Labor/Delivery Staffing Ratios

Labor and Delivery 1 RN to 1 patient

According to The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), continuous labor support, available from a Registered Nurses is a critical component for achieving improved birth outcomes.

Labor support and labor care are influential and powerful nursing functions as the RN assesses, develops, implements and evaluates nursing care plans that are individualized based on each mother’s physical, psychological and socio-economic needs. This includes considering and reviewing each woman’s expectations of the birthing experience. It is each facilities responsibility to provide enough RNs to encourage this RN-patient relationship during childbirth.

During labor, the RN constantly assesses and manages the physiological and psychological process of labor. Specifically, the RN-

provide suggestions for increased physical comfort,

offers emotional and informational support,

evaluates the well-being of the fetus,

provides direction or instruction during labor

provides role modeling to facilitate family participation and

collaborates with other members of the patient’s care team to coordinate care.


Research has demonstrated that women who are provided continuously available support during labor have improved outcomes compared with women who do not have one-to-one continuously available support

(Hodnett, E. D., Gates, S., Hofmeyr, G. J. & Sakala, C. (2003). Continuous support for women during childbirth. The Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD003766. doi: 10.1002/14651858.CD003766.pub3)


Improved outcomes include but are not limited to:

-shorter labor,


-decreased use of analgesia/anesthesia,


-decreased operative vaginal births or cesarean births,


-decreased need for medications to induce labor such as oxytocin/uterotonics

(Kennell, Klaus, & McGrath, 1991), Kennell, J. H., Klaus, M. & McGrath, S. K. (1991). Continuous emotional support during labor in a US hospital. Journal of the American Medical Association, 265, 2197-2201.


-increased success in breastfeeding

(Hofmeyr,Nikodem, & Wolmen, 1991),Hofmeyr, G. J., Nikodem, V. C. & Wolmen, W. (1991). `Companionship to modify the clinical birth environment: effects on progress and perceptions of labor and breastfeeding. British Journal of Obstetrics and Gynaecology, 98, 756-764.


-increased satisfaction with the childbirth experience (Hodnett et al.).


These improved outcomes for the mothers also translate to improved outcomes for the infant as well. For example, cesarean births have higher frequency rates of infant breathing problems.


With the increase in cesarean births and inductions over the past several decades and the percentage of women with medical and obstetric complications on the rise, acuity of laboring moms has increased as well. These increases coupled with new medications and other technological advances have increased the acuity of patients even more yet many institutions fail to recognize the increased demand on surveillance and documentation required, leaving nurses in risky situations and patients vulnerable. As evidence by the improved patient outcomes along with the increased acuity of laboring patients today, every woman delivering an infant should have 1:1 attention from her Laboring RN.