Hospitals With Adequate Nurse Staffing Levels Have 11% Fewer C-sections, Study Finds

Every year, more women in the U.S. give birth via cesarean section (C-section), a trend that raises concerns about maternal and infant health. In 2023, the C-section rate hit 32.4%—and it’s still climbing. But new research published in Nursing Outlook highlights a key factor that could help bring that number down: better nurse staffing in labor and delivery units.

Let’s break down what this study found and why it matters for nurses, moms, and babies alike.

What the Research Shows

A comprehensive study analyzed staffing levels in maternity units from 2,786 nurses across 193 hospitals in 23 states. Researchers linked nurse staffing levels to hospital data, patient discharge records, and C-section rates. Here’s what they found:

• The average C-section rate was 27.3%, with some hospitals reporting rates as low as 11.7% and others as high as 47.2%.
• Hospitals with nurse staffing that adhered to the national standards saw 11% fewer C-sections. 
• VBAC (Vaginal Birth After Cesarean) rates were higher when hospitals adhered to recommended nurse staffing standards.
• Nurse staffing was an independent predictor of both lower C-section rates and higher VBAC success.

According to guidelines set by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), there should be:

• One nurse per birthing person during parts of labor
• Two nurses at birth
• One nurse per mother-newborn pair in the critical hours after delivery

Hospitals that followed these staffing levels saw better birth outcomes overall. As lead researcher and executive vice dean at NYU’s Rory Meyers College of Nursing Audrey Lyndon noted, "Our findings highlight how crucial nurse staffing is for optimal maternal outcomes."

Why This Matters

While C-sections can be lifesaving when necessary, reducing unnecessary surgical births leads to better health outcomes for both mothers and babies. Benefits of avoiding unnecessary C-sections include:

• Faster recovery for moms
• Lower risk of complications in future pregnancies
• Better bonding and breastfeeding initiation
• Lower healthcare costs due to fewer surgical interventions

Joanne Spetz, director of the Institute for Health Policy Studies at UCSF, pointed out, "Concern about cesarean section rates in the U.S. has been high for many years, and there has been little progress toward improvement. This study points us toward one important solution: aligning labor and delivery nurse staffing with consensus- and expert-developed guidelines."

How Nurses Make a Difference

Labor and delivery nurses play a critical role in supporting natural births. With proper staffing, nurses can:

• Provide continuous bedside support
• Assist with positioning and movement to promote labor progression
• Offer pain management techniques beyond medication
• Monitor for complications and intervene early to avoid surgery

Kathleen Rice Simpson, a perinatal nurse specialist and study author, explained, "While nurses intuitively know that having enough nurses to provide the attentive care that mothers and babies need and deserve improves outcomes, research has been minimal in linking maternity nurse staffing and patient outcomes."

What Needs to Change

Many hospitals struggle with staffing issues due to budget limitations. However, research suggests that investing in nurse staffing could ultimately save money by preventing unnecessary C-sections and reducing complications.

Lyndon pointed out, “Nursing care is looked at as a cost center as opposed to a revenue center in hospitals, so it’s often one of the first things cut when hospitals are trying to keep costs in line. But research continues to show that nurse staffing is a key contributor to patient safety across departments.”

A Call for Federal Standards

To improve birth outcomes nationwide, experts recommend that CMS (Centers for Medicare & Medicaid Services) establish regulatory standards for nurse staffing in childbirth as part of their “Birthing-Friendly” designation for high-quality maternity care.

Spetz emphasized, "While increasing nurse staffing can be challenging, this investment could reduce overall costs by lowering rates of surgical C-sections and long-term adverse outcomes for mothers and babies."

🤔What do you think? Have you seen staffing levels impact patient outcomes in your hospital? Join the conversation in the discussion forum below!