AWHONN maintains that continuously available labor support by a professional registered nurse is a critical component to achieve improved birth outcomes. The childbirth experience is an intensely physical and emotional event with lifelong implications. AWHONN views labor care and labor support as powerful nursing functions, and believes it is incumbent on health care facilities to provide an environment that encourages the unique patient-nurse relationship during childbirth. Only the registered nurse combines adequate formal nursing education and clinical patient management skills with experience in providing physical, psychological and sociocultural care to laboring women.

Because of their comprehensive education and experiences, registered nurses are capable of providing both highly skilled technical and complex emotional care. The registered nurse facilitates the childbirth process in collaboration with the laboring woman. The nurse's expertise and therapeutic presence influence patient and family satisfaction with the labor and delivery experience. Women who are provided with continuously available support during labor experience improved labor and delivery outcomes compared with those who labor without a skilled support person. Such care can lead to:

• Shorter labors
• Decreased use of analgesia/anesthesia
• Decreased operative vaginal delivery or cesarean section
• Decreased need for oxytocin
• Increased satisfaction with the childbirth experience

Professional registered nurses draw on a deep and broad base of nursing knowledge, along with clinical expertise, to provide a level of care and support beyond that of lay personnel. They are able to effectively implement patient management strategies for both low-risk and high-risk patients. The registered nurse is able to assess, plan, implement and evaluate an individualized plan of care based on each woman's physical, psychological and sociocultural needs including desires and expectations of the laboring process.

• The support provided by the professional registered nurse should include:
• Assessment and management of the physiologic and psychologic processes of labor
• Provision of emotional support and physical comfort measures
• Evaluation of fetal well-being during labor
• Instruction regarding the labor process
• Patient advocacy – the clinical assessment and evaluation that results from collaboration among professional members of the health care team.
• Role modeling to facilitate family participation during labor and birth
• Direct collaboration with other members of the health care team to coordinate patient care

Background: In today's health care environment, there are numerous factors that may influence the nurse's ability to provide bedside labor care, including:

• Limited numbers of available experienced registered nurses
• Limited financial resources
• Rigid organizational processes and structures
• Cumbersome documentation requirements
• Decreasing reimbursement by third party payers in the United States

AWHONN challenges healthcare facilities to continuously evaluate the impact of patient-to-nurse ratios on resource utilization, overall operating expenses, patient outcomes and patient satisfaction. In addition, AWHONN supports evaluation models that would measure the impact that a registered professional nurse has on indirect cost savings, such as savings resulting from lower cesarean section rates, shorter labors, and fewer technologic interventions.

AWHONN encourages women and families to request labor support from a professional registered nurse and/or advanced practice nurse (clinical nurse specialist, certified nurse-midwife or nurse practitioner) for their labor and birth.

Studies on professional nursing care for laboring women are currently in progress. AWHONN supports continued research efforts to further document the essential role of professional nursing labor support on maternal-newborn outcomes, as well as the potential financial benefits of such support for the health care system.

Approved by the Executive Board, April 2000