In Practice

Knowledge Gained Through aLabor Support Seminar

by Gayle Kipnis, PhD MSN RNC-08 AHN-8C

Abstract: Continuous labor support hasbeenfound to be the gold standard in themanagement of labor but the increaseddemands on nurses take them away fromthe bedside. Labor coaching is beingtaught to student nurses within their col-lege curriculum through three-hour laborsupport seminars in Northern California.As an evaluation tool, a test was devel-oped and administered pre and post semi-nar to document knowledge acquisition.Results showed a statistically significantincrease in scores. Toensure that laboringwomen receive the continuous labor sup-port they need, interdisciplinary collabora-tion between childbirth educators, doulas,and nursing schoolfaculty is vital.

Keywords: Labor support, nursing students, childbirth education,prepared childbirth

IntroductionNursing programs throughout the United States offer

obstetrical curricula to thousands of nursing students eachsemester that include hospital clinical experiences in laborand delivery. Student nurses enter into their hospital rotationin labor and delivery but may not have the necessary infor-mation to function with comfort and competency. Limitedclinical placement sites require beginning clinical practicumearly in the semester prior to the presentation of the major-ity of the didactic obstetrical content. Teaching labor supportto nursing students needs to be an interdisciplinary effort asit can enhance knowledge as well as increase respect amongprofessionals that begins while they are novices. Effective

nursing education can be accomplished in a variety of waysincluding having collaboration between university/collegefaculty, childbirth educators, and doulas.

A three-hour labor support seminar was developedthrough a Northern California university (Kipnis, 2011) andis now being offered each semester during the first weeksof class in order to prepare student nurses for their labor& delivery experience. This seminar is also being taught tostudents in other schools of nursing upon invitation. Priorto one of these guest seminars, a test was developed andadministered to 36 associate degree nursing students. Theobjective of this test was to compare the student nurses'knowledge before and after this labor support seminar.

Background and SignificanceContinuous labor support has been found to be the

gold standard in labor management. According to a Co-chrane systematic review of 21 research trials involving15,061 laboring women, continuous labor support can resultin decreased use of epidurals and cesarean births as well asan increase in shorter labors and satisfaction with the birthexperience (Hodnett, Gates, Hofmeyr, Sakala, & Weston,2011). However, in 2011, AWHONN (Association ofWom-en's Health, Obstetric and Neonatal Nurses, 2011) publishedtheir position statement, "Nursing Support of LaboringWomen," which identified that although labor support bynurses is a vital component to achieving improved birth out-comes, many institut~ons do not staff adequately to enableregistered nurses to'provide it. The increase in obstetricalacuity, technology, obstetrical interventions, and high-alertmedications consume the focus and time of the nurses whichallows little time to offer support to the laboring woman.

Hodnett et al, (2011) also reported that the personmost beneficial in providing continuous labor support is onewho is present solely to provide labor support and is not amember of the woman's family or social circle. Doulas arespecifically trained to provide labor support but in our rural

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Knowledge Gained Through a Labor Support Seminarcontinued from previous page

setting the public is either unaware of their presence or un-able to pay for individualized services. Nursing students wantto be involved and participate in their obstetrical clinicalhospital experience but often they are limited by a lack oflabor basics, the practical aspects of labor support, and whatthey can do to assist the nursing staff and the patients. Itwas hypothesized that with this seminar, the student nurses'knowledge level would increase so that they would be ableto offer labor assistance to women and their families in thehospital setting during their clinical practicum.

SettingA three hour labor support seminar was offered to 36

associate-degree students in the Sacramento, California area.The seminar was held during the second week of their ob-stetrical course content in a childbirth education classroomat a local area hospital. Twenty-five percent of this groupof students had already started their clinical practicum in aSacramento area hospital. A to-question test was designedto evaluate student nurses' knowledge of practical obstetri-cal concepts and labor support. The test was administeredimmediately prior to and at the conclusion of the three-hourlabor support seminar. The data was analyzed utilizing apaired sample t-test to evaluate the impact of the seminar onstudent's knowledge scores.

ResultsThere was a statistically significant increase in scores

from the pre-test (M=64.44, SD 12.06) (Refer to Figure I) tothe post-test (M=91.11, SD 11.66) (Refer to Figure 2), t (36) =10.45, p< .0005 (two-tailed). The mean increase in scores was26.67 with a 95% confiden"ce interval ranging from 21.49 to31.85 (Refer to Table 1}."J;heeta squared statistic (.76) indi-cated a large effect size.

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Table 1. Paired Samples J-test

Figure 1. Mean Scores on Labor Support Pre-Testpre

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Figure 2. Mean Scores on labor Support Post-Test

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Paired Differences95% Confidence Interval

Std. Error "of the DifferenceMean Std. Deviation Mean Lower Upper t df Sig. (z-talled)

Pair 1 post - pre 26.66667 1<;.'\06'\9 2.<;<;[07 21·48770\ -0\1.84<;61 10-4<;0\ 0\<; .000

-sooo 6000 moo 60.00 9'-JOO 'l{JOOO 1 000

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70 I International Journal of Childbirth Education I Volume 28 Number 2 April 2013

Knowledge Gained Through a Labor Support Seminarcontinued from previous page

DiscussionThe magnitude of the effect of this labor support

seminar was quite large. The average score of the 36 studentswas 64/100 on the pre-test and 91/100 on the post-test.The interactive focus to this labor support seminar engagesmultiple senses of each learner and demands full focus as thestudents learn the practical and hands-on aspects of being alabor coach. Once basic concepts were covered, the studentsformed laboring dyads and learned interventions such asmassage, relaxation, verbal encouragement, and labor symp-tom management. Breathing exercises are a favorite focusof almost each group of nursing students especially as theyeach have the opportunity to practice pushing techniquesfor second stage labor. Being fully present during an activelearning experience is very powerful and makes recall easierfor students.

ImplicationsAs a childbirth educator, participating in teaching

labor support seminars to nursing students can expand theirawareness of and respect for the vital roles of childbirth edu-cators and doulas. As these new nurses enter the profession,there will be an enhanced understanding of labor educationand the primary role of doulas in providing continuous laborsupport. Interdisciplinary collaboration between nursingfaculty, childbirth educators, and doulas is vital for success oflabor support seminars since most faculty do not possess thespecialty training as a childbirth educator or doula.

As a childbirth educator, participatingin teaching labor support seminars tolocal nursing students can expand theirawareness of and respect for the vitalroles of childbirth educators and doulas.

As with any educational program, evaluation is neces-sary to assess whether knowledge acquisition is occurring.Statistical analysis can be utilized through the pre/post-testmethod utilizing paired sample t-tests which can be run onstatistical software within minutes. Output includes tablesand charts that can explain the results graphically.

ConclusionOffering a 3-hour labor support seminar is a very effec-

tive approach in delivering obstetrical content and experien-tial learning of labor support for nursing students. For thisgroup of 36 nursing students, their test scores demonstrateda statistically significant increase averaging over 26 points.Most importantly, they enjoyed their learning and haveknowledge that can be applied to assist laboring women dur-ing their clinical practicum.

If labor & de1iv~iynurses do not have the time to offercontinuous support, within every community we need analternative to supporting laboring women and their familiestoward the goal of lessening cesarean births and promotingshorter labors and birth experience satisfaction. The collabo-ration between childbirth educators, doulas, and faculty inproviding labor support seminars to nursing students can bean effective component toward a solution.

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ReferencesAssociation OfWomen's Health. Obstetric. And Neonatal Nurses (201 I).Position statement: Nursing support of laboring women. loumal ofDbstetnc, Gynecologic &Neonatal Nursing, 40, 665-666. DOl:lo.1 I I lij.1552-6909.2011.01288.](

Hodnett. E. D.• Gates. 5.• Hofmeyr, G. J., Sakala, C. & Weston. J. (201 I).Continuous support for women during childbirth. Cochrane Database of Sys-tematic Reviews, 2. Art No: (003766. DOl:!o.J0021!4651858.(Do03766.pub}.

Kipnis. G. (201 I). Baccalaureate nursing students learn labor supportthrough customized childbirth education. lntemational joumal of ChildbitthEducation, 26(4). 56-59.

Gayle Kipnis is an assistant professor in the School of Nursing atCalifornia State University in Chico, California. She has been anurse for 40 years and remains passionate about providing laborsupport to women during childbirth and in mentoring her nurs-ing students.

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