Continuous Intrapartum Nurse Support Improves Neonatal Outcomes Without Increasing Cesarean Rates

The nulliparous, term, singleton, vertex (NTSV) cesarean birth rate is a key quality indicator in obstetrics, reflecting both maternal and neonatal health outcomes. High rates of primary cesarean sections can lead to increased maternal morbidity (e.g., hemorrhage, infection, longer recovery) and potential complications in future pregnancies. Current standard care often lacks consistent, dedicated one-on-one support during labor, which has been shown to positively influence birth outcomes. This study investigates whether continuous professional support can bridge this gap, aiming to reduce unnecessary surgical interventions.

This study evaluated the impact of continuous intrapartum support by a professional nurse with a university degree on birth outcomes. The intervention was implemented unit-wide in the HGZ No. 4 of the Mexican Institute of Social Security, focusing on women pregnant less than 40 years of age. The primary objective was to reduce the NTSV cesarean birth rate. Secondary outcomes included the need for additional uterotonic agents and postoperative change in hematocrit. All women with a planned vaginal delivery, meeting inclusion criteria of term pregnancy (>37 weeks), were included in the trial population, utilizing the WHO partograph and LCG according to protocol.

Unit-wide implementation of continuous intrapartum support was associated with improved neonatal outcomes. Specifically, the intervention led to fewer NNU admissions, indicating better health for newborns. While the primary objective was to reduce the NTSV cesarean birth rate, the study found that the intervention did not result in an increase in adjusted cesarean section rates. This suggests that the support did not inadvertently lead to more surgical births, despite not achieving a reduction. However, a notable finding was that postpartum blood loss was higher post-implementation, measuring 497 mL compared to 438 mL pre-implementation (p < 0.001). This increase in blood loss warrants further investigation, even as neonatal outcomes improved. The overall findings support continuous intrapartum support as a promising intervention for improving neonatal health.