Impact of a nurses' strike on the cesarean birth rate.

Abstract

Our purpose is to describe the impact of a 31-day nurses' strike on the cesarean birth rate in the province of Manitoba, Canada. Computerized hospital records, obtained for all births over a 24-month period, were used to identify complications of labor indicating cesarean section, method of delivery, and adverse maternal and newborn outcomes. The strike interval was compared with a 16-month prestrike period. The cesarean section rate in the strike interval, 12.5 per 100 deliveries, was significantly lower than the prestrike rate of 14.6 per 100 deliveries (p < 0.05). Reductions occurred primarily among breech deliveries and among women with a previous cesarean section. No differences were observed in the rates of individual adverse maternal or newborn outcomes. However, the pooled incidence of adverse newborn outcomes was significantly higher during the strike than during the prestrike period (10.2 vs 8.1/100 deliveries, odds ratio 1.27, 95% confidence interval 1.07 to 1.52). In response to constraints imposed by a reduced nursing complement, physicians increased the frequency of vaginal birth in breech presentation and among women with previous cesarean section.