title: Labor Nurses' Views of Their Influence on Cesarean Birth.
abstract: BACKGROUND
  As part of an ongoing study about nurse staffing during labor and birth sponsored by the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN), outcomes that may be linked to aspects of labor nursing were considered. The purpose of this study was to see if labor nurses felt they influenced whether a woman has a cesarean birth. These data were used to determine if cesarean birth should be included as an outcome measure in the multistate labor nurse staffing study.
  
  
  METHODS
  Focus groups were used to explore the role of labor nurses and cesarean birth. Participants were attending the AWHONN national convention in 2015. Two open-ended questions were asked: 1) Do labor nurses influence whether a woman has a cesarean? 2) What specific things do you do as a labor nurse to help a woman avoid a cesarean?
  
  
  RESULTS
  Two focus groups were held (n = 15 and n = 9). Nurses overwhelmingly agreed nursing care can influence mode of birth. They described multiple strategies routinely used to help a woman avoid a cesarean, which were categorized into three main themes: support, advocacy, and interactions with physicians. Support was emotional, informational, and physical. Advocacy involved advocating for women and helping women advocate for themselves. Nurses tried to focus on positive aspects of labor progress when communicating with physicians. Descriptions of interactions with some physicians implied less than optimal teamwork and lack of collaboration.
  
  
  CONCLUSIONS
  Labor nurses are likely influential in whether some women have a cesarean. They reported consistently taking an active role to help women avoid a cesarean. Promoting vaginal birth as appropriate to the clinical situation was a high priority. Trust, partnership, and respect for roles and responsibilities of each discipline were not evident in some of the clinical situations nurses described.
authors.affiliation: Kathleen Rice Simpson is a Perinatal Clinical Nurse Specialist (Volunteer), Mercy Hospital St. Louis, St. Louis, MO. The author can be reached via e-mail at krsimpson@prodigy.net Audrey Lyndon is an Associate Professor & Vice Chair for Academic Personnel, Department of Family Health Care Nursing, University of California San Francisco School of Nursing, San Francisco, CA. Kathleen Rice Simpson is the Editor-in-Chief of MCN. She did not participate in the peer review process or in the editorial decision for this article. An editorial board member acting as associate editor managed the peer review and editorial decision processes.
authors.forename: Kathleen Rice
authors.initials: KR
authors.lastname: Simpson
authors.forename: Audrey
authors.initials: A
authors.lastname: Lyndon
mesh_terms: D000328:Adult; D000368:Aged; D002585:Cesarean Section / Q000451:nursing / Q000523:psychology*; D003657:Decision Making; D036861:Delivery, Obstetric / Q000451:nursing / Q000523:psychology; D017144:Focus Groups; D006801:Humans; D007400:Interprofessional Relations; D008875:Middle Aged; D024802:Nurse's Role / Q000523:psychology*; D009773:Obstetric Nursing / Q000379:methods*; D010120:Oxytocics / Q000494:pharmacology / Q000627:therapeutic use; D010121:Oxytocin / Q000494:pharmacology / Q000627:therapeutic use; D010465:Perception; D010561:Personnel Staffing and Scheduling / Q000592:standards; D010820:Physicians / Q000523:psychology; D000078329:Workforce
chemical_list: D010120:Oxytocics; D010121:Oxytocin