Maternal-Fetal Medicine Units Network Cesarean Registry: impact of shift change on cesarean complications

Jennifer L. Bailit, Mark B. Landon, Yinglei Lai, Dwight J. Rouse, Catherine Y. Spong, Michael W. Varner, Atef H. Moawad, Hyagriv N. Simhan, Margaret Harper, Ronald J. Wapner, Yoram Sorokin, Menachem Miodovnik, Mary Jo O'Sullivan, Baha M. Sibai, Oded Langer

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Objective: This study was undertaken to evaluate the effect of change of shift for physicians and nurses on complications associated with cesarean delivery. Study Design: 17,996 term women undergoing an unscheduled cesarean delivery in 13 centers from 1999-2000 were included. Maternal and neonatal morbidities were evaluated by time of infant delivery vis-à-vis nursing change of shift (6 am-8 am, 2 pm-4 pm, 10 pm-12 am vs all other hours). The sample was then limited to weekdays only and physician shift changes were evaluated (physician shift change 6 am-8 am, 5 pm-7 pm vs all others). A composite of 30 maternal morbidities was also evaluated by logistic regression, controlling for potentially confounding factors. Results: Physician change of shift had no measurable effect on maternal and neonatal outcomes. Neonatal facial nerve palsies were increased at nursing change of shift (5 vs 0) as were hysterectomies (33 [0.24%] vs 23 [0.53%]; P < .007). Nursing change of shift had no impact on composite maternal morbidity after controlling for age, race, insurance, medical problems, prior incision type, weekend day, and prenatal care (odds ratio = 0.98; 95% confidence interval = 0.89-1.08). Conclusion: Physician change of shift does not appear to be associated with an increase in morbidities. However, cesarean delivery during nursing change of shift is associated with increased risk of neonatal facial nerve palsy and hysterectomy. Further investigation is needed to understand the cause of this association.

Original languageEnglish (US)
Pages (from-to)173.e1-173.e5
JournalAmerican journal of obstetrics and gynecology
Issue number2
StatePublished - Feb 2008
Externally publishedYes


  • change of shift
  • obstetrics
  • quality of care
  • work hours

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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