262683 A view from the front lines: Nurses' experience working under different models of labor and delivery care

Tuesday, October 30, 2012

Jennifer Rienks, PhD , Family Health Outcomes Project, Dept. of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
Malini Nijagal, MD , Department of Obstetrics and Gynecology, Prima Medical Foundation/Marin Community Clinics, San Rafael, CA
Katherine Gillespie, MA, MPH , Family Health Outcomes Project, Dept. of Family and Community Medicine, University of California, San Francisco, San Francisco, CA
Geraldine Oliva, MD, MPH , Family Health Outcomes Project, University of California San Francisco Dept. Family and Community Medicine, University of California, San Francisco, San Francisco, CA
Background: There are multiple models under which women in the United States give birth. At one medium-sized community hospital, privately insured women deliver with an obstetrician in private practice , and publicly insured and uninsured women deliver within a Certified Nurse Midwife -obstetrician hospitalist collaborative model, with the hospital's labor and delivery (L+D) nurses staffing both models. Given a decade of rising rates of maternal morbidity and mortality in California, there is a need to understand if model of L+D care is an influencing factor. Methods: Thirty-two L+D Nurses completed a survey regarding their level of concern when working under different models, and opinions regarding cesarean births and certified nurse midwives. Paired Ttests were done to compare mean responses about the different models. Results: Compared to situations where the managing physician is working in the hospital (i.e. laborist/hospitalist), nurses expressed a significantly higher level of concern about the physician not arriving in a timely manner for emergency delivery [t(31) = 6.16, p<.0001], not coming to evaluate the patient when requested [t(30)= -4.59, p<.0001], not communicating well with patients [t(31)=4.25, p<0.0002], and expediting delivery for convenience [t(31)=6.43, p<0.0001] in situations where the managing physician is taking call from home. Nurses (88%) agree that expanding midwifery care will reduce the hospital's overall intervention rate. Conclusions: The higher level of concern among nurses when managing physician is taking call from home rather than from within the hospital suggests the need for more research examining the role of L+D care model in maternal outcomes.

Learning Areas:
Other professions or practice related to public health
Public health or related nursing
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Describe different models of labor and delivery common in the United States today and explain how these models may play a role in influencing birth outcomes.

Keywords: Nurses, Pregnancy Outcomes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I hold a faculty position at the University of California, San Francisco and have been the research coordinator on numerous grants related to maternal and child health issues and strategies and interventions to improve the health of these populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.