Improving Labor Support for Patients in an Urban, Academic Medical Center: An Evidence-Based Practice Project


Poster Presentation

Purpose for the Program

To improve the labor support provided for women in active labor by nurses in an urban, academic medical center.

Proposed Change

All registered nurses who work in labor and delivery will participate in a 4-hour workshop about labor support techniques. This workshop will provide every nurse with a similar skill set and should increase nurse confidence with the use of these various techniques in clinical practice.

Implementation, Outcomes, and Evaluation

In 2010, the labor and delivery senior clinical nurse staff recognized inconsistent practice among nurses in the provision of labor support. A committee of five registered nurses, four labor and delivery nurses, and one international board certified lactation consultant conducted an extensive literature review about continuous labor support and recognized a potential gap between current practice and best practice. To quantify this gap, the committee developed two surveys, one for the nurses and one for the patients. The nurse survey assessed the nurses’ attitudes about current labor support practices. The patient survey targeted labor and delivery patients and sought to identify specific support practices that patients expected during labor. Survey results confirmed that there were gaps between patient expectations and nurses’ attitudes and behaviors.

Based on these results, the committee developed an interactive, 4-hour workshop for all labor and delivery nurses. The workshop reviewed the survey results, as well as the importance of providing continuous labor support. The history of childbirth education also was reviewed, which provided context for the physiological and psychological mechanisms of pain and pain mitigation during childbirth. The majority of the workshop was spent conducting interactive simulations of breathing techniques, birth bag tools, hydrotherapy, Reiki, intermittent fetal monitoring, comfort measures for patients with an occiput posterior fetus, comfort measures for patients with an epidural, and an update about breastfeeding initiation within the first hour postpartum. To date, five workshops have been offered, 88% of the nursing staff has participated, and evaluations have been positive. Staff currently uses information learned in this workshop to improve practice and improve the patient experience. The committee is now conducting a follow-up survey with nurses to determine the perceived effectiveness of the workshop.

Implications for Nursing Practice

In an urban, academic medical center, there are barriers to providing quality labor support. All labor and delivery nurses, however, including the novice nurse and the most expert senior nurse, must be educated about evidence-based labor support techniques and empowered to incorporate these techniques into clinical practice.