Date of Award

Summer 2025

Project Type

Thesis

College or School

CHHS

Department

Nursing

Departments (Collect)

Nursing

Program or Major

Direct Entry Masters of Nursing

Degree Name

Master of Science

First Advisor

Jordan Lavallee

Second Advisor

Elizabeth Evans

Third Advisor

Pamela Kallmerten

Abstract

Background: Cesarean section (CS) delivery is an important and necessary intervention, yet comes with increased risks to the patient and fetus compared to vaginal birth. CS rates have been increasing globally, and implementing interventions to promote vaginal birth, especially for nulliparous, term, singleton, vertex (NTSV) patients is of interest to patients, providers, and institutions.

Local Problem: In 2024, the CS rate within the microsystem was 32%, more than double the WHO-recommended benchmark of 10–15%. Of all CS deliveries in 2024, 31% were nulliparous, term, singleton, vertex (NTSV) patients, who are considered optimal candidates for vaginal delivery. Given the elevated rate of CSs and associated risks, there is a need for targeted strategies to promote vaginal birth.

Methods: This quality improvement project was conducted using the Plan, Do, Study, Act (PDSA) framework in a small labor and delivery unit with 26 participants. The intervention consisted of a quiz-style educational module on intentional labor positioning delivered via Google Forms. The impact was assessed using a pre/post-survey design measuring self-reported knowledge and confidence on a 5-point Likert scale.

Results: Following the intervention, average scores on all eight knowledge and confidence statements increased, with the most significant gains in confidence selecting labor positions based on fetal station, knowledge of midpelvis positioning, and understanding of birth physiology. Increases in nurses’ perceived confidence in their knowledge and skills ranged from 9.5% to 17.9%. Paired t-tests showed statistically significant improvements across all items (p < 0.05).

Conclusions: Results demonstrated that implementing a concise, quiz-based educational intervention significantly improved labor and delivery nurses’ perceived confidence in their intentional labor positioning knowledge and skills. Findings suggest that brief, targeted education can effectively reinforce evidence-based practice and support safe, patient-centered care. Future initiatives should explore the addition of hands-on educational components and broader implementation across diverse settings to assess long-term impact and scalability.

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