1. Capitulo, Kathleen Leask
  2. Ma, Amy DNP, APRN, FNP-BC
  3. Rosario-Sim, Maria G. EdD, RNC, PNP, BC

Article Content


In my opinion, nursing students benefit from direct participation in the unique experience of labor and birth. No two labors and births are alike, and therefore caring for women at this time cannot and should not be replaced by any other alternative learning experiences, including simulated laboratory or video watching. Both the National Council of State Boards of Nursing (2005) and the American Association of Colleges of Nursing (AACN) (2008) recommend that prelicensure nursing education programs include clinical experiences with actual patients. Since participating in childbirth is an essential part of perinatal nursing care, it seems clear that all nursing students should be required to participate in actual births.


Students trust and expect their educational program to provide them with accurate information and opportunities to practice what they have learned in the classroom. However, in the recent past, some nursing programs have decreased or eliminated the amount of clinical time designated to labor and birth (Benson-Soros, 2006). Research has shown that many nursing students are not satisfied with the clinical component of their nursing education, and graduate feeling anxious and incompetent, lacking in the professional nursing skills needed to care for patients in varied clinical settings (Sharif & Masoumi, 2005). Nurses in our specialty could help alleviate this anxiety by assuring that true clinical experiences are included during childbirth.


Nursing is a practice profession; clinical education has always been a vital part of every undergraduate nursing curriculum. Clinical practice provides students with opportunities to apply didactic content with "hands-on" patient care activities, and therefore, to combine cognitive, psychomotor, and affective skills. It also provides students with opportunities to apply professional communication strategies with clients and other professional colleagues, as well as acquire a professional identity. Direct patient care experiences provide valuable opportunities for student learning not found in other experiences, and therefore can increase students' self-confidence, professional image, and sense of belonging to facilitate the transition to competent and confident practice (AACN, 2008).


There are multiple challenges and barriers to making sure that all nursing students participate in real births. The twin problems of fewer faculty and decreased availability of clinical sites mean that creative teaching methods and new approaches to clinical education are needed. Some possibilities include using smaller accredited and reputable birth centers for teaching, and finding qualified clinical preceptors who can act as faculty extenders for nursing students for the labor and birth experience. Additionally, flexible clinical hours could be instituted when possible in order to assure participation; for example, if a patient is expected to give birth after assigned clinical hours are over, the student able to do so could stay with a preceptor longer in order to gain that experience of witnessing childbirth.


There are those who suggest that high-fidelity nursing simulation experiences should be used to augment clinical learning. These techniques, however, should be complementary to clinical work, and not replace the direct patient care experience, during which students can experience the patients' and families' emotions, subtle or dramatic, and provide nursing care during this matchless time. Such an experience cannot be simulated.


As nursing education programs evolve over time, the content and length of specific courses and related clinical experiences also change. Most contemporary nursing curricula provide students a fully integrated academic and clinical preparation. It is essential that nurse education continues to have a strong clinical element, and during the obstetric clinical rotation, students should be required to participate in a real life birth experience.




American Association of Colleges of Nursing. (2008). The Essentials of Baccalaureate Education for Professional Nursing Practice. Retrieved June, 25, 2009, from [Context Link]


Benson-Soros, J. (2006). Promoting student participation and learning in the observational clinical setting. Teaching and Learning in Nursing, 1(2), 43-46. [Context Link]


National Council of State Boards of Nursing. (2005). Clinical instruction in prelicensure nursing programs. Retrieved June, 26, 2009, from [Context Link]


Sharif, F. & Masoumi, S. (2005). A quality study of nursing student experience of clinical practice. BMC Nursing 2005, 4(6), 1-7. Retrieved June, 26, 2009, from [Context Link]



I believe there are several important reasons why nursing students should not be required to participate in actual births during their obstetric clinical experience. While clinical observations and clinical applications are necessary, they are not sufficient to achieve clinical competency in labor and delivery.


First, obstetric student clinical placements are challenging to secure. Many maternal-infant educators struggle in negotiating with hospitals to find adequate, appropriate clinical sites to provide students with optimal labor and birth clinical experiences. Competition for limited clinical placements for nursing students has resulted in fewer hours available for clinical rotations. In addition, the scarcity of competent faculty mentors is a further challenge and thus patients may not be afforded the best care when nursing students are allowed to participate in actual births without adequate supervision.


Second, nursing students in labor and delivery units actually have limited opportunities to practice clinical judgment and work with interdisciplinary teams. Sadly, nursing students, especially male nursing students, are many times not even given the opportunity to observe actual births; it is doubtful that nurses in clinical settings would allow students to participate in the care of laboring patients unless they had a clinical instructor with them. Opportunities to participate in labor and birth experiences are more commonly given to graduate nursing students or medical students. Changing this ingrained system would be necessary.


Third, their lack of clinical experience, the unfamiliarity of the settings, the unusual care required, and the fear of making mistakes creates anxieties among nursing students. Sharif and Masoumi (2005) have found that the integration of both theory and practice with good clinical supervision are necessary to enable students to feel they are competent enough to take care of patients.


Fourth, high-tech simulators can accomplish the clinical experiences that the labor and birth experiences would otherwise provide nursing students. Innovative teaching methods and learning experiences (such as simulation) in which students can practice skills in a safe environment, where errors in clinical judgment will not result in harm to living patients, have been created and can be used to the students' advantage. Clinical simulations provide a bridge between theory and practice as nursing students learn to provide safe-care within the constraints of their inexperience (Bambini, Washburn, & Perkins, 2009; Larew, Lessans, Spunt, Foster, & Covington, 2006). High-tech simulators mimic reality through the display of vital signs, such as heart rate and blood pressure, enabling students to experience and practice assessment and critical thinking skills. Nursing in labor and birth settings is fast-paced and requires quick assessment skills and critical thinking. Simulation gives students the opportunity to learn and practice obstetrical care skills in a controlled and safe environment. Simulation can assist students to refine their patient management skills and collaborate with multidisciplinary team members to resolve common clinical obstetric conditions. In addition, simulations enable students to gain a tremendous amount of experience by doing procedures and then observing their impact without compromising health and safety of the laboring patients.


Simulations and high-tech simulation models provide opportunities to teach nursing students how to manage actual births during their obstetrical clinical rotation without prior hands-on experiences and assists students to reduce their anxieties about lack of experience and fears of harming a patient. Given the availability of safe alternative learning experiences, in my opinion it is not necessary for nursing students to participate in actual births during their obstetric clinical experience to achieve their education goals.



Bambini, D., Washburn, J., & Perkins, R. (2009). Outcomes of clinical simulation for novice nursing students: Communication, confidence, clinical judgment. Nursing Education Perspectives, 30(2), 79-82. [Context Link]


Larew, C., Lessans, S., Spunt, D., Foster, D., & Covington, B. G. (2006). Innovations in clinical simulation: Application of Benner's Theory in an interactive patient care stimulation. Nursing Education Perspectives, 27(1), 16-21. [Context Link]


Sharif, F., & Masoumi, S. (2005). A qualitative study of nursing student experiences of clinical practice. BioMed Central Nursing, 4(6), Retrieved June 28, 2009, from [Context Link]