Labor and delivery unit management varies dramatically across and within hospitals in the US, with some proactive management practices potentially associated with increased risk of primary cesarean delivery and maternal morbidity, a recent study found. Primary nurse and physician managers at 53 diverse hospitals across the US were interviewed and a management measurement instrument was developed. Patient-level regressions were constructed to assess the independent association between 3 management themes (management of unit culture, patient flow, and nursing) and maternal outcomes. Researchers found:
- Proactive management of unit culture and nursing was associated with a significantly higher risk of primary cesarean delivery in low-risk patients (relative risk [RR] 1.30).
- Proactive management of unit culture was also associated with a significantly higher risk of prolonged length of stay (RR, 4.13), postpartum hemorrhage (RR, 2.57), and blood transfusion (RR, 1.87).
- Conversely, proactive management of patient flow and nursing was associated with a significantly lower risk of prolonged length of stay (RR, 0.23).
Plough AC, Galvin G, Li Z, et al. Relationships between labor and delivery unit management practices and maternal outcomes. [Published online ahead of print July 7, 2017]. Obstet Gynecol. doi:10.1097/AOG.0000000000002128.