Researchers: Better Staffing Leads to Fewer C-Sections

• A new study determined that lowering the number of C-sections can also decrease the “associated risk of morbidity and mortality.” 
• The study authors have called on the Centers for Medicare and Medicaid Services to implement registered nurse staffing standards for childbirth. 
• Association of Women’s Health, Obstetric and Neonatal Nurses issued nurse-to-patient staffing ratio guidance more than 20 years ago. That guidance was updated in 2022. 

Some researchers are calling on the Centers for Medicare and Medicaid Services (CMS) to implement registered nurse (RN) staffing standards for childbirth. Doing so, they argue, will help decrease the number of cesarean birth rates. 

A study published in the March-April 2025 issue of Nursing Outlook determined that lowering the number of C-sections can also decrease the “associated risk of morbidity and mortality.” 

Joanne Spetz, a study author and director of the Institute for Health Policy Studies at the University of California, San Francisco (UCSF), said in a news release that concern about C-section rates has been high for “many years.” 

“There has been little progress toward improvement,” she said. “This study points us toward one important solution: aligning labor and delivery nurse staffing with consensus- and expert-developed guidelines.” 

Decreasing C-Sections, Increasing Staff 

The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) issued nurse-to-patient staffing ratio guidance in 2010. That guidance was updated in 2022 to include newer research and evidence that shows “the links between nurse staffing and patient outcomes.” 

“Health care leaders are responsible for ensuring that adequate nurse staffing is budgeted and resourced to promote the best outcomes for all those who give birth and their babies,” AWHONN stated in its Staffing Standards Executive Summary. “Ultimate outcomes are best optimized by making sure that childbearing women are well cared for and supported and that their babies at the beginning of life have the best start we can provide.” 

As part of its Healthy People 2030 initiative, the Office of Disease Prevention and Health Promotion (ODPHP) wants to decrease the number of C-sections “among low-risk women with no prior births” by 3%. ODPHP argues that in addition to being linked to “increased risk of infections and blood clots,” many women undergo “unnecessary C-sections.” 

Adequate staffing in labor and delivery departments, according to the Nursing Outlook study, predicts “lower cesarean birth rates and higher [vaginal birth after cesarean] VBAC rates.” 

Audrey Lyndon, an author of the Nursing Outlook study and executive vice dean at New York University’s Rory Meyers College of Nursing, stated that nursing care is viewed as a “cost center,” and is one of the first line items cut when budget concerns emerge. 

“But research continues to show that nurse staffing is a key contributor to patient safety across departments,” she said. 

Addressing Maternal Mortality

Several studies have shown the United States has high maternal mortality rates, though the most recent Centers for Disease Control and Prevention (CDC) data indicates a decrease. 

Maternal-related deaths reached 669 in 2023, compared to 817 in 2022, while the maternal mortality rate decreased to 18.6 deaths per 100,000 live births from 22.3 in the same timeframe. 

In addition to advocating for adequate staffing during and after delivery, other efforts aim to help reduce maternal mortality rates both at the state and federal level. 

The University of Arkansas for Medical Sciences is seeking accreditation for its new nurse midwifery program, which could help address the state’s status as having the highest maternal mortality rate in the country. 

Last April, federal grants were issued to 16 universities for programs that work with expectant mothers, particularly in underserved areas. Information about the federal effort, known as the White House Blueprint for Addressing the Maternal Health Crisis, which was introduced under the previous White House administration, is no longer available on WhiteHouse.gov.  

The Bottom Line

A new study published in Nursing Outlook found that better staffing ratios lead to fewer C-sections and better outcomes for mother and child. The authors have called on the Centers for Medicare and Medicaid Services to implement staffing standards for labor and delivery departments. Their research comes as the United States grapples with high, but decreasing, rates of maternal mortality. 

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