Date of Award
Doctor of Philosophy (PhD)
Most American women deliver their babies in the hospital; an opportunity for nurses to make a positive impact. However, nursing labor support has been associated with fewer positive outcomes than support performed by lay providers, doulas, or midwives. Positive outcomes associated with continuous labor support include decreased cesarean deliveries, and use of medication or epidurals for pain. It was unclear why the outcomes were not as great when nurses provided labor support.
The purpose of this study was to describe the relationships between nurse attributes, organizational characteristics, and labor support attitudes, behaviors, and perception of barriers among intrapartum nurses. Conceptual frameworks for the study included the Theory of Reasoned Action and The Professional Labor Support Model. An exploratory, descriptive, mixed methods study was conducted with a purposive sample of labor and delivery nurses who work in three different hospital settings (rural, suburban, urban) in one region of a midwestern state. Participants completed the Labor Support Questionnaire (LSQ) in an online format. Participants who completed the survey were asked to participate in follow-up interviews. Responses to questions on the LSQ were statistically evaluated to identify differences between sites and significant correlations. Sixty nurses (57%) responded to the online survey and 11 participated in follow-up interviews. There were no significant differences in LSQ findings between participants in the three settings.
Personal birth experiences were correlated with attitudes and intended behaviors. Data triangulation revealed that LSQ and interview findings were consistent; women-centered care, preparing women, using presence (or nonpresence), and taking charge when needed, were aspects of labor support that were highly valued by the nurses studied. However, labor support differed when women used epidurals for analgesia; use of nonpresence increased. Barriers to labor support included staffing, documentation, physicians, high-technology interventions, doulas, and birth plans. Enablers of labor support included valuing collaboration with managers, doulas, providers, education and experience. Participants placed great importance on women-centered labor support but may not be aware of personal factors that impact care they provide. Interventions that are based only on women's perceived needs, and do not reflect evidence-based practice may not promote labor progress and improved outcomes.