Inadequate Staffing, Communication Issues Force Nurses to Skip Important Care During Labor and Birth
New parents who receive attentive, supportive nursing care during labor and immediately after childbirth are more likely to exclusively breastfeed their newborn when leaving the hospital, finds a study published in MCN: The American Journal of Maternal/Child Nursing.
“Nurses make substantial, often unrecognized, contributions to public health during pregnancy, and during and following birth. Our research provides a great example of how supportive nursing care can have longer term effects on maternal and infant health,” said study author Audrey Lyndon, PhD, RN, FAAN, professor of nursing and assistant dean for clinical research at NYU Rory Meyers College of Nursing.
Breast milk is a complete nutritional source for babies and helps strengthen their immune systems. Because of these benefits, exclusive breastfeeding during hospitalization—where breast milk is the only source of nutrition for newborns—is considered a national quality indicator of maternity care in hospitals.
“Breastfeeding is proven to have a range of health benefits for both the mother and child and should be supported by health systems,” said Lyndon.
Nurses play a central role supporting families with their feeding goals after childbirth, which often includes breastfeeding, although some parents are not able to breastfeed or choose not to. To assist with breastfeeding, nurses provide education and encouragement, promote skin-to-skin contact immediately after birth, make referrals to lactation consultants as needed, and keep healthy birth parents and babies together.
Having adequate nursing staff is critical for nurses to be able to fully perform these essential aspects of care—likewise, too few nurses may hurt their ability to give each patient enough attention, or provide the care in a timely fashion, a concept researchers refer to as “missed nursing care.” The Association of Women's Health, Obstetric and Neonatal Nurses' (AWHONN) guidelines on nurse staffing levels for maternity units 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 following birth.
In their study of nursing care and breastfeeding rates, researchers from Mercy Hospital St. Louis, NYU Rory Meyers College of Nursing, the University of California, San Francisco, and Trinity Health surveyed 512 labor nurses from 36 hospitals in three states. The nurses answered a series of questions about their ability to complete essential aspects of nursing care during labor and birth and how often care was missed by nurses on their units. The researchers also evaluated each hospital’s rate of exclusive breastfeeding, measured as infants who are exclusively fed breast milk during their birth hospitalization. The rate excludes infants likely to have barriers to breastfeeding, including those who are born preterm, admitted to a neonatal ICU, or have a hospital stay of more than 120 days.
The researchers found that hospitals with higher rates of exclusive breastfeeding had less missed nursing care, with nurses more consistently providing important care such as assisting with breastfeeding within an hour of birth and facilitating skin-to-skin contact. Exclusive breastfeeding was also associated with hospitals adhering to AWHONN’s nurse staffing guidelines during labor and for immediate postpartum care.
The nurses surveyed reported that some facets of nursing care during childbirth were occasionally delayed, unfinished, or completely missed. They attributed these lapses or delays to communication problems and inadequate staffing.
“We suspect that multiple structural factors affect nurses’ capacity to provide sufficient and appropriate support for successful exclusive breastfeeding. Hospital and maternity unit culture, policies, communication, availability of resources, including adequate nurse staffing, and promotion of effective practices for initiation and sustainment of human milk feeding are all important,” said Kathleen Rice Simpson, PhD, RNC, CNS-BC, FAAN, a perinatal clinical nurse specialist in St. Louis, MO, and the study’s lead author.
The researchers recommend that maternity units focus on improving nurse staffing in order to avoid missed nursing care. Beyond AWHONN’s guidelines, they cite research demonstrating that having one nurse continuously at a new parent’s bedside during the two hours immediately after delivery can support safe skin-to-skin positioning and breastfeeding.
In addition to Lyndon and Simpson, study authors include Joanne Spetz and Caryl Gay of the University of California, San Francisco, and Gay Landstrom of Trinity Health. The research was supported in part by AWHONN and by the Agency for Healthcare Research and Quality (grant R01HS025715).
About NYU Rory Meyers College of Nursing (@NYUNursing)
NYU Rory Meyers College of Nursing is a global leader in nursing and health. Founded in 1932, the College offers BS, MS, DNP, and PhD degree programs providing the educational foundation to prepare the next generation of nursing leaders and researchers. NYU Meyers has several programs that are highly ranked by U.S. News & World Report and is among the top 10 nursing schools receiving NIH funding, thanks to its research mission and commitment to innovative approaches to healthcare worldwide.