Date of Award

Spring 4-2-2026

Document Type

Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Monica Ketchie, DNP, CNM, ANP, FACNM

Second Advisor

Talecia Warren, DNP, RN

Abstract

Abstract

Cesarean sections (C-sections) account for approximately one-third of births in the United States and remain the most common inpatient surgical procedure. Primary cesarean sections are a major contributor to rising rates, often leading to repeat cesareans in subsequent pregnancies. While medically necessary C-sections are lifesaving, their overuse in low-risk pregnancies is associated with increased maternal morbidity. Labor dystocia is one of the leading indications for primary cesarean delivery and may be mitigated through evidence-based, nurse-driven interventions such as maternal positioning and peanut ball utilization. Registered nurses are uniquely positioned to influence labor progression and promote vaginal birth through continuous bedside care and clinical decision-making. This quality improvement project used a pre- and post-intervention design to evaluate the impact of nurse-driven interventions on cesarean delivery rates. The intervention included education on evidence-based positioning techniques and peanut ball use, along with audit and feedback processes. Outcomes were compared before and after implementation. At baseline, nurses demonstrated moderate readiness for change, independent of demographic or professional characteristics. Cesarean deliveries prior to the intervention were primarily associated with labor-related factors such as gravidity, parity, and induction or augmentation. Following the intervention, no statistically significant reduction in cesarean rates was observed. However, documentation of labor-support practices, particularly maternal position changes, increased, suggesting partial adoption of the intervention. Although the intervention improved the use of some evidence-based practices, it did not significantly reduce Cesarean delivery rates in the short term. These findings suggest that longer implementation periods, standardized protocols, and interdisciplinary collaboration may be necessary to achieve meaningful improvements in outcomes. Continued emphasis on nurse-driven interventions is essential to reducing unnecessary cesarean births and improving maternal health.

Keywords: Length of labor, cesarean section, peanut ball, position changes, epidural, nurse-driven interventions

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