Poster Session 1
Erin K. Johnson, MD
Resident
Washington University in St. Louis
St. Louis, Missouri, United States
Drew M. Hensel, MD
Clinical Fellow
Washington University in St. Louis
St. Louis, Missouri, United States
Rachel Paul, MPH (she/her/hers)
Clinical Research Specialist
Washington University School of Medicine
St. Louis, Missouri, United States
Adia Woodson, BS, RN
Registered Nurse
Barnes Jewish Hospital
St. Louis, Missouri, United States
Jeannie C. Kelly, MD, MS (she/her/hers)
Associate Professor
Washington University School of Medicine in St. Louis
St. Louis, Missouri, United States
Antonina I. Frolova, MD, PhD (she/her/hers)
Assistant Professor of Ob&Gyn
Washington University School of Medicine
St. Louis, Missouri, United States
Nandini Raghuraman, MD, MSCI
Assistant Professor of Ob&Gyn
Washington University School of Medicine in St. Louis
St. Louis, Missouri, United States
To characterize nursing perspectives and practices regarding intrapartum maternal position changes.
Study Design:
We performed an anonymous, nationwide survey of nurses that had worked on a labor and delivery unit in the past year. The survey was disseminated through social media and email via snowball sampling. The primary objective was to determine the proportion of respondents using intrapartum position changes and why they used these position changes. Our secondary outcomes included use of a circuit of position changes and the reasons position changes were not utilized. We used descriptive statistics to characterize responses and bivariate analyses to compare respondents who employed a circuit to inform further research.
Results:
Our sample included 498 respondents. Nearly all (98.8%) respondents use intrapartum position changes and 95.6% believe labor maneuvers are effective and improve maternal and neonatal outcomes. Nurses routinely use positional maneuvers for the indications of slow labor progress (91.5%), suspected occiput posterior fetal position (86.2%), and suspected asynclitic fetal position (83.5%). Commonly reported reasons for not using position changes included patient BMI (67.3%), patient preference (66.3%), fetal monitoring (64.9%), and lack of knowledge or references (64.7%). Approximately two-thirds of nurses utilizing maneuvers (67.1%) employ a circuit of position changes. Of the 20 listed maneuvers, 7 were used by >50% of respondents (Figure 1). These maneuvers were also perceived as the most efficacious and were the most commonly used in a circuit. Nurses that employ circuits were younger (p=0.03) and more likely to work in the Southwest or Midwest (p=0.04, Table 1).
Conclusion:
Maternal position changes are a frequently used intrapartum intervention despite lack of supporting Level I evidence. Labor and delivery nurses utilize position changes in the setting of protracted labor or fetal malposition. Further research is needed to elucidate the effectiveness of circuit-based position changes in labor.
