At a Glance
- U.S. maternal deaths the year after pregnancy more than doubled from 1999 to 2019
- Labor nurse Jen Hamilton says one pre-birth question can determine safety
- AWHONN recommends one nurse per actively laboring patient
- Why it matters: Unsafe ratios may contribute to the nation’s highest developed-world maternal mortality rate
A viral plea from a labor-and-delivery nurse is urging expectant parents to ask hospitals a single question before delivery day: whether the unit follows safe-staffing standards set by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN).
The Question That Could Save Lives
“If you or someone you love is going to give birth in a hospital, there is a question you need to ask before you go that can determine whether you are likely to have safe care or not,” Jen Hamilton said. The North Carolina nurse’s multi-part TikTok series drew 300,000 views in 24 hours and begins with a blunt directive:
“You need to know whether the hospital you are going to give birth in follows AWHONN’s safe staffing standards. Your nurse should be caring for no more than two patients ever. And that should be on a bad day.”
AWHONN’s 95-page evidence-based document does not list a single universal ratio, but the group “generally recommend[s] one nurse for every patient in active labor,” an AWHONN spokesperson told News Of Fort Worth. The organization notes that “numerous studies have validated the relationship between inadequate staffing and inpatient mortality and adverse events.”
Why Nurses Say the System Is Broken
Hamilton, a mother of two and author of the upcoming book Birth Vibes, says she is “very fortunate” to work where staffing is usually adequate. Yet messages from colleagues across the country tell a different story.
“I hear these stories from other nurses who work in places where unsafe staffing is the norm,” she told News Of Fort Worth. Hamilton believes chronic short-staffing is a major driver of the United States’ worst-in-class maternal mortality rate among developed nations.
Comments on her posts show nurses backing her up:
- “Sooooo fast. Admin on call’s phone would be ringing.”
- “Absolutely fast. But as a nurse, I tell management I’m not even clocking in if it’s unsafe.”
- “Soo fast. They would be offering big money to come in-that they didn’t have two hours earlier-to make it safe from the start!”
How to Find Out Your Hospital’s Ratio
Hamilton advises starting the conversation weeks before labor, but warns that getting an honest answer may be tough once her videos have circulated.
Instead of cold-calling the hospital, she recommends:
- Ask friends who recently delivered there
- Post in local parent Facebook groups
- Seek out staff who work the unit and ask, “How often are you assigned more than two laboring patients?”
“You’re only going to get the right answer from people who live it,” Hamilton says.
What to Do If You Arrive and Staffing Is Unsafe
If your nurse is juggling more than two active labor patients, Hamilton outlines two immediate steps:
- Ask for the house supervisor.
- Request documentation in your chart that you are receiving care under an “unsafe assignment.”
She stresses never to blame the bedside nurse, who is likely as frustrated as the patient. Tell administrators the concern is yours, not the nurse’s.
“If anything happens to go wrong with your care, adding a note in your chart automatically points a finger at the unsafe staffing, that the hospital knew and did not do anything about it,” Hamilton explains. Sometimes the mere request prompts administrators to call in extra staff or offer incentive pay.
Is Switching Hospitals an Option?
The choice is murkier once labor has begun. Hamilton calls it “a risk-benefit analysis that everybody has to make for themselves.”
If you are in the hospital for a non-medical induction, she notes you can still leave. For active labor, families must weigh travel time, insurance networks, and clinical stability.
“That’s always a personal decision,” she says.
Enlist Your Support Team
Hamilton emphasizes that patients in active labor rarely have the bandwidth to advocate alone. Doulas, partners, relatives, or friends should understand the staffing question ahead of time and be ready to speak up.
“It’s important for support people and doulas to keep this in mind,” she says.
Key Takeaways
- U.S. maternal deaths in the year after delivery more than doubled between 1999 and 2019
- AWHONN recommends one labor nurse per actively laboring patient; many units exceed that ratio
- Ask about staffing standards before admission and document any unsafe assignment
- Escalate concerns to the house supervisor and request chart documentation
- Support people, not laboring patients, should lead advocacy when possible
