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Thematic analysis of US stakeholder views on the influence of labour nurses’ care on birth outcomes
  1. Audrey Lyndon1,
  2. Kathleen Rice Simpson2,
  3. Joanne Spetz3
  1. 1 Department of Family Health Care Nursing, University of California San Francisco, San Francisco, California, USA
  2. 2 Mercy Hospital Saint Louis Area, Saint Louis, Missouri, USA
  3. 3 Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Audrey Lyndon, Department of Family Health Care Nursing, University of California San Francisco, 2 Koret Way, San Francisco, CA 94143-0606, USA; Audrey.Lyndon{at}


Background Childbirth is a leading reason for hospital admission in the USA, and most labour care is provided by registered nurses under physician or midwife supervision in a nurse-managed care model. Yet, there are no validated nurse-sensitive quality measures for maternity care. We aimed to engage primary stakeholders of maternity care in identifying the aspects of nursing care during labour and birth they believe influence birth outcomes, and how these aspects of care might be measured.

Methods This qualitative study used 15 focus groups to explore perceptions of 73 nurses, 23 new mothers and 9 physicians regarding important aspects of care. Transcripts were analysed thematically. Participants in the final six focus groups were also asked whether or not they thought each of five existing perinatal quality measures were nurse-sensitive.

Results Nurses, new mothers and physicians identified nurses' support of and advocacy for women as important to birth outcomes. Support and advocacy actions included keeping women and their family members informed, being present with women, setting the emotional tone, knowing and advocating for women's wishes and avoiding caesarean birth. Mothers and nurses took technical aspects of care for granted, whereas physicians discussed this more explicitly, noting that nurses were their ‘eyes and ears’ during labour. Participants endorsed caesarean rates and breastfeeding rates as likely to be nurse-sensitive.

Conclusions Stakeholder values support inclusion of maternity nursing care quality measures related to emotional support and providing information in addition to physical support and clinical aspects of care. Care models that ensure labour nurses have sufficient time and resources to engage in the supportive relationships that women value might contribute to better health outcomes and improved patient experience.

  • Nurses
  • Obstetrics and gynecology
  • Qualitative research
  • Quality measurement
  • Womens health

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  • Twitter Follow Audrey Lyndon @audreylyndon

  • Contributors KRS and AL designed the study, collected the data and conducted the analysis. JS participated in study design, data collection and analysis. AL led the development and revision of this manuscript. KRS and JS critically reviewed and revised the manuscript.

  • Funding Support was provided by the Association of Women's Health, Obstetric and Neonatal Nurses for travel for data collection, participant meals and participant gift cards.

  • Competing interests None declared.

  • Ethics approval Western Institutional Review Board; University of California, San Francisco.

  • Provenance and peer review Not commissioned; externally peer reviewed.