Thematic Analysis of US Stakeholder Views on the Influence of Labor Nurses’ Care on Birth Outcomes


Audrey Lyndon, Kathleen Rice Simpson and Joanne Spetz

April 20, 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 nurse-sensitive quality measures for maternity care. We aimed to engage primary stakeholders of maternity care 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. It was determined that nurses, new mothers and physicians identified nurses’ support of and advocacy for women is 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 the 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.