Gagnon, A. J., Meier, K. M., & Waghorn, K. (2007). Birth, 34, 26-31.
High cesarean birth rates are a significant concern. This study of low-risk women took place in an academic medical center hospital in Montreal, Quebec. The authors undertook retrospective chart reviews on more than 450 charts of study-eligible women. These women were identified as primiparas with singleton pregnancies who were at least 37 weeks' gestation and whose fetuses were in the vertex position. Data were extracted from the medical records of every second birth. The women received care from between 1 and 17 nurses. The same nurse was responsible for care for between 10 and 1,045 minutes. Responsibility changed hands between 1 and 18 times. The researchers controlled for length of labor, maternal age, maternal height, infant weight, gestational age induction, type of rupture of membranes, and epidural anesthesia. The results demonstrated a statistically significant association between the number of nurses caring for a laboring woman and the woman's risk of cesarean delivery. They stated in their reasons for undertaking the study that they had consistently noted that the management of laboring women changed when nursing responsibility changed hands. They observed that when one-to-one care was interrupted by a lunch break, interventions such as amniotomies, Pitocin augmentation, and the placement of intravenous lines occurred. They believed that the interventions had occurred because the replacement nurses were not in tune with the women's progress of labor. Their study concluded that the odds ratio for cesarean birth due to the number of nurses was 1.17. They also measured the number of times that care responsibilities changed hands and whether at least a third of the labor was attended by the same nurse; however, these latter measures were not statistically significant. This study adds to the evidence that continuity of care is important. The authors suggested that pairing of nurses to cover for each other may lead to joint planning and increased continuity.
Judith A. Lewis