This study was partially supported by the Fonds de la recherche en santé du Québec through a career award to Anita J. Gagnon and a student bursary to Katharine M. Meier from the Faculty of Medicine of McGill University, Montreal, Quebec.
Continuity of Nursing Care and Its Link to Cesarean Birth Rate
Article first published online: 26 FEB 2007
2007, Blackwell Publishing, Inc.
Volume 34, Issue 1, pages 26–31, March 2007
How to Cite
Gagnon, A. J., Meier, K. M. and Waghorn, K. (2007), Continuity of Nursing Care and Its Link to Cesarean Birth Rate. Birth, 34: 26–31. doi: 10.1111/j.1523-536X.2006.00143.x
- Issue published online: 26 FEB 2007
- Article first published online: 26 FEB 2007
- Accepted July 19, 2006
- cesarean section;
- continuity of patient care;
- obstetrical delivery
ABSTRACT: Background: High cesarean birth rates are an international concern. The role of patterns of nursing care responsibility in preventing or contributing to cesarean births has been understudied. Our study sought to identify and describe indicators of continuity of nursing care responsibility during labor and to explore whether any association between these indicators and risk of cesarean birth could be identified empirically using an existing data set. Methods: We obtained a representative sample of low-risk women giving birth in an intrapartum unit at a university hospital in Quebec, Canada, with approximately 3,700 births per year. To be considered for inclusion, women needed to have been primiparous, carrying singletons in vertex position, and at 37 weeks’ gestation or more. All women giving birth over a 13-month period were assessed for eligibility using the hospital’s birth log. Data were extracted from the medical records of every second eligible birth, including information related to patterns of nursing care responsibility, maternal and infant characteristics, obstetric procedures, non–health-related risk factors, and type of birth. Results: Data on all variables of interest were available for 467 women. These women were cared for by 1–17 nurses, care responsibility changed hands for them from 1 to 28 times, and the mean length of labor for which the same nurse was responsible for a woman ranged from 10 to 1,045 minutes. After controlling for length of labor, maternal age, maternal height, infant weight, gestational age, induction, type of rupture, and epidural analgesia, the odds ratio for cesarean birth due to number of nurses was 1.17 (95% CI 1.04, 1.32); 1 or more nurses switch per 2 hours (i.e., number of times care responsibilities changed hands), 1.04 (95% CI 0.62, 1.74); and 33 percent or more of the labor attended by the same nurse, 0.74 (95% CI 0.42, 1.30). Conclusions: An association was observed between number of nurses caring for a laboring woman and risk of cesarean delivery. Estimates of the association of other patterns of nursing care responsibility on cesarean birth were not sufficiently precise to draw conclusions. (BIRTH 34:1 March 2007)