and consolidation. Obstetricians, family physicians, midwives, anesthesiologists, and labor nurses were recruited from 79 hospitals in California. Exploratory factor analysis was used to reduce the number of survey items and identify latent constructs to form the basis of subscales. Confirmatory factor analysis examined reliability in 31 additional hospitals. Poisson regression assessed associations between hospitals' mean score on each individual item and cesarean rates. A total of 1718 individuals from 70 hospitals were included in the exploratory factor analysis. The final Labor Culture Survey (LCS) consisted of 29 items and six subscales: "Best Practices to Reduce Cesarean Overuse," "Fear of Vaginal Birth," "Unit Microculture," "Physician Oversight," "Maternal Agency," and "Cesarean Safety." The revised LCS is a valid and reliable tool to measure constructs shown to be associated with cesarean rates. These findings support prior research that has shown that hospital culture is measurable, and that clinician attitudes are predictive of clinician behaviors. Unique to our survey is the construct of labor and delivery unit microculture.

Fostering Collegial Collaboration Between Labor Nurses and Doulas

Nurses and doulas do not always have positive views of each other. When labor nurses face challenges in their ability to provide continuous labor support, one might believe that a doula would be welcomed, yet this is not always true. Conflicts can arise between nurses and doulas, often because of overlapping roles. However, an optimal health care system is one for which there is an integrated system that fosters collegial interprofessional collaboration. This commentary explores the role of doulas and the care they provide and describes strategies to promote collegial relationships between nurses and doulas.

Physician and Nurse Perceptions of Gentle Cesarean Birth.

Protocols for neonatal care and mother-baby interaction at cesarean birth frequently differ from those at vaginal birth. There is increasing interest in adopting family-friendly or gentle protocols for women having cesarean birth. Current evidence suggests challenges in achieving interdepartmental cooperation and consensus are potential barriers to implementing gentle cesarean protocols. To describe how care providers' professional role and characteristics may affect perception about gentle cesarean birth techniques and inform specific concerns about protocol changes. A cross-sectional survey with mixed-methods analysis incorporating quantitative and qualitative conventional content analysis was used. A structured survey was distributed via email to all care providers on the labor and birth unit, including attending physicians, resident physicians in training, fellows, labor nurses, respiratory therapists, and operating room technicians. Quantitative responses were analyzed with bivariable tests and logistic regression to describe associations between provider attitudes and provider characteristics. Open-ended responses were analyzed with conventional content analysis to develop a model describing influences on overall provider attitudes. Physicians and nurses generally have positive attitudes on benefits of gentle cesarean techniques. Their perceptions overall are informed by the balance of concerns about patient safety and logistical challenges versus perceived benefits of the techniques. On an individual level, care provider demographic and professional characteristics of gender and prior experience affected attitudes more than their specific role in patient care. Most labor and birth care providers have positive attitudes about gentle cesarean birth. Implementation of such programs should prioritize patient safety, educate physician and nurses about potential benefits for patients, and use experienced physicians and nurses as ambassadors to increase acceptance.

The Maternal Infant Microbiome: Considerations for Labor and Birth.

The human microbiome plays a role in maintaining health, but is also thought to attenuate and exacerbate risk factors for adverse maternal-child health outcomes. The development of the microbiome begins in utero; however, factors related to the labor and birth environment have been shown to influence the initial colonization process of the newborn microbiome. This "seeding" or transfer of microbes from the mother to newborn may serve as an early inoculation process with implications for the long-term health outcomes of newborns. Studies have shown that there are distinct differences in the microbiome profiles of newborns born vaginally compared with those born by cesarean. Antibiotic exposure has been shown to alter the microbial profiles of women and may influence the gut microbial profiles of their newborns. Considering that the first major microbial colonization occurs at birth, it is essential that labor and birth nurses be aware of factors that may alter the composition of the microbiome during the labor and birth process. The implications of various activities and factors unique to the labor and birth environment that may influence the microbiome of women and newborns during the labor and birth process (e.g., route of birth, antibiotic use, nursing procedures) are presented with a focus on the role of labor nurses and the potential influence of nursing activities on this process.

Thematic analysis of US stakeholder views on the influence of labour nurses’ care on birth outcomes

BackgroundChildbirth is a leading reason for hospital admission in the USA, and most labour care is provided by registered nurses under physician or midwife supervision in a nurse-managed care model....