Use of Intentional Positioning During Labor to Promote Vaginal Birth

Background: In the United States, c-section (CS) rates are currently 32.1% of all live births. Comparatively, the mortality rate for women delivering operatively is 2.7% versus 0.9% for women having vaginal births. Morbidity is also higher among women who have CS birth. A significant problem contributing to these trends is modern laboring practices that limit the mobility of women in tertiary health care settings. Local Problem: Evidence underpins recommendations for the use of various positioning techniques that can be implemented during labor to encourage optimal fetal positioning resulting in successful vaginal birth. However, labor and delivery (L&D) registered nurses (RNs) are rarely educated on how and when to use these positions. Methods: A quality improvement project was designed to educate the L&D RNs at McKay Dee Hospital in Ogden, Utah, on how to effectively use intentional positioning in labor to reduce CS rates. Nurses' level of knowledge and confidence regarding intentional positioning in labor were assessed before and after the intervention using surveys. Chart audits were conducted to monitor the use of intentional positioning, assure documentation in the electronic health record (EHR) and to track rates of CS for nulliparous, singleton, vertex, and term (NSVT) patients pre- and post-implementation. Interventions: A toolkit was developed, consisting of an educational booklet for each nurse's station and a one-page position guide placed in each patient room. The objectives of the project and the toolkit were presented to nurses through a series of in-service presentations. Results: Following the project, nurses reported significantly higher knowledge and confidence levels when using intentional positioning in labor. Although not significant, the rate of CS 3 decreased from 28.8% to 27.1%. Of 306 charts audited for NSVT patients during the implementation period, 216 had positioning changes documented in the EHR. Conclusions: This project improved intentional positioning use among staff nurses on the unit. Although not significant, CS rates did decrease. Nurses indicated that they felt more confident and knowledgeable when using intentional positioning as a consequence of the study. Further study of intentional positioning will be required over a longer period of time to determine if CS rates can be significantly reduced.