Purpose for the program: To improve the labor support provided to women in active labor by nurses in an urban, academic medical center.

Proposed change: All registered nurses who work in Labor and Delivery (L&D) will participate in a four hour workshop about labor support techniques.  This workshop will provide every nurse with a similar skill set and should increase nurse confidence with the use of these various techniques in clinical practice.

Implementation, outcomes and evaluation: In 2010, the L&D senior clinical nurse staff recognized inconsistent practice among nurses in the provision of labor support.  A committee of five registered nurses, four L&D nurses and one International Board Certified Lactation Consultant conducted an extensive literature review about continuous labor support and recognized a potential gap between current practice and best practice.  To quantify this gap, the committee developed two surveys, one for nurses and one for patients.  The nurse survey assessed the nurse's attitudes about current labor support practices.  The patient survey targeted L&D patients and sought to identify specific support practices that patients expected during labor.  Survey results confirmed that there were gaps between patient expectations and nurse's attitudes and behaviors.  Based on these results, the committee developed an interactive, four hour workshop for all L&D nurses.  The workshop reviewed the survey results, as well as the importance of providing continuous labor support.  The history of Childbirth Education was also reviewed, which provided context for the physiological and psychological mechanisms of pain and pain mitigation during childbirth.  The majority of the workshop was spent conducting interactive simulations of breathing techniques, birth bag tools, hydrotherapy, Reiki, intermittent fetal monitoring, comfort measures for patients with an occiput posterior fetus, comfort measures for patients with an epidural, and an update about breastfeeding initiation within the first hour postpartum.  To date, five workshops have been offered, 88% of the nursing staff has participated, and evaluations have been positive.  Staff currently uses information learned in this workshop to improve practice and improve the patient experience.  The committee is now conducting a follow up survey with nurses to determine the perceived effectiveness of the workshop.

Implications for nursing practice: In an urban, academic medical center there are barriers to providing quality labor support.  All L&D nurses, however, including the novice nurse and the most expert senior nurse, must be educated about evidence based labor support techniques, and empowered to incorporate these techniques into clinical practice.

Keywords: Labor support techniques, birth bag tools, comfort measures, hydrotherapy, breastfeeding.