A new study by researchers at the University of California, San Francisco, New York University, and several healthcare systems found that hospitals serving more patients at risk for complications during childbirth are less likely to have enough nurses to care for patients during labor, delivery, and recovery. The findings reveal one of many factors that may be contributing to poor maternal health outcomes in the U.S. for the most vulnerable childbearing populations, including Black mothers.
The Association of Women’s Health, Obstetric and Neonatal Nurses’ issues guidelines on nurse staffing levels for maternity units. Its guidelines call for one nurse to one birthing person during many parts of labor, two nurses at birth, one nurse for each mother-newborn pair during the first few hours after birth, and one nurse for every three pairs of mothers and babies after that period.
The researchers surveyed 3,471 registered nurses from 271 hospitals across the country. Nurses were asked about levels of staffing on their maternity units during labor, delivery, and recovery. Overall, more than 80 percent of respondents said that their unit frequently or always met the staffing guidelines.
Analyzing hospital characteristics, the researchers found that teaching hospitals as well as hospitals with higher birth volumes, neonatal intensive care units, and higher percentages of births paid by Medicaid were associated with lower staffing guideline adherence.
“These gaps in staffing are particularly troubling for our most at-risk patients,” explains Audrey Lyndon, the Vernice D. Ferguson Professor in Health Equity and assistant dean for clinical research at the Rory Meyers College of Nursing at New York University, and a co-author of the study. “Many maternal complications can be prevented or quickly addressed through timely recognition of risk factors and clinical warning signs, and, when issues are identified, the escalation of care and coordination with the care team — but this is only possible when there are enough nurses monitoring patients.”
The full study, “Hospital Characteristics Associated With Nurse Staffing During Labor and Birth: Inequities for the Most Vulnerable Maternity Patients,” was published on the website of the journal Nursing Outlook. It may be accessed here.
