ArticleNursing outlook
Relationship between nurse staffing during labor and cesarean birth rates in U.S. hospitals.
Article in Nursing outlook. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Epidemiology, Risk Factors, and Management of Pregnancy-Related Chronic Back Pain.Current pain and headache reports · 2026Review
- Facility-Level Factors Associating Antenatal Corticosteroid Administration Rates and Subsequent Term Birth Rates: A Nationwide Cross-Sectional Observational Study Using the 2020-2022 Perinatal Registry Database in Japan.The journal of obstetrics and gynaecology research · 2026Observational
- Making the "Birthing-Friendly" hospital designation better.Health affairs scholar · 2025Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundCesarean birth increases risk of maternal morbidity and mortality. PURPOSE: Examine the relationship between labor and delivery staffing and hospital cesarean and vaginal birth after cesarean (VBAC) rates.
methodsSurvey of U.S. labor nurses in 2018 and 2019 on adherence to AWHONN nurse staffing standards with data linked to American Hospital Association Survey data, patient discharge data, and cesarean birth and VBAC rates.
findingsIn total, 2,786 nurses from 193 hospitals in 23 states were included. Mean cesarean rate was 27.3% (SD 5.9, range 11.7%-47.2%); median VBAC rate 11.1% (IQR 1.78%-20.2%; range 0%-40.1%). There was relatively high adherence to staffing standards (mean, 3.12 of possible 1-4 score). After adjusting for hospital characteristics, nurse staffing was an independent predictor of hospital-level cesarean and VBAC rates (IRR 0.89, 95% CI 0.84-0.95 and IRR 1.58, 95% CI 1.25-1.99, respectively). DISCUSSION: Better nurse staffing predicted lower cesarean birth rates and higher VBAC rates.
conclusionHospitals should be accountable for providing adequate nurse staffing during childbirth.
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