56: Nurse-specific cesarean rates: why and how

Greene, Naomi; Kilcoyne, Jolene; Grey, Adam; Hawkes, S; Edmonds, Joyce K.; Gregory, Kimberly D.

doi:10.1016/j.ajog.2018.11.062

Cited by 1 publication

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“…Although nurse staffing is an important consideration with respect to oxytocin administration and birth outcomes, one must not forget variations in nurse practice. Authors of retrospective studies found large variations in nurse‐specific cesarean rates, indicating that nursing care is an important factor in influencing mode of birth . Cesarean rates for nurses ranged from 4.9% to 53.3%, and these differences could not be explained by differences in maternal characteristics, labor interventions, or provider type .…”

Section: Discussionmentioning

confidence: 99%

“…Authors of retrospective studies found large variations in nurse‐specific cesarean rates, indicating that nursing care is an important factor in influencing mode of birth . Cesarean rates for nurses ranged from 4.9% to 53.3%, and these differences could not be explained by differences in maternal characteristics, labor interventions, or provider type . The adjusted odds of cesarean birth for women cared for by nurses in the highest cesarean rate quintile was 2.73 times higher than for women cared for by nurses in the lowest quintile .…”

Section: Discussionmentioning

confidence: 99%

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

Maeder

Park

Vonderheid

et al. 2020

Birth

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Background: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. Methods: 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 6 mU/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. Results: The mean time to reach 6 mU/min was longer for women who birthed by cesarean (172.5 minutes) than for women who had vaginal birth (125.0 minutes, P = .024). The mean time to reach 6 mU/min was also longer for women admitted on night shift (147.0 minutes) than day shift (110.2 minutes, P = .018). No maternal characteristics were significantly related to the time to reach a rate of 6 mU/min. Conclusions: 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. K E Y W O R D Scesarean, intrapartum, labor induction, nurse, oxytocin

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%