How do Stakeholders Perceive Labor Nurses' Influence on Birth Outcomes?


Audrey Lyndon, Kathleen Rice Simpson and Joanne Spetz

April 21, 2017


Childbirth is a leading reason for hospital admission in the USA, and most labor care is provided by registered nurses under physician or midwife supervision in a nurse-managed care model. Yet, there are no validated quality measures for maternity care that are thoughtful about the role of nurses. In this paper primary stakeholders of maternity care were engaged in identifying the aspects of nursing care during labor and birth they believe influence birth outcomes, and how these aspects of care might be measured.


This qualitative study used 15 focus groups to explore perceptions of 73 nurses, 23 new mothers and nine physicians regarding important aspects of care. Transcripts were analyzed thematically. Participants in the final six focus groups were also asked whether or not they thought each of five existing perinatal quality measures were nurse-sensitive.


Nurses, new mothers and physicians identified nurses' support of and advocacy for women as important to birth outcomes. Support and advocacy actions included keeping women and their family members informed, being present with women, setting the emotional tone, knowing and advocating for women's wishes and avoiding caesarean birth. Mothers and nurses took technical aspects of care for granted, whereas physicians discussed this more explicitly, noting that nurses were their ‘eyes and ears’ during labor. Participants endorsed caesarean rates and breastfeeding rates as likely to be nurse-sensitive.


Stakeholder values support inclusion of maternity nursing care quality measures related to emotional support and providing information in addition to physical support and clinical aspects of care. Care models that ensure labor nurses have sufficient time and resources to engage in the supportive relationships that women value might contribute to better health outcomes and improved patient experience.