Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson; Lois C. Howland, DrPH, MSN, RN; Mary Barger, PhD, MPH, CNM, FACNM


Cesarean birth, Fetal heart monitoring, morbidity, nursing, nursing surveillance, women


Purpose: Birth by cesarean delivery is a major public health issue with nearly one in three births delivered by cesarean section. Cesarean birth may be necessary to save mother or baby, but the rapid rise since 1996 without concomitant reduction in maternal and neonatal morbidity and mortality may indicate this mode of delivery may be over utilized. Cesarean births pose significant maternal and newborn health risks. Identification of factors that may contribute to reduction in the first cesarean birth in low-risk women who are nulliparous, term gestation, with single fetus in head down position (NTSV) is a health priority. The purpose of this study was two-fold: (1) to examine nursing assessment of fetal heart rate (FHR) tracing and their interventions (nursing surveillance) in response to identification of an FHR tracing consistent with category II pattern and (2) to identify whether nursing surveillance and frequency of category II patterns contribute to the risk of cesarean birth in NTSV women. Methodology: A descriptive, cross-sectional, correlational research design with purposive sample was used. Retrospective review of patient's electronic medical record was conducted for NTSV women who delivered at a large tertiary women's hospital between May and June 2013. Results: Statistically significant relationships were found between maternal age, admission BMI, induced labor, and cesarean birth. The odds of having a cesarean delivery was 12% (OR = 1.12) higher among women who had an increased number of nursing interventions within four hours prior to delivery. However, when examining the type of nursing intervention, none of the nursing interventions entered into the model were statistically significant as predictors of cesarean delivery. There was statistical significance between women who delivered vaginally and those who delivered by cesarean when examining nursing documentation of frequency of category II FHR tracing and nursing interventions. Conclusions: The primary aims of this research study were to examine if nursing identification of a category II FHR pattern and nursing interventions were predictors of cesarean birth. The presence of category II FHR pattern was not a predictor but frequency of nursing interventions was a statistically significant predictor when entered into a logistic regression model.

Document Type

Dissertation: Open Access



Included in

Nursing Commons