Date of Award

Spring 5-27-2017

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Mary Barger, PhD, MPH, CNM


Objective: To improve cesarean rates without worsening perineal tissue integrity or neonatal 5 minute Apgar score. Design: Quality improvement project evaluated with descriptive statistics. Setting: A 24-bed perinatal floor at a general acute care hospital in San Diego County California. Patients: Nulliparous term mothers with a vertex singleton pregnancy (NTSV) with or without epidural anesthesia (EA). Intervention/Measurements: To implement the Association of Women’s Health, Obstetrical, and Neonatal Nurses’ (AWHONN) evidence based clinical practice guidelines, Nursing Care and Management of the Second Stage of Labor and Nursing Care of the Woman Receiving Regional Analgesia/Anesthesia in Labor and measure the outcomes of cesareans, episiotomy, third and fourth degree lacerations, and 5 minute Apgar scores less than 7. Results: A 2.23% decrease in cesareans was realized with a corresponding increase of 0.19% in 3rd and 4th degree lacerations, a 0.23% increase in episiotomies, and a 0.72% increase in 5 min Apgar less than 7. Conclusions: Instituting AWHONN’s evidenced based practice guidelines in managing the second stage of labor can improve cesarean rates even after recommended benchmarks are achieved. Balance outcome measures must be monitored within the context of appropriate cesarean benchmarks in helping to determine their significance. A collaborative approach when instituting professional evidence based practice guidelines is recommended.

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License